术后下牙槽神经功能障碍的研究进展

doi:10.7518/gjkq.2023071

摘要/Abstract

摘要：

下牙槽神经功能障碍是下颌正颌手术、下颌后牙种植手术以及下颌第三磨牙拔除术后的一种常见并发症。虽然大部分情况下发生率较低，但一旦发生，部分患者的持续时间可以很久，而且不适感可能较为明显。因此，这一并发症备受口腔科医生和患者关注。下牙槽神经功能障碍常表现为术侧颏部和嘴唇皮肤的感觉减退与异常感觉，伴或不伴感觉过敏、患侧下颌牙列不适感等症状。大多数患者在神经功能障碍发生后的6个月内，可得到明显缓解，也有少部分患者在随访超过6个月甚至更长的时间后，仍无明显恢复。本文对不同类型的手术后所发生的下牙槽神经功能障碍的症状及预后特点进行综述，并尝试分析其差异和相关性。

关键词: 下牙槽神经, 神经功能障碍, 正颌手术, 牙种植手术, 第三磨牙

Abstract:

Neurosensory disturbance (NSD) is a common complication after mandibular orthognathic surgery, mandi-bular posterior teeth implant surgery and mandibularthird molar extraction. Although in most cases the incidence is low, some patients suffer fromobvious discomfortin a long term. Clinicians and patients have paid great attention to this pro-blem. NSD of the inferior alveolar is often manifested as hypoesthesia and abnormal sensation, and sometimes hyperesthesia of the chin and lips on the surgical side, as well as discomfort of the mandibular dentition on the affected side. Most patients can recovery within 6 months after the occurrence of NSD, whereas a small number of patients were reported failed to recover from disturbance after 6 months or even longer. This article attempts to review symptoms and prognostic characteristics during NSD of the inferior alveolar nerve after different types of operations, and try to analyze the differences and correlations among them.

Key words: inferior alveolar nerve, neurosensory disturbance, orthognathic surgery, tooth implant surgery, third molar

中图分类号:

R 782.1

刘云通,刘畅,高丽钞,罗瑜雪,曹钰彬,华成舸. 术后下牙槽神经功能障碍的研究进展[J]. 国际口腔医学杂志, 2023, 50(4): 479-484.

Liu Yuntong,Liu Chang,Gao Lichao,Luo Yuxue,Cao Yubin,Hua Chengge.. Research progress on the postoperative inferior alveolar neurosensory disturbance[J]. Int J Stomatol, 2023, 50(4): 479-484.

