Inferior alveolar nerve damage after lower third molar surgical extraction:: A prospective study of 1117 surgical extractions
Inferior alveolar nerve damage after lower third molar surgical extraction:: A prospective study of 1117 surgical extractions
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DOI：
10.1067/moe.2001.118284
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发表时间：
2001-10-01
期刊：
影响因子：
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通讯作者：
Gay-Escoda, C
中科院分区：
文献类型：
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作者：
Valmaseda-Castellón, E;Berini-Aytés, L;Gay-Escoda, C
目的。本研究的目的是确定下颌第三磨牙拔除手术后下牙槽神经(Ian)损伤的发生率，找出原因，并构建预测模型来评估Ian损伤的风险。我们在巴塞罗那大学口腔外科进行了一项非随机前瞻性前瞻性研究，研究对象为946名连续接受手术拔除1117颗下颌磨牙的门诊患者。收集术前、术中和术后的数据，通过非参数检验、皮尔逊卡方检验和Fisher精确检验确定Ian损伤的可疑原因。Logistic回归预测Ian损伤的危险性。虽然只有1.3%的摘除会造成暂时性神经损伤，但25%的损伤是永久性的。以下所有因素均显著增加Ian损伤的风险(P<；0.05)：年龄、根尖与下颌管的放射学关系、接近下颌管时牙根偏转、远端截骨、第三磨牙根尖至下颌管的距离、截骨、牙冠切除、牙根脱位时疼痛、伤口一期闭合、手术时间延长、出血、神经外露和术后瘀斑。前4个因素包括在预测Logit模型中。患者年龄、第三磨牙远端骨质切除、第三磨牙牙根与下颌管之间的放射学关系以及下颌管的偏转增加了Ian损伤的风险。年龄较大的患者遭受永久性伤害的风险更高。
Purpose. The purpose of this study was to determine the incidence of inferior alveolar nerve (IAN) damage after surgical removal of lower third molars, to identify the causes, and to construct a predictive model to assess the risk of IAN injury.Study design. We performed a nonrandomized forward prospective study of 946 consecutive outpatients subjected to surgical extraction of 1117 lower molars in the University of Barcelona Oral Surgery Department. Preoperative, intraoperative, and postoperative data were gathered, and suspected causal factors of IAN damage were identified by using nonparametric tests, the Pearson chi-square test, and the Fisher exact test. Logistic regression predicted the risk of IAN injury.Results. Although only 1.3% of the extractions caused temporary nerve damage, 25% of the lesions were permanent. All of the following significantly increased the risk of IAN damage (P < .05): age, the radiologic relationship between the apices and the mandibular canal, deflection of the root when approaching the mandibular canal, distal ostectomy, the distance of the apices of the third molar to the mandibular canal, ostectomy, crown sectioning, pain during root luxation, primary closure of the wound, prolonged operating time, bleeding, exposure of the nerve, and postoperative ecchymosis. The first 4 factors were included in a predictive logit model.Conclusions. Patient age, ostectomy of the bone distal to the third molar, the radiologic relationship between the roots of the third molar and the mandibular canal, and deflection of the mandibular canal increased the risk of IAN damage. older patients were at a higher risk for suffering permanent injuries.