Department of Oral and Maxillofacial Surgery (Head of Department: Dr. Daniel Hrusak, Ph.D.), University Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, AlejSvobody 80, 304 60 Pilsen, Czech Republic.
Department of Oral and Maxillofacial Surgery (Head of Department: Dr. Daniel Hrusak, Ph.D.), University Hospital and Faculty of Medicine in Pilsen, Charles University in Prague, AlejSvobody 80, 304 60 Pilsen, Czech Republic.
J Craniomaxillofac Surg. 2019 Jan;47(1):1-5. doi: 10.1016/j.jcms.2018.05.032. Epub 2018 May 18.
Impacted mesiodentes in the inverted position may interfere with the base of the nasal cavity or the nasal septum. They can rarely erupt into the nose as well. Traditionally they are extracted via intraoral approaches (transpalatal or vestibular). Also, an endoscopically assisted transnasal approach can be used. In this paper, the authors are the first to present a group of patients suffering from impacted mesiodentes who have been surgically treated using a modified maxillary vestibular approach with subperiostal intranasal dissection.
The prospective study was completed in the time period 12/2013-6/2017. The inclusion criteria were: 1. Mesiodens impacted in the inverted position extending to the base of the nasal cavity or into the nasal septum without concomitant pathological lesion and without eruption into the nasal cavity. 2. Localization of the mesiodens at the level of or dorsally to the roots of the upper middle incisors in the sagittal plane or ventrally to the roots of these teeth, but with the crown extending significantly posteriorly to the base of the nasal cavity.3. Indication for extraction because of clinical or orthodontic reasons.
In total, 9 patients were enrolled into the group. In these patients, surgical extractions of 9 mesiodentes were performed using the alternative approach described above. All extractions were done according to a uniform surgical protocol. The mean age of the patients was 11.7 ± 3.1 years (age range 7-17 years). The crown's most cranial point exceeded the bone of the nasal cavity on average by2.0 ± 1.4 mm (in the range 0-5 mm). 8 mesiodentes were conical, 1 was tuberculate. Surgical procedure and postoperative healing were always without any complications.
For the removal of midline supernumerary teeth, the modified maxillary vestibular approach with subperiostal intranasal dissection in comparison to the intraoral palatal approach provides less postoperative morbidity and a lower risk of complications (smaller surgical wound, minimal exposure of maxilla, minimal bone loss, reduced risk of damage to the roots of the upper incisors, lower risk of damage to the nasopalatine neurovascular bundle, good visibility in the surgical field, easier surgery, and finally no need of postoperative palatal splint). For oral and maxillofacial surgeons the presented technique represents a more traditional way of surgical tooth extraction than the endoscopically assisted transnasal approach.
倒置位置的埋伏中切牙可能会干扰鼻腔底部或鼻中隔。它们也很少会向鼻腔内萌出。传统上，这些埋伏牙可以通过口腔内入路（经腭或经前庭）来拔除。此外，也可以使用经鼻内镜辅助的入路。在本文中，作者首次报道了一组接受过改良上颌前庭入路伴骨膜下经鼻腔内解剖的手术治疗的埋伏中切牙患者。
这项前瞻性研究完成于 2013 年 12 月至 2017 年 6 月期间。纳入标准为：1. 倒置埋伏的中切牙延伸至鼻腔底部或鼻中隔，无伴随的病理病变，也无向鼻腔内萌出。2. 中切牙在矢状面上位于或位于上颌中切牙根的背侧，或位于这些牙齿的根的腹侧，但牙冠明显向后延伸至鼻腔底部。3. 由于临床或正畸原因需要拔除。
共有 9 名患者纳入本研究。在这些患者中，使用上述替代方法进行了 9 例埋伏中切牙的手术拔除。所有手术均按照统一的手术方案进行。患者的平均年龄为 11.7 ± 3.1 岁（年龄范围为 7-17 岁）。牙冠最颅侧点平均超出鼻腔骨 2.0 ± 1.4mm（范围为 0-5mm）。8 颗中切牙为圆锥形，1 颗为结节状。手术过程和术后愈合均无任何并发症。
对于中线额外牙的去除，与经口腔腭入路相比，改良上颌前庭入路伴骨膜下经鼻腔内解剖的方法术后并发症发生率更低，风险更小（手术切口更小，上颌暴露程度最小，骨量丢失更少，对上颌切牙牙根损伤的风险降低，损伤鼻腭血管神经束的风险降低，手术视野良好，手术更容易，最后无需术后腭托）。对于口腔颌面外科医生来说，与经鼻内镜辅助的入路相比，所介绍的技术代表了一种更传统的手术拔牙方法。
