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在下颌骨良性肿瘤切除与重建过程中保护下牙槽神经对改善患者生活质量的作用。

Inferior alveolar nerve preservation during resection and reconstruction of the mandible for benign tumors as a factor improving patient's quality of life.

机构信息

The Peoples' Friendship University of Russia, 6 Miklukho-Maklaya St., Moscow, 117198, Russian Federation; Burdenko Main Military Clinical Hospital, 3 Gospitalnaya Poloschad, Moscow, 105229, Russian Federation.

The Peoples' Friendship University of Russia, 6 Miklukho-Maklaya St., Moscow, 117198, Russian Federation; I.M. Sechenov First Moscow State Medical University (Sechenov University), 8/2 Trubetskaya St., 119991, Moscow, Russian Federation.

出版信息

J Craniomaxillofac Surg. 2022 May;50(5):393-399. doi: 10.1016/j.jcms.2022.02.008. Epub 2022 Mar 7.

DOI:10.1016/j.jcms.2022.02.008
PMID:35307312
Abstract

This prospective study aimed to evaluate neurosensory disturbance and quality of life in patients who underwent mandibular resection for benign tumors and whose inferior alveolar nerve (IAN) was either preserved or sacrificed. Mandibular resection was indicated owing to the presence of osteoradionecrosis in 25 patients and ameloblastoma in 15 patients. Resection was unilateral in 24 patients and bilateral in 16 patients. The authors assessed the inferior alveolar nerve's sensory dysfunction by measuring the electroexcitability of skin receptors using an electro-odontometer. Study participants' quality of life was estimated with the oral health impact profile (OHIP)-14 and short-form (SF)-36 questionnaire. All the patients in whom the inferior alveolar nerve was sacrificed experienced persistent numbness in the area of innervation with mental nerve on the affected side. The average pain threshold reached preoperative levels (point 1-22.7 ± 2.5, p-value = .025; point 2-25.8 ± 2.7, p-value = .023) 6 months after the operation in patients in whom the IAN was preserved (point 1-23.7 ± 2.3, p-value = .022; point 2-25.4 ± 2.8, p-value = .025). The results of the OHIP-14 and SF-36 showed that patients with preserved IANs had a significantly better quality of life than the patients in whom the IAN was sacrificed. The results of OHIP-14 twelve months after the operation in unilateral resection: control group - 16.0 ± 1.6, p-value = .029; study group - 8.0 ± 0.8, p-value = .029, and in bilateral resection: control group - 26.0 ± 3.2, p-value = .044; study group - 9.0 ± 0.7, p-value = .027. The possibility of sparing the inferior alveolar nerve should not be ignored when planning mandibular resection and reconstruction.

摘要

本前瞻性研究旨在评估因下颌骨骨放射性坏死(25 例)和造釉细胞瘤(15 例)而接受下颌骨切除术并保留或牺牲下牙槽神经(IAN)的患者的神经感觉障碍和生活质量。24 例患者为单侧切除,16 例患者为双侧切除。作者使用电牙动计测量皮肤感受器的电兴奋性来评估下牙槽神经的感觉功能障碍。研究参与者的生活质量采用口腔健康影响简表(OHIP-14)和短表(SF-36)问卷进行评估。所有 IAN 被切断的患者患侧下颌神经支配区域均出现持续性麻木。在 IAN 保留的患者中,术后 6 个月时,疼痛阈值达到术前水平(点 1-22.7±2.5,p 值=0.025;点 2-25.8±2.7,p 值=0.023)(点 1-23.7±2.3,p 值=0.022;点 2-25.4±2.8,p 值=0.025)。OHIP-14 和 SF-36 的结果表明,保留 IAN 的患者生活质量明显优于 IAN 被切断的患者。单侧切除术后 12 个月的 OHIP-14 结果:对照组 - 16.0±1.6,p 值=0.029;研究组 - 8.0±0.8,p 值=0.029,双侧切除:对照组 - 26.0±3.2,p 值=0.044;研究组 - 9.0±0.7,p 值=0.027。在规划下颌骨切除和重建时,不应忽视保留下牙槽神经的可能性。

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