牙髓治疗后三叉神经损伤的药物治疗：回顾性分析。

Pharmacologic management of trigeminal nerve injury after endodontic treatment: A retrospective analysis.

机构信息

Graduate School, Yonsei University, Seoul, South Korea.

School of Dentistry, Dental Research Institute, Seoul National University, Seoul, South Korea.

出版信息

J Oral Rehabil. 2024 Sep;51(9):1737-1747. doi: 10.1111/joor.13765. Epub 2024 Jun 6.

DOI:10.1111/joor.13765

PMID:38845175

Abstract

BACKGROUND

Trigeminal nerve injury following endodontic treatment, leading to unpleasant sensations or partial sensory loss in the face or oral mucosa, is uncommon but significant when it occurs.

OBJECTIVE

This study analysed the pharmacological management of trigeminal nerve injuries (TNI) in a university-based hospital.

METHODS

We conducted a retrospective analysis of 47 patients who visited the Department of Orofacial Pain and Oral Medicine at Yonsei University Dental Hospital, Seoul, Korea, after TNI following endodontic procedures in primary clinics. Both objective tests and subjective evaluations, assessed the extent and duration of sensory injury during the initial visit. The patient's initial symptoms, presumed cause of TNI, referral delay (time interval between TNI and the first visit to our clinic), and medications were analysed to determine whether these factors affected the outcomes.

RESULTS

Most patients with TNI experienced dysesthesia with hypoesthesia (70.2%). The mandibular molars were predominantly affected (72.3%), with the inferior alveolar nerve (IAN), lingual nerve (LN), both IAN and LN, and maxillary nerve compromised in 83.0, 12.8, 2.1, and 2.1% of cases, respectively. Causes of TNI included local anaesthesia (29.8%), overfilling/over-instrumentation (25.5%), endodontic surgery (17.0%), and unknown factors (27.7%). A shorter referral delay was associated with better outcomes, with an average delay of 8.6 weeks for symptom improvement compared with 44.1 weeks for no change. The medication regimens included steroids, NSAIDs, topical lidocaine, vitamin B complex, Adenosine Triphosphate (ATP), antiepileptics, antidepressants, and opioids administered alone or in combination, with a mean duration of 20.7 weeks. 53.2% of the patients reported improvement in their symptoms, 27.7% experienced no significant change, and 19.1% had unknown outcomes.

CONCLUSIONS

Swift referral to an orofacial pain specialist is recommended for effective recovery in cases of TNI arising from endodontic treatment.

摘要

背景

根管治疗后发生三叉神经损伤，导致面部或口腔黏膜出现不愉快的感觉或部分感觉丧失，这种情况虽然不常见，但发生时却很重要。

目的

本研究分析了在一所大学附属医院中三叉神经损伤（TNI）的药物治疗管理。

方法

我们对在韩国首尔延世大学牙科医院口腔颌面痛科就诊的 47 例原发性诊所根管治疗后发生 TNI 的患者进行了回顾性分析。在初次就诊时，通过客观测试和主观评估来评估感觉损伤的程度和持续时间。分析患者的初始症状、TNI 的推测原因、转介延迟（TNI 与首次就诊到我们诊所之间的时间间隔）以及药物使用情况，以确定这些因素是否影响治疗结果。

结果

大多数 TNI 患者表现为感觉异常伴感觉减退（70.2%）。下颌磨牙是最常受累的部位（72.3%），分别有 83.0%、12.8%、2.1%和 2.1%的病例累及下牙槽神经（IAN）、舌神经（LN）、IAN 和 LN，以及上颌神经。TNI 的原因包括局部麻醉（29.8%）、超填/超扩（25.5%）、根管手术（17.0%）和未知因素（27.7%）。转介延迟越短，治疗效果越好，症状改善的平均延迟时间为 8.6 周，而无变化的平均延迟时间为 44.1 周。药物治疗方案包括单独或联合使用类固醇、非甾体抗炎药、局部利多卡因、维生素 B 复合物、三磷酸腺苷（ATP）、抗癫痫药、抗抑郁药和阿片类药物，平均持续时间为 20.7 周。53.2%的患者报告症状改善，27.7%的患者无明显变化，19.1%的患者结果未知。