Darawsheh H M, Safronova A A, Vasil'ev Yu L, Makarova N I, Diachkova E Yu, Saleeva G T, Saleev N R, Saleev R A
Sechenov University, Moscow, Russia; Penza State University, Penza, Russia.
Saint Petersburg State University of Aerospace Instrumentation, St. Petersburg, Russia.
Ann Anat. 2023 Apr;247:152055. doi: 10.1016/j.aanat.2023.152055. Epub 2023 Jan 22.
One of the most popular methods of local anesthesia in dentistry, inferior alveolar nerve block (IANB) involves the blockade of the inferior alveolar nerve (IAN) and lingual nerve (LN) in the pterygomandibular space. Despite the large number of works describing the contents of this space, the spatial displacements of the anatomical structures of this area at different positions of the mandible have not been sufficiently studied. The aim of our study was to study the spatial movements of the IAN and inferior alveolar artery (IAA) at various positions of the mandible using computer simulation and finite element analysis to find the safest way to conduct IANB.
Reverse engineering was used to create a model of the cranial base and the mandible based on computed tomography (CT) data obtained from patient N (male, 24 years old), the arteries of the head and neck were designed from the data of multiphase angiography of patient M (female, 61 years old). Masticatory muscles, sphenomandibular ligament, temporomandibular joint and mandibular nerve were modeled in the SolidWorks software package based on an open database of anatomical structures. The finite element grid was generated in the Solidworks software. In the first series of experiments, the displacement of the mandible was modeled along the vertical axis down by 48 mm (maximum opening of the mouth), in the second series, the jaw was displaced vertically by 48 mm with a simultaneous transversal movement of 10 mm, in the third series, the jaw was displaced along the vertical axis down by 34 mm and transversally by 22 mm.
The largest distance between IAN and IAA was noted in the third series of experiments. The distance between the nerve and the vessel was minimal in the first series, with an open mouth without lateral displacements.
The generated computer model opens new possibilities for studying the dynamic anatomy of the pterygomandibular space. The results of this study can be used for further experimental and clinical trials to find the safest approach to the implementation of IANB, as well as applied in the practice of the educational process.
下牙槽神经阻滞（IANB）是牙科最常用的局部麻醉方法之一，涉及翼下颌间隙内下牙槽神经（IAN）和舌神经（LN）的阻滞。尽管有大量著作描述了该间隙的内容，但该区域解剖结构在不同下颌位置的空间位移尚未得到充分研究。我们研究的目的是使用计算机模拟和有限元分析来研究IAN和下牙槽动脉（IAA）在不同下颌位置的空间移动，以找到进行IANB的最安全方法。
采用逆向工程，根据从患者N（24岁男性）获得的计算机断层扫描（CT）数据创建颅底和下颌骨模型，根据患者M（61岁女性）的多期血管造影数据设计头颈部动脉。咀嚼肌、蝶下颌韧带、颞下颌关节和下颌神经基于解剖结构的开放数据库在SolidWorks软件包中建模。在Solidworks软件中生成有限元网格。在第一组实验中，下颌骨沿垂直轴向下移动48毫米（最大开口度）进行建模；在第二组实验中，下颌骨垂直移动48毫米同时横向移动10毫米；在第三组实验中，下颌骨沿垂直轴向下移动34毫米并横向移动22毫米。
在第三组实验中，IAN和IAA之间的距离最大。在第一组实验中，即无侧向位移的开口状态下，神经与血管之间的距离最小。
所生成的计算机模型为研究翼下颌间隙的动态解剖学开辟了新的可能性。本研究结果可用于进一步的实验和临床试验，以找到实施IANB的最安全方法，并应用于教育过程的实践中。
