In 2007, the 7-year-old group A, who visited the clinic at Gachon University Gil Hospital, had completely collapsed. He attributed it to Möbius Syndrome, a rare condition that causes cranial nerves to become paralyzed. Damage to his nerve function caused problems with the structure of his mouth as the lips and tongue were out of balance. He was not an easy patient even for Prof. Moon Cheol-hyeon of the Department of Orthodontics at Gachon University Gil Hospital, who had met many types of patients. However, what surprised Professor Moon even more was the attitude of the patient and guardian.
“Usually, it is easy to despair and become discouraged after only a few years of orthodontic treatment, but both group A and the mother of group A were surprisingly optimistic. I have never met such patients. I can’t believe how much I have done. It is rather a luck and blessing for a doctor to have met.”
The relationship between Group A and Professor Moon continued for 16 years from that day.
◆ Normalization of Möbius Syndrome: The first case in Korea
Moebius syndrome is so rare that it is difficult to calculate the exact prevalence. In Korea, about 300 cases were reported by 2006 and about 3,500 cases by 2015.
Möbius syndrome appears when there is a congenital problem with the 6th and 7th nerves out of a total of 12 pairs of cranial nerves. The inability to move the eyelids, tongue, and chin freely causes discomfort in everyday life, such as unnatural facial expressions when smiling or frowning.
Although it is a neurological disease, it is necessary to receive dental treatment because oral deformation occurs. Professor Moon said, “The structure of the dentition can be maintained only when the forces of the lips and tongue are balanced, but if there is a problem with the cranial nerve, the tongue cannot move normally.” The inner structure is deformed,” he explained.
Group A was first diagnosed at the age of 2, and started treatment at the age of 7 at Gachon University Gil Hospital. Professor Moon recalled, “Although the dentition had already collapsed considerably, it was difficult to conduct active orthodontic treatment right away because the permanent teeth had not yet erupted.” During his first 5 months, the primary treatment was to rebuild the collapsed dental structure and adjust the basic alignment.
For the next 4 years, the timing of his treatment was adjusted while observing the replacement of group A’s primary teeth with permanent teeth. This is because the correction period is extended if the treatment point is too early. The second treatment was started around the age of 12. Dental correction was performed for 30 months using fixed braces, and it was completed around the time Group A entered middle school.
Fortunately, the orthodontic result was clear, and Group A visits the clinic once a year while wearing an orthodontic appliance. I still have to wear a retainer and still have the problem of unnatural expressions when I smile, but I have recovered to the point where I can go about my daily life.
Professor Moon summarized the treatment and prognosis of group A by period and recently reported it in the «Journal of the Korean Orthodontic Society». It is important that it is a case of a rare disease, but the academic value of continuing orthodontic treatment without side effects for a long time is great. When asked about long-term treatment, Professor Moon shook his hand. Professor Moon attributed the 16 years of treatment and improvement to the guardians and patients with the modesty that it was not a ‘great clinical achievement’.
“16 years is not a long time in orthodontic treatment (where patients are often followed for a long time). Overseas, there are many cases of more than 20 years. Just as you can’t brag just because you’re old, you can’t boast that you’ve been treated for a long time. It’s not something for doctors to brag about, but something for patients and guardians to think is great.”
Despite Professor Moon’s modesty, this is the first time in Korea that a patient suffering from Möbius syndrome has been restored to normal dental structure and maintained a healthy condition without cavities or gum disease. Regarding these achievements, he said, “It is the result of intense contemplation by the medical staff, but it is the patients who have contributed the most.” “For Group A, the key was to use a retainer, and I am grateful to the patients and their guardians for enduring the device for a long time. The doctor is just a ‘ helper ‘.”
In addition, dental treatment is based on brushing habits, so when treating young patients, most of the time is spent teaching teeth brushing, but Professor Moon recalled that he was able to focus only on treatment because the guardian taught the child so well.
“Brushing is the most important thing in dental treatment. Doctors only see you once every six months or a year, but you brush your teeth three times a day, every day. No matter how complex and difficult dental treatment is, the most important thing is the patient himself. It is brushing one’s teeth. In that respect, orthodontic treatment can be said to be performed together by the patient, guardian, and doctor.”
Due to the nature of long-term orthodontic treatment, it is inevitable to go through puberty, so three people must run together to not give up during this process. This is because if a patient who has been exhausted for a long time is pessimistic about his condition and takes off the retainer or stops visiting the hospital, the treatment will stop.
He says he feels rewarded when patients he has seen for a long time become more and more comfortable as they visit the hospital. Unlike general treatment, the longer orthodontic treatment does not mean that the treatment is slower, but that the patient actively cooperates with the treatment. This is because you have to keep wearing the retainer and manage it diligently so that you can visit the hospital and check the condition.
◆Increased interest in oral treatment for the disabled메이저놀이터
Although all the credit for treatment was given to patients and their guardians in the past, Professor Moon is a specialist who has actively taken the lead in oral treatment for the disabled.
Based on his long clinical experience, Professor Moon expanded manpower and facilities specializing in oral treatment for the disabled, taking the lead in treating cleft lip and palate (a disease in which the upper lip or the roof of the mouth is congenitally cracked). In recognition of these achievements, in 2017, he received the Lifetime Achievement Award from ‘Marquiz Who’s Who’, one of the world’s top three biographical dictionaries.
Professor Cheol-Hyeon Moon has established and is running the Oral Care Center for the Disabled, hoping that patients suffering from oral disorders can meet a good doctor and receive appropriate treatment. [Photo = Reporter Choi Ji-hyun]
Professor Moon emphasized that more attention should be paid to the treatment of various oral disorders, citing the fact that there is still a lack of manpower and systems for treatment of oral disorders and that publicity is not working properly. Gachon University Gil Hospital was selected as an oral care center for the disabled in Incheon by the Ministry of Health and Welfare in 2013 and has been operating its own center since 2016.
With the idea that it would be good for patients suffering from oral disorders to meet a good doctor and receive proper treatment, the center was established to facilitate smooth consultation between obstetrics and gynecology, plastic surgery, otolaryngology, and dentistry. However, the wall of cooperation is still high. There are limitations in that there are many people who cannot come because they do not know that such treatment is possible, and there are many patients who try to hide their diseases.
“Patients with congenital oral disorders are very rare, but that’s why there are not many experienced doctors. I want to be a hospital and a doctor who is always ready so that patients can come to receive treatment without missing the timing.”
This is the future goal revealed by Professor Moon. He added, “I hope that an environment can be created where you can visit the hospital with a comfortable mind without worrying because you can receive enough treatment.”