图/表 1

表 1

参考文献 40

1	Pogrel MA, Thamby S. Permanent nerve involvement resulting from inferior alveolar nerve blocks[J]. J Am Dent Assoc, 2000, 131(7): 901-907.
2	Aquilanti L, Mascitti M, Togni L, et al. A systematic review on nerve-related adverse effects following mandibular nerve block anesthesia[J]. Int J Environ Res Public Health, 2022, 19(3): 1627.
3	Garisto GA, Gaffen AS, Lawrence HP, et al. Occurrence of paresthesia after dental local anesthetic administration in the United States[J]. J Am Dent Assoc, 2010, 141(7): 836-844.
4	Kipp DP, Goldstein BH, Weiss WW Jr. Dysesthesia after mandibular third molar surgery: a retrospective study and analysis of 1 377 surgical procedures[J]. J Am Dent Assoc, 1980, 100(2): 185-192.
5	Daware SN, Balakrishna R, Deogade SC, et al. Assessment of postoperative discomfort and nerve injuries after surgical removal of mandibular third molar: a prospective study[J]. J Family Med Prim Care, 2021, 10(4): 1712-1717.
6	Arora A, Patil BA, Sodhi A. Validity of the vertical tube-shift method in determining the relationship between the mandibular third molar roots and the inferior alveolar nerve canal[J]. J Korean Assoc Oral Maxillofac Surg, 2015, 41(2): 66-73.
7	Yamada SI, Hasegawa T, Yoshimura N, et al. Prevalence of and risk factors for postoperative complications after lower third molar extraction: a multicenter prospective observational study in Japan[J]. Medicine (Baltimore), 2022, 101(32): e29989.
8	George AL, Panicker P, Johny J, et al. Reliability of cone beam computed tomography in comparison with panoramic radiography to predict the anatomical relationship of inferior alveolar nerve with mandibular third molar: a radiological and clinical study[J]. J Pharm Bioallied Sci, 2020, 12(): S367-S372
9	Buyuk C, Akkaya N, Arsan B, et al. A fused deep learning architecture for the detection of the relationship between the mandibular third molar and the mandibular canal[J]. Diagnostics (Basel), 2022, 12(8): 2018.
10	Wang DM, Lin TY, Wang YL, et al. Radiographic features of anatomic relationship between impacted third molar and inferior alveolar canal on coronal CBCT images: risk factors for nerve injury after tooth extraction[J]. Arch Med Sci, 2018, 14(3): 532-540.
11	Chen YF, Liu JY, Pei J, et al. The risk factors that can increase possibility of mandibular canal wall damage in adult: a cone-beam computed tomography (CBCT) study in a Chinese population[J]. Med Sci Monit, 2018, 24: 26-36.
12	Scarano A, Sinjari B, Murmura G, et al. Neurosensory disturbance of the inferior alveolar nerve after 3 025 implant placements[J]. Implant Dent, 2017, 26(5): 735-743.
13	Na JY, Han SS, Jeon K, et al. Prognosis in case of nerve disturbance after mandibular implant surgery in relation to computed tomography findings and symptoms[J]. J Periodontal Implant Sci, 2019, 49(2): 127-135.
14	Jamil FA, Mohammed JA, Hasan TA, et al. The relia-bility of surgeons to avoid traumatic insertion of dental implants into high-risk regions: a panoramic radiograph study[J]. BMC Oral Health, 2020, 20(1): 96.
15	Kan JY, Lozada JL, Goodacre CJ, et al. Endosseous implant placement in conjunction with inferior alveo-lar nerve transposition: an evaluation of neurosensory disturbance[J]. Int J Oral Maxillofac Implants, 1997, 12(4): 463-471.
16	Deryabin G, Grybauskas S. Dental implant placement with inferior alveolar nerve repositioning in severely resorbed mandibles: a retrospective multicenter study of implant success and survival rates, and lower lip sensory disturbances[J]. Int J Implant Dent, 2021, 7(1): 44.
17	Ylikontiola L, Kinnunen J, Oikarinen K. Comparison of different tests assessing neurosensory disturbances after bilateral sagittal split osteotomy[J]. Int J Oral Maxillofac Surg, 1998, 27(6): 417-421.
18	Kuhlefelt M, Laine P, Suominen AL, et al. Nerve manipulation during bilateral sagittal split osteotomy increases neurosensory disturbance and decrea-ses patient satisfaction[J]. J Oral Maxillofac Surg, 2014, 72(10): 2052.e1-2052.e5
19	Monnazzi MS, Real Gabrielli MF, Passeri LA, et al. Inferior alveolar nerve function after sagittal split osteotomy by reciprocating saw or piezosurgery instrument: prospective double-blinded study[J]. J Oral Maxillofac Surg, 2014, 72(6): 1168-1172
20	Khan M, Sattar N, Erkin M. Postoperative complications in genioplasty and their association with age, gender, and type of genioplasty[J]. Int J Dent, 2021, 2021: 8134680.
