交通事故による頭頸部外傷症候群への咬合治療例

Outcome of occlusion therapy for head and neck trauma syndrome with occlusion disorder induced by traffic accident

要約　目的：下顎骨外傷に関連した咬合不全のある頭頸部外傷症候群8症例に咬合治療を行い，眼と全身症状が改善した報告。

症例：過去4年間に交通外傷によって咬合異常が生じた頭頸部外傷症候群8例を対象とした。男性2例，女性6例で年齢は29〜66歳，平均46.9歳であった。受傷時に全例がシートベルトを装着しており，5例が追突事故であった。

所見と経過：症状として，全身の倦怠疲労感，調節不全，輻輳不全，複視，眩暈などがあった。画像検査として，顎顔面頭蓋のパノラマX線撮影，MRIなどを行った。咬合治療として7例にはマウスピースなどの口腔内装置，1例には咬合調整を行った。3〜35か月間の経過を観察した。

結果：咬合試験は全例で症状または所見が改善した。6例で眼球運動，垂直眼位偏位量が改善し，融像域が拡大した。羞明は2例で軽減した。6例で頸部の軟組織の緊張が軽減した。

結論：咬合異常を伴う頭頸部外傷症候群8例に咬合治療を行い，6例で眼と全身症状が改善した。

Abstract　Purpose：To report 8 cases who developed head and neck trauma syndrome with occlusion disorder following traffic accident and who improved after occlusion therapy.

Cases：This retrospective study was made on 8 cases who developed head and neck trauma syndrome with occlusion disorder following traffic accident in the past 4 years. The series comprised 2 males and 6 females. The age ranged from 29 to 66 years, average 46.9 years. All the 8 cases were involved in traffic accident while wearing safety seat belt. Five cases suffered from rear-end collision.

Findings and Clinical Course：Subjective symptoms were variable and involved tired feelings, insufficient accommodation or convergence, diplopia and vertigo. They were examined by panoramic x-ray examination of the head, face, or mandibula, and by magnetic resonance imaging（MRI）of the head, maxillofacial cranium, spine. Occlusion disorder was treated by oral appliances including mouth piece in 7 cases. One case received adjustment of occlusion only.

Results：State of occlusion improved in all the cases. Six cases showed improved ocular movement, enlarged vertical eye movement, or wide fusion area. Photophobia improved in 2 cases. Six cases showed decreased tension of soft tissue in the neck.

Conclusion：Six out of eight cases of head and neck trauma syndrome with occlusion disorder showed improvements in ocular and systemic symptoms following treatment for occlusion.