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从现行法理学角度对智齿拔除后神经及颌骨损伤的法医鉴定

[Forensic evaluation of injuries to nerves and jaw bone after wisdom tooth extraction from the viewpoint of current jurisprudence].

作者信息

Handschel J, Figgener L, Joos U

机构信息

Klinik und Poliklinik für Mund-, Kiefer- und Gesichts-Chirurgie, Westfälische-Wilhelms-Universität, Waldeyerstrasse 30, 48129 Münster.

出版信息

Mund Kiefer Gesichtschir. 2001 Jan;5(1):44-8. doi: 10.1007/s100060000253.

DOI:10.1007/s100060000253
PMID:11272387
Abstract

The removal of lower wisdom teeth is one of the most frequent operations in oral surgery. Iatrogenic lesions of the lingual and inferior alveolar nerve and fractures of the lower jaw are rare, but can lead to actions for damage and compensation for personal suffering. The aim of our investigation was to elaborate recommendations for the oral surgeon from the legal point of view. Therefore we investigated in two data banks all court decisions concerning wisdom teeth and analysed them in regard to the obligation to provide information, documentation and the minimum requirements of the surgical treatment. In 57% of all court decisions the obligation to provide information was omitted by the surgeon. Surprisingly, regarding injuries of the lingual nerve we found different opinions from various law courts. In some former decisions only the fact of the damage was equivalent to a lack of care, while recently other courts had the opinion that an injury of the lingual nerve could also be caused in spite of careful treatment. With regard to lower jaw fracture all courts emphasized that the patient must be informed about the risk by the surgeon. Moreover, minimum requirements for the removal of wisdom teeth were given. In conclusion, the recent court decisions restrict the liability for complications but demand the observance of minimum requirements for the surgical treatment. Additionally, all courts stress that informed consent about the risk of nerve damage of jaw fracture must be obtained before the removal of wisdom teeth.

摘要

拔除下颌智齿是口腔外科最常见的手术之一。舌神经和下牙槽神经的医源性损伤以及下颌骨折虽罕见,但可能引发损害赔偿诉讼和人身伤害赔偿。我们调查的目的是从法律角度为口腔外科医生制定建议。因此,我们在两个数据库中调查了所有关于智齿的法院判决,并就信息提供义务、文件记录以及手术治疗的最低要求进行了分析。在所有法院判决中,有57%的案件外科医生未履行信息提供义务。令人惊讶的是,对于舌神经损伤,我们发现不同法院有不同观点。在一些以前的判决中,仅损害事实就等同于护理不当,而最近其他法院认为,即使治疗谨慎,舌神经也可能受损。关于下颌骨折,所有法院都强调外科医生必须告知患者风险。此外,还给出了拔除智齿的最低要求。总之,最近的法院判决限制了并发症的责任,但要求遵守手术治疗的最低要求。此外,所有法院都强调,在拔除智齿前必须获得关于下颌骨折神经损伤风险的知情同意。

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Mund Kiefer Gesichtschir. 2001 Jan;5(1):44-8. doi: 10.1007/s100060000253.
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Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases.三叉神经口腔支的医源性损伤:449例记录
Clin Oral Investig. 2007 Jun;11(2):133-42. doi: 10.1007/s00784-006-0089-5. Epub 2006 Dec 22.