21	Song GD, Yu PX, Huang GQ, et al. Simultaneous surgery of mandibular reduction and impacted mandibular third molar extraction: a retrospective study of 65 cases[J]. Medicine (Baltimore), 2020, 99(15): e19397.
22	Sharifi R, Fekrazad R, Taheri MM, et al. Effect of photobiomodulation on recovery from neurosensory disturbances after sagittal split ramus osteotomy: a triple-blind randomised controlled trial[J]. Br J Oral Maxillofac Surg, 2020, 58(5): 535-541.
23	Burian E, Sollmann N, Ritschl LM, et al. High resolution MRI for quantitative assessment of inferior alveolar nerve impairment in course of mandible fractures: an imaging feasibility study[J]. Sci Rep, 2020, 10(1): 11566.
24	Consolo U, Setti G, Tognacci S, et al. Histological changes in odontogenic parakeratinized keratocysts treated with marsupialization followed by enuclea-tion[J]. Med Oral Patol Oral Cir Bucal, 2020, 25(6): e827-e833.
25	Niu ZX, Li Y, Chen WT, et al. Study on clinical and biological characteristics of ameloblastic carcinoma[J]. Orphanet J Rare Dis, 2020, 15(1): 316.
26	Qiu JY, Huang KM, Lin NC. Use of the cover-lif-ting technique in mandibular cemento-ossifying fibroma excision to preserve the inferior alveolar nerve[J]. Medicina (Kaunas), 2021, 57(12): 1383.
27	Nogami S, Yamauchi K, Shiiba S, et al. Evaluation of the treatment modalities for neurosensory disturbances of the inferior alveolar nerve following retromolar bone harvesting for bone augmentation[J]. Pain Med, 2015, 16(3): 501-512
28	Gianni AB, D’Orto O, Biglioli F, et al. Neurosensory alterations of the inferior alveolar and mental nerve after genioplasty alone or associated with sa-gittal osteotomy of the mandibular ramus[J]. J Craniomaxillofac Surg, 2002, 30(5): 295-303.
29	Qi W, Wang YG, Huang YY, et al. Photobiomodulation therapy for management of inferior alveolar nerve injury post-extraction of impacted lower third molars[J]. Lasers Dent Sci, 2020, 4(1): 25-32.
30	Kazancioglu HO, Ezirganli S, Demirtas N. Comparison of the influence of ozone and laser therapies on pain, swelling, and trismus following impacted third-molar surgery[J]. Lasers Med Sci, 2014, 29(4): 1313-1319.
31	祝颂松, 王旭东, 杨学文, 等. 下颌支矢状骨劈开术并发症防治的专家共识[J]. 华西口腔医学杂志, 2022(3): 247-254.
	Zhu SS, Wang XD, Yang XW, et al. Experts’consensus on precaution and treatment for complications of sagittal split ramus osteotomy[J]. West China J Stomatol, 2022(3): 247-254
32	Al-Bishri A, Rosenquist J, Sunzel B. On neurosensory disturbance after sagittal split osteotomy[J]. J Oral Maxillofac Surg, 2004, 62(12): 1472-1476
33	Seo K, Tanaka Y, Terumitsu M, et al. Efficacy of steroid treatment for sensory impairment after orthognathic surgery[J]. J Oral Maxillofac Surg, 2004, 62(10): 1193-1197.
34	Pourdanesh F, Khayampour A, Jamilian A. Therapeutic effects of local application of dexamethasone during bilateral sagittal split ramus osteotomy surgery[J]. J Oral Maxillofac Surg, 2014, 72(7): 1391-1394
35	Semper-Hogg W, Fuessinger MA, Dirlewanger TW, et al. The influence of dexamethasone on postoperative swelling and neurosensory disturbances after orthognathic surgery: a randomized controlled clinical trial[J]. Head Face Med, 2017, 13(1): 19.
36	Firoozi P, Keyhan SO, Kim SG, et al. Effectiveness of low-level laser therapy on recovery from neurosensory disturbance after sagittal split ramusosteotomy: a systematic review and meta-analysis[J]. Ma-xillofac Plast Reconstr Surg, 2020, 42(1): 41.
37	Bittencourt MAV, Paranhos LR, Martins-Filho PRS. Low-level laser therapy for treatment of neurosensory disorders after orthognathic surgery: a systematic review of randomized clinical trials[J]. Med Oral Patol Oral Cir Bucal, 2017, 22(6): 780-787.
38	Kushnerev E, Yates JM. Evidence-based outcomes following inferior alveolar and lingual nerve injury and repair: a systematic review[J]. J Oral Rehabil, 2015, 42(10): 786-802
39	Weyh A, Pucci R, Valentini V, et al. Injuries of the peripheral mandibular nerve, evaluation of interventions and outcomes: a systematic review[J]. Craniomaxillofac Trauma Reconstr, 2021, 14(4): 337-348.
40	Bagheri SC, Meyer RA, Cho SH, et al. Microsurgical repair of the inferior alveolar nerve: success rate and factors that adversely affect outcome[J]. J Oral Maxillofac Surg, 2012, 70(8): 1978-1990.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

