La Monaca Gerardo, Vozza Iole, Giardino Rita, Annibali Susanna, Pranno Nicola, Cristalli Maria Paola
Department of Sense Organs, "Sapienza" University of Rome, Rome, Italy.
Department of Oral and Maxillo-Facial Sciences, "Sapienza" University of Rome, Rome, Italy.
Ann Stomatol (Roma). 2017 Nov 8;8(2):45-52. doi: 10.11138/ads/2017.8.2.053. eCollection 2017 Apr-Jun.
Surgery to the mandibular third molar is common, and injuries to the inferior alveolar nerve and the lingual nerve are well-recognized complications of this procedure. The aim of these technical notes is to describe operative measures for reducing neurological complications during mandibular third molar surgery. The following procedure should be used to prevent damage to the inferior alveolar nerve: a well-designed mucoperiosteal flap, to obtain appropriate access to the surgical area; a conservative ostectomy on the distal and distal-lingual side; tooth sectioning, to facilitate its removal by decreasing the retention zones; tooth dislocation in the path of withdrawal imposed by the curvature of the root apex; and careful socket debridement, when the roots of the extracted tooth are in intimate contact with the mandibular canal. To prevent injury to the lingual nerve, it is important (I) to assess the integrity of the mandibular inner cortex and exclude the presence of fenestration, which could cause the dislocation of the tooth or its fragment into the sublingual or submandibular space; (II) to avoid inappropriate or excessive dislocation proceedings, in order to prevent lingual cortex fracture; (III) to perform horizontal mesial-distal crown sectioning of the lingually inclined tooth; (IV) to protect the lingual flap with a retractor showing the cortical ridge; and (V) to pass the suture not too apically and from the inner side in a buccal-lingual direction in the retromolar area.
下颌第三磨牙手术很常见，下牙槽神经和舌神经损伤是该手术公认的并发症。这些技术要点的目的是描述在下颌第三磨牙手术中减少神经并发症的手术措施。应采用以下步骤预防下牙槽神经损伤：设计良好的黏骨膜瓣，以便适当暴露手术区域；在远中及远中舌侧进行保守的截骨术；牙齿分割，通过减少固位区域便于牙齿拔除；根据根尖弯曲情况使牙齿在拔除路径上脱位；当拔除牙齿的牙根与下颌管紧密接触时，仔细清理牙槽窝。为预防舌神经损伤，重要的是：（I）评估下颌骨内皮质的完整性，排除开窗情况，开窗可能导致牙齿或其碎片脱位至舌下或下颌下间隙；（II）避免不适当或过度的脱位操作，以防止舌侧皮质骨折；（III）对舌倾牙齿进行近远中向的水平冠部切割；（IV）用显示皮质嵴的牵开器保护舌瓣；（V）在磨牙后区缝线不要过于靠近根尖且从内侧向颊舌方向穿过。
