Department of Oral & Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea.
Department of Oral and Maxillofacial Surgery, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Kyonggi-do, Korea.
Int Endod J. 2016 Nov;49(11):1020-1029. doi: 10.1111/iej.12560. Epub 2015 Nov 5.
To evaluate the neurosensory outcome of management of damaged inferior alveolar nerves caused by endodontic overfilling and to assess the efficacy of delayed surgical intervention.
Nine patients who underwent surgical removal of extruded endodontic material were included. All patients were evaluated for neurosensory function using a set of standardized tests. The outcome of surgical intervention was evaluated through patient interview and quantitative statistical analysis.
Surgical procedures included foreign body removal, microsurgical external/internal decompression, excision of neuroma followed by nerve repair, and excision of damaged nerve segment with interpositional nerve graft. Seven of the nine patients had significant improvement according to the follow-up neurosensory assessment. Four patients reported significant improvement, three patients reported mild improvement and two patients reported no appreciable improvement in the Visual Analog Scale (VAS). Two patients who reported no appreciable improvement in VAS also did not achieve FSR. In these patients, calcium hydroxide was spread widely along the IAN and a surgical approach was obtained via sagittal spit osteotomy. The mean time to reach FSR was 222.7 (±41.8) days with a range of 106-397 days. In the early repair group who received surgery within 60 days, three out of five patients achieved FSR in a mean time of 198.0 (±76.2) days. The mean time to FSR in all four subjects who received surgical attention over 60 days after injury was 241.3 (±139.8) days with a range of 106-397 days. As all four cases in the late repair group with limited amount of nerve injury achieved FSR, only 3 of 5 early repair cases with wide-spread injury achieved a similar outcome.
The results of this case series confirmed the notion that surgical management of the inferior alveolar nerve is effective in the treatment of nerve injuries caused by endodontic extrusion of calcium hydroxide paste. Delayed surgical repair of the inferior alveolar nerve can be indicated and helpful for the neurosensory recovery of damaged IAN, however, the surgical management was less effective in case of widespread nerve injuries.
评估因根管超填导致的下牙槽神经损伤的神经感觉预后，并评估延迟手术干预的效果。
纳入 9 例行挤出根管材料切除术的患者。所有患者均采用一套标准化测试来评估神经感觉功能。通过患者访谈和定量统计分析评估手术干预的结果。
手术程序包括去除异物、显微外/内减压、切除神经瘤后行神经修复、以及切除有损伤的神经段并行神经移植。根据随访的神经感觉评估，9 例患者中有 7 例有显著改善。4 例患者报告有明显改善，3 例患者报告有轻度改善，2 例患者在视觉模拟量表（VAS）上没有明显改善。2 例 VAS 无明显改善的患者也未达到感觉功能恢复标准（FSR）。这 2 例患者的 IAN 内广泛分布氢氧化钙，采用矢状劈开骨切开术获得手术入路。达到 FSR 的平均时间为 222.7（±41.8）天，范围为 106-397 天。在 60 天内接受手术的早期修复组中，5 例中有 3 例在 198.0（±76.2）天的平均时间内达到 FSR。所有 4 例在损伤后 60 天以上接受手术治疗的患者达到 FSR 的平均时间为 241.3（±139.8）天，范围为 106-397 天。由于晚期修复组中所有 4 例神经损伤程度有限的患者均达到 FSR，只有 5 例广泛损伤的早期修复病例中有 3 例获得了类似的结果。
本病例系列的结果证实了这样一种观点，即手术治疗下牙槽神经因氢氧化钙挤出引起的神经损伤是有效的。延迟手术修复下牙槽神经可促进损伤的 IAN 神经感觉恢复，但在神经广泛损伤的情况下，手术治疗效果较差。