病因	发病率	主要症状	预后
阻滞麻醉	1∶13 800 970~ 1∶26 762	麻木感及感觉减退	发病率极低，预后不明
第三磨牙拔除术	0.4%~13.4%	患侧颏部、面颊和下唇的麻木感、感觉迟钝；异常疼痛、烧灼感或感觉过敏等	1%~43.5%的患者在术后6个月仍有明显症状
种植手术	1.4%~43.5%	患侧颏部、面颊和下唇的感觉减退	5%~15%的病例1年后仍未完全恢复；伴蠕虫爬行感者预后较好，伴紧绷感者预后较差
正颌手术	6.8%~95%	患侧颏部、面颊和下唇的感觉减退；电击样感、疼痛感、针刺感、紧绷感、烧灼感、压迫感、僵硬感、患侧下颌牙列牙齿疼痛等异常感觉	多在6个月后完全恢复；11%的下颌支矢状劈开术后1年仍未完全恢复；异常感觉/减退的恢复顺序为：冷觉、触觉>热觉、痛觉、牙列感觉异常>主观不适、两点辨别

[1]	柴安,雷荣昌,蒋智升,曲彬彬,郭锦材,李鹤,邵奇. 评估下颌第三磨牙拔除难度分类方法的概述[J]. 国际口腔医学杂志, 2023, 50(6): 718-722.
[2]	马建斌,薛超然,王沛棋,李彬,白丁. 不同补偿间隙3D打印正颌手术𬌗板对咬合精度的影响[J]. 国际口腔医学杂志, 2022, 49(3): 296-304.
[3]	刘程程, 丁一. 妊娠期常见口腔感染性疾病的临床诊疗和管理策略[J]. 国际口腔医学杂志, 2021, 48(6): 621-628.
[4]	谢瑜,周懿. 截冠术：下颌第三磨牙保守拔除术[J]. 国际口腔医学杂志, 2020, 47(1): 17-21.
[5]	潘韦霖,曹钰彬,刘畅,刘济远,李春洁,潘剑,华成舸. 不同翻瓣设计对下颌第三磨牙拔除术后疼痛的影响：系统评价与Meta分析[J]. 国际口腔医学杂志, 2019, 46(2): 142-148.
[6]	赵文俊,刘媛媛,郝晓琪,王凯利,任家银,郭文豪,郑广宁. 46例患者第三磨牙区多生牙的影像学分析[J]. 国际口腔医学杂志, 2019, 46(1): 20-25.
[7]	胡俊, 李秀芬, 华成舸, 马丽源. 24例自体牙移植的临床疗效观察[J]. 国际口腔医学杂志, 2017, 44(4): 437-439.
[8]	张睿, 张玲阁, 李喜红, 李锐. 改良三角瓣对下颌第三磨牙拔除术后并发症的影响及其临床应用[J]. 国际口腔医学杂志, 2017, 44(2): 153-156.
[9]	温小萌, 马文盛. 下颌第三磨牙萌出相关问题的研究进展[J]. 国际口腔医学杂志, 2017, 44(1): 114-117.
[10]	郭培珠冯云霞任娟. 手术优先治疗骨性错牙合畸形的研究进展[J]. 国际口腔医学杂志, 2016, 43(1): 43-.
[11]	胡艺蝶周力王艳民. 拔牙矫治与下颌第三磨牙萌出状况的关系[J]. 国际口腔医学杂志, 2015, 42(3): 367-370.
[12]	龙明生陆俊刘彩云董红. 上颌第三磨牙根管形态的显微研究[J]. 国际口腔医学杂志, 2014, 41(3): 262-264.
[13]	张婷李纾. 下牙槽神经相关神经肽及其非神经传导功能[J]. 国际口腔医学杂志, 2014, 41(3): 337-340.
[14]	蔡勇涛1,2 罗顺云1 李旭艳2. 45°涡轮钻在第三磨牙拔除术中的改良应用[J]. 国际口腔医学杂志, 2013, 40(5): 577-579.
[15]	姜世同1 刘军2 陈玉长2 王作君3 马德庆1 焦广军1 姜良坤1. 近中水平阻生下颌第三磨牙的矫治探索[J]. 国际口腔医学杂志, 2012, 39(6): 730-732.