植牙手術於下顎前牙區之口底血腫

Hemorrhaging Associated the Floor of the Mouth With Implant Surgery in the Anterior Mandible

陳昶愷(Chang-Kai Chen) ； 喻大有(Da-Yo Yuh) ； 鄭國良(Guo-Liang Cheng) ； 倪志偉(Chih-Wei Ni) ； 邱賢忠(Hsien-Chung Chiu) ； 傅鍔(Earl Fu) ； 江正陽(Cheng-Yang Chiang)

《臺灣牙周病醫學會雜誌》 16卷3期 (2011/09) Pp. 205-214

摘要

人工植體在直入於下顎前牙區，常被視為簡單又安全的手術，但有報告指出在下顎前牙區施行植牙手術造成嚴重流血，使得口底血腫進而壓迫到呼吸道，讓病人呼吸困難造成潛在性的致命危險。此文獻回顧指出在手術過程中使用器械，將下顎前牙區的舌側骨板穿破和舌側骨膜撕裂，進而傷害到在口底豐富的動脈血管，使得口內大量出血，造成血腫。研究大部份的案例中，口底血腫常出現在手術當中，所以暢通病人呼吸道是首要之急，才能避免有致命的危險。文獻回顧指出為解決口底血腫的狀況，常需要手術介入，進而把破損的血管結紮牙和口內造成血腫的血塊清出，為了減少有致命危險的侵入，要小心注意在下顎前牙區施行人工植牙手術的當中是否傷害到動脈血管，才能減少血腫的發生。提出施行人工植牙手術之口底血腫併發症的文獻整理，以作為未來臨床治療之參考。(台灣牙周醫誌16:205-214, 2011)

關鍵字

下顎前牙 ； 呼吸阻塞 ； 植牙併發症 ； 口內血腫

並列摘要

Although placement of dental implants in the anterior region of the mandible is generally considered a routine, simple, and safe surgical procedure, severe bleeding and hematoma in the floor of the mouth have been reported about potentially fatal complication . This review presents massive internal bleeding in the highly vascularized region of the floor of the mouth is the result of an arterial trauma induced by instrumentation, usually through a perforation of the lingual cortical plate and a tear of lingual periosteum. In almost all cases the expanding hematoma formation starts during surgery, a secure airway was successfully established in all patients without fatal consequences. Resolution of hemorrhage required a surgical intervention for ligation of the bleeding vessels and hematoma evacuation. In order to reduce the probability of such a fatal complication, preventive and precautionary measures to be taken before, during, and after implant placement in the anterior mandible are presented (J Taiwan Periodontol 16: 205-214, 2011)

並列關鍵字

anterior mandible ； airway obstruction ； implant complication ； oral hemorrhage