矯正錯位上顎犬齒之急性淋巴性白血病患

Orthodontic Management of Transposed Canines in A Patient with Acute Lymphocytic Leukemia

小兒白血病與淋巴癌佔兒童癌症的三分之一，其中急性淋巴性白血病是最常見的小兒白血病（75%～80%）。患童經過治療如化療、電療，60%的病患都有超過五年的存活率。此類患童若有齒顎矯正的需求仍是可行的，但若在矯正進行期間白血病復發，則會有牙齦滲血、疼痛、增生、淋巴病變、口腔潰瘍甚至壞死。矯正治療的策略可使用輕微的力量、減少牙根吸收危險因素、盡量簡易的矯正裝置、折衷的治療計畫，且能比正常所需的矯正治療時間提早完成。若在矯正進行期間白血病復發，則應停止矯正治療減少口腔感染的機會。本病例報告一位患有急性淋巴性白血病的十一歲半女孩，主訴其上顎兩側犬齒擁擠且錯位。患童已完成化學治療，經其小兒血液腫瘤主治醫師確認情況穩定，於是開始矯正治療。測顱分析屬於一級空間不足與上顎兩側犬齒錯位的異常咬合，治療方法予以拔除四顆第一小臼齒後進行全口矯正治療，前後歷經約一年五個月，完成時達到和諧的外觀及咬合，後續一年半的追蹤咬合仍然穩定。

Acute lymphoblastic leukemia (ALL) makes up approximately 75% to 80% of childhood leukemia. Longterm survivors through current medical management make orthodontic treatment available. However, the risk of these patients should be carefully evaluated. After the patient has completed all cancer therapy and has at least a 2-year event-free survival, orthodontic treatment can be started. Patients with ALL sometimes have to accept a compromised treatment result and finish the treatment earlier than normal due to the concerns of recurrence. To treat the maxillary canine-first premolar transposition require a lengthy treatment time. However, every effort should be made to bring the transposed canine back to its proper position in the dentition rather than to leave the canine in its transposed place. We present an ALL case with bilaterally transposed maxillary canines in an 11-year-old girl. She was in a well condition two years after chemotherapy. We started orthodontic correction by extracting her four first premolars, followed by comprehensive fixed orthodontic appliances, and finished within 17 months. No recurrence of leukemia was noted during these periods.