Li Xiu-Fen, Liu Chang, Liu Ji-Yuan, Qu Tao, Pan Wei-Lin, Pan Jian, Hua Cheng-Ge
Dept. of Stomatology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China.
State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China.
Hua Xi Kou Qiang Yi Xue Za Zhi. 2021 Apr 1;39(2):170-174. doi: 10.7518/hxkq.2021.02.007.
The present study aimed to explore the innervation of the anterior hard palatine and its relationship with individual development stage. Specifically, the effects of anesthesia on patients of different ages were observed, and neurodevelopment in the maxillofacial region was invesitgated. References that are helpful in selecting local anesthesia were provided.
A total of 182 patients with mixed dentition were randomly divided into the nasopalatine nerve block and greater palatine nerve block groups. Then, 219 patients with permanent dentition were divided into an adolescent group (13-18 years old) and adult group (over 19 years old), all of whom underwent bilateral greater palatine nerve block. Palatal mucosal pain sensation was tested pre- and post-anesthesia with Von Frey hairs.
Among the children with mixed dentition, bilateral greater palatine nerve block tended to result in better anesthetic effects than nasopalatine nerve block (<0.05), except in the incisive papilla. No difference in anesthetic effect was observed between adolescents and adults (>0.05). The bilateral greater palatine nerve block was more effective in inducing an anesthestic effect in the anterior hard palatine in mixed dentition than in permanent dentition (over 13 years old; <0.05).
The sensation of the anterior hard palatine seems mainly dominated by the greater palatine nerve until mixed dentition and gradually shifted to the nasopalatine nerve in conjunction with maxillary development and tooth replacement. Hence, the innervation of the anterior hard palatine induce a secondary development during the development of the maxilla.
本研究旨在探讨硬腭前部的神经支配及其与个体发育阶段的关系。具体而言,观察麻醉对不同年龄患者的影响,并研究颌面区域的神经发育。提供有助于选择局部麻醉的参考依据。
将182例混合牙列患者随机分为鼻腭神经阻滞组和腭大神经阻滞组。然后,将219例恒牙列患者分为青少年组(13 - 18岁)和成人组(19岁以上),所有患者均接受双侧腭大神经阻滞。在麻醉前后用von Frey毛发测试腭黏膜的痛觉。
在混合牙列儿童中,除切牙乳头外,双侧腭大神经阻滞的麻醉效果往往优于鼻腭神经阻滞(<0.05)。青少年和成人之间的麻醉效果无差异(>0.05)。双侧腭大神经阻滞在混合牙列中诱导硬腭前部麻醉效果比恒牙列(13岁以上)更有效(<0.05)。
在混合牙列期之前,硬腭前部的感觉似乎主要由腭大神经支配,并随着上颌骨发育和牙齿替换逐渐转移至鼻腭神经。因此,硬腭前部的神经支配在上颌骨发育过程中诱导了二次发育。