国际口腔医学杂志 ›› 2023, Vol. 50 ›› Issue (4): 479-484.doi: 10.7518/gjkq.2023071

• 综述 • 上一篇    下一篇

术后下牙槽神经功能障碍的研究进展

刘云通(),刘畅,高丽钞,罗瑜雪,曹钰彬,华成舸()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心四川大学华西口腔医院口腔全科 成都 610041
  • 收稿日期:2022-12-12 修回日期:2023-04-05 出版日期:2023-07-01 发布日期:2023-06-21
  • 通讯作者: 华成舸
  • 作者简介:刘云通,硕士,Email:847814755@qq.com

Research progress on the postoperative inferior alveolar neurosensory disturbance

Liu Yuntong(),Liu Chang,Gao Lichao,Luo Yuxue,Cao Yubin,Hua Chengge.()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2022-12-12 Revised:2023-04-05 Online:2023-07-01 Published:2023-06-21
  • Contact: Chengge. Hua

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

表 1

不同原因的NSD比较"

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
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