Private Practice, Facial and Cosmetic Surgery of Fort Worth, Fort Worth, TX; and Former Fellow, Georgia Oral & Facial Reconstructive Surgery, Atlanta, GA.
Fellow, Cosmetic and Advanced Maxillofacial Surgery, Georgia Oral & Facial Reconstructive Surgery, Atlanta, GA.
J Oral Maxillofac Surg. 2021 Jul;79(7):1434-1446. doi: 10.1016/j.joms.2021.01.037. Epub 2021 Feb 6.
An uncommon, but serious complication of endodontic treatment is inferior alveolar nerve (IAN) injury warranting operative intervention for exploration, debridement, and repair. The purpose of the study was to evaluate outcomes of microneurosurgical intervention for endotontic-related IAN injuries in terms of achievement of functional sensory recovery (FSR) and pain relief and to identify factors affecting outcomes.
A retrospective cohort study of patients who had microsurgical exploration and repair of IAN injuries sustained during endodontic therapy was performed. The primary predictor variable is time to surgery and the primary outcome variables were time to FSR, whether or not the patient regained FSR, and postoperative pain level at 12 months (1-10 on a visual analog scale). Secondary variables include intraoperative findings, surgical treatment rendered, sensory recovery, and preoperative pain level. Analyses include Kaplan-Meier estimation, Fisher exact test, 1-way and mixed-design analysis of variance, and paired t-test.
The sample included 23 patients with a mean age of 48.6 years with a female:male ratio of 20:3. Painful sensation was present in 17 (73.9%) of 23 patients at initial consultation. Mean time to surgery was 10.9 months (median 4.8 months, standard deviation = ±16.9). FSR was achieved in 10 of 21 patients at 1 year. Pain level at 1 year following surgical intervention improved from 4.86 to 2.76 (P = .001) with no effect from other variables.
Surgical exploration and repair of endodontic-related IAN injuries is shown to improve neuropathic pain levels, while only delivering a modest recovery of sensory function. These injuries can be severe and debilitating and present with a variety of diagnoses and surgical findings. While this study fails to identify any particular factors affecting outcome, the data presented can help with clinician recommendations for treatment in patient-centered care.
牙髓治疗的一种罕见但严重的并发症是下牙槽神经（IAN）损伤，需要手术干预以进行探查、清创和修复。本研究的目的是评估牙髓相关 IAN 损伤的显微神经外科干预的结果，以实现功能感觉恢复（FSR）和疼痛缓解，并确定影响结果的因素。
对接受显微神经探查和修复牙髓治疗所致 IAN 损伤的患者进行回顾性队列研究。主要预测变量是手术时间，主要结果变量是 FSR 的时间、患者是否恢复 FSR 以及术后 12 个月的疼痛水平（视觉模拟量表 1-10 分）。次要变量包括术中发现、手术治疗、感觉恢复和术前疼痛水平。分析包括 Kaplan-Meier 估计、Fisher 精确检验、单因素和混合设计方差分析以及配对 t 检验。
该样本包括 23 名平均年龄为 48.6 岁的患者，女性：男性比例为 20:3。23 例患者中有 17 例（73.9%）在初次就诊时存在疼痛感觉。平均手术时间为 10.9 个月（中位数 4.8 个月，标准差±16.9）。1 年后，21 例患者中有 10 例达到 FSR。手术干预 1 年后疼痛水平从 4.86 改善至 2.76（P=.001），其他变量无影响。
牙髓相关 IAN 损伤的手术探查和修复可改善神经病理性疼痛水平，同时仅能适度恢复感觉功能。这些损伤可能很严重且使人虚弱，并伴有多种诊断和手术发现。尽管本研究未能确定任何特定的影响结果的因素，但所提供的数据可有助于临床医生在以患者为中心的护理中提供治疗建议。
