Bastien A-V, Adnot J, Moizan H, Calenda É, Trost O
Department of Oral and Maxillofacial Surgery, University Hospital of Rouen, Charles-Nicolle Hospital, 1, rue de Germont, 76031 Rouen, France.
Department of Odontology, University Hospital of Rouen, Saint-Julien Hospital, rue Guillaume-Lecointe, 76140 Le Petit-Quevilly, France.
J Stomatol Oral Maxillofac Surg. 2017 Dec;118(6):389-392. doi: 10.1016/j.jormas.2017.09.001. Epub 2017 Sep 9.
The authors report the case of a 43-year-old woman who underwent endodontic treatment of the right second mandibular molar with substantial extrusion of endodontic material into the mandibular canal. The patient presented at the Department of Oral and Maxillofacial Surgery with a persistent total anaesthesia of the lower lip and chin after two months. 2D panoramic view and 3D CT-scan examination highlighted the overfilling into the mandibular canal with a more than 50% stenosis of the canal and a consequently significant compression of the dental pedicle. A surgical decompression of the inferior alveolar nerve was performed through an inferior vestibular approach, using PiezoSurgery. The tooth was conserved. After a period of 8days, paraesthesia of the lower lip and chin appeared. Thermoalgic sensitivity was recovered at 1month. At 3months postoperatively, the patient had recovered protopathic and epicritic sensitivity. Dental prosthetic rehabilitation was finally achieved one year postoperatively. The authors discuss the physiopathology of nervous injuries during dental procedures, and further strategies in the case of persistent neurologic disorders.
作者报告了一例43岁女性患者的病例，该患者接受了右下第二磨牙的根管治疗，根管材料大量挤出至下颌管。两个月后，患者因下唇和下巴持续完全麻醉就诊于口腔颌面外科。二维全景片和三维CT扫描检查显示下颌管超充，管腔狭窄超过50%，牙蒂因此受到明显压迫。采用压电手术，通过下颌前庭入路对下牙槽神经进行了手术减压。患牙得以保留。8天后，下唇和下巴出现感觉异常。1个月时热痛觉恢复。术后3个月，患者浅感觉和精细感觉恢复。术后1年最终完成了牙修复。作者讨论了牙科手术中神经损伤的病理生理，以及持续性神经功能障碍情况下的进一步策略。
