Department of Oral and Maxillofacial Surgery, School of Dentistry, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Brazil.
Dent Traumatol. 2011 Oct;27(5):393-8. doi: 10.1111/j.1600-9657.2011.01012.x. Epub 2011 May 27.
Maxillary tuberosity fractures during molar teeth extraction commonly occur in dental practice; however, very few cases have been reported and discussed in the literature. A correct preoperative radiographic interpretation, coupled with the anatomical knowledge of the structures involved, is essential to prevent such complications.
The purpose of this paper is to enumerate the predisposing and etiological factors of maxillary tuberosity fractures during the extraction of upper molars, discuss the procedures that need to be taken when small or large fractured fragments of the tuberosity are evident during surgery, and suggest appropriate recommendations. This study is based on a thorough literature review.
Upon discovering that a maxillary tuberosity has fractured, the dentist must first halt the procedure before inadvertent laceration of the adjoining soft tissue occurs and then determine the extent of the fracture by palpating the mobile fragment. After performing the dissection of the soft tissues, immediate removal of the small fractures, including the tooth with small bony fragments, may be the best option, because of the difficulty incurred when attempting to retain the bone. When a large bony fragment is present, it is recommended (i) that the extraction be abandoned and surgical removal of the tooth be performed using root sectioning, (ii) that the dentist tries to detach the fractured tuberosity from the roots, or (iii) that the dentist stabilizes the mobile part(s) of the bone by means of a rigid fixation technique for 4-6 weeks and, at a future moment, attempts a surgical removal without the use of a forceps.
上颌结节骨折在上颌磨牙拔牙术中较为常见，但在文献中报道和讨论的病例却很少。正确的术前影像学解读，加上对相关解剖结构的了解，对于预防此类并发症至关重要。
本文旨在列举上颌磨牙拔除术中上颌结节骨折的诱发和病因因素，讨论术中发现小或大的结节骨折碎片时需要采取的程序，并提出适当的建议。本研究基于对文献的全面回顾。
牙医在发现上颌结节骨折后，必须在不慎撕裂相邻软组织之前停止手术，然后通过触诊移动的碎片来确定骨折的程度。在完成软组织解剖后，立即去除小的骨折碎片，包括带有小骨碎片的牙齿，可能是最佳选择，因为试图保留骨块会增加难度。如果存在大的骨块，建议（i）放弃拔牙，采用分根术进行手术拔牙，（ii）尝试将骨折的上颌结节从根部分离，或（iii）通过刚性固定技术稳定骨的活动部分 4-6 周，然后在未来的某个时刻，尝试在不使用钳子的情况下进行手术去除。
