Nkenke E, Schultze-Mosgau S, Radespiel-Tröger M, Kloss F, Neukam F W
Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Glückstrasse 11, 91054 Erlangen, Germany.
Clin Oral Implants Res. 2001 Oct;12(5):495-502. doi: 10.1034/j.1600-0501.2001.120510.x.
In a prospective study, 20 patients who underwent harvesting of chin grafts as outpatients, were followed up for 12 months (3 further patients with incomplete follow-up data were excluded from the study). Preoperatively and 7 days, 1, 3, 6 and 12 months postoperatively, follow-up data were assessed. Evaluation of the superficial sensory function of the inferior alveolar nerve was determined by the Pointed-Blunt Test and the Two-Point-Discrimination Test. Sensory disturbances were objectively assessed by testing thermal sensitivity with the "Pain and Thermal Sensitivity" Test (PATH Test). In addition, evaluation of the pulp sensitivity of teeth 35-45 was carried out by cold vitality testing. One week postoperatively, 8 patients were affected by superficial sensory impairment. 8 nerve territories showed hypoaesthetic reactions and 5 showed hyperaesthetic reactions. After 12 months, two patients still suffered from hypoaesthesia of one side of the chin. There was a statistically significant sensitivity impairment of the chin for all patients comparing the preoperative data of the Two-Point-Discrimination Test (left/right median: 8.17/8.17 mm, interquartile range (IQR) 1.00/2.00 mm) with the first postoperative measurement (left/right median 9.00/8.33 mm, IQR 1.67/2.66 mm). Comparing the latter to the last postoperative measurement there was significant tendency for regeneration of a nerve function (left/right median 8.00/7.84 mm, IQR 0.66/2.00 mm). In the PATH Test all hypoaesthetic areas could be identified by a reduction of thermal sensitivity. After the first postoperative examination 21.6% (n=38/176) of the examined teeth had lost their pulp sensitivity. After 12 postoperative months 11.4% (n=20/176) still did not react sensitively. Many of these were canines (n=8/20). Comparing the preoperative to the first postoperative examination, there was a significant reduction of pulp sensitivity. However, statistically significant recovery until the last postoperative follow-up could not be detected. The assessed data show that patients have to be informed extensively about disturbances of the inferior alveolar nerve function lasting longer than 12 months. Moreover, the loss of pulp sensitivity is a very frequent event which has always to be taken into account. Considering the high rate of complications with harvesting of chin grafts, more prospective trials should be done to find out whether there are other donor sites for autogenous bone which put less strain on patients.
在一项前瞻性研究中，20例门诊接受颏部植骨采集的患者接受了12个月的随访（另有3例随访数据不完整的患者被排除在研究之外）。在术前以及术后7天、1个月、3个月、6个月和12个月时评估随访数据。通过尖钝试验和两点辨别试验评估下牙槽神经的表面感觉功能。通过“疼痛和热敏感性”试验（PATH试验）测试热敏感性来客观评估感觉障碍。此外，通过冷活力测试对35 - 45号牙的牙髓敏感性进行评估。术后1周，8例患者出现表面感觉障碍。8个神经区域表现为感觉减退反应，5个表现为感觉过敏反应。12个月后，2例患者仍存在一侧颏部感觉减退。将两点辨别试验的术前数据（左/右中位数：8.17/8.17 mm，四分位间距（IQR）1.00/2.00 mm）与术后首次测量数据（左/右中位数9.00/8.33 mm，IQR 1.67/2.66 mm）进行比较，所有患者颏部的感觉功能损害具有统计学意义。将后者与术后最后一次测量数据进行比较，神经功能有明显的恢复趋势（左/右中位数8.00/7.84 mm，IQR 0.66/2.00 mm）。在PATH试验中，所有感觉减退区域均可通过热敏感性降低来识别。术后首次检查后，21.6%（n = 38/176）的受检牙齿失去了牙髓敏感性。术后12个月，11.4%（n = 20/176）的牙齿仍无敏感反应。其中许多是尖牙（n = 8/20）。将术前与术后首次检查进行比较，牙髓敏感性有显著降低。然而，直到术后最后一次随访，未检测到统计学上显著的恢复。评估数据表明，必须让患者充分了解下牙槽神经功能障碍持续超过12个月的情况。此外，牙髓敏感性丧失是一个非常常见的情况，必须始终予以考虑。考虑到颏部植骨采集的高并发症发生率，应进行更多的前瞻性试验，以找出是否存在对患者负担较小的其他自体骨供区。
