下齒槽神經阻斷術後之眼部併發症

下齒槽神經阻斷術現已廣泛運用於牙科治療中，並同時認為此麻醉方式為安全的治療術式之一，但若操作不慎，仍偶有出現系統性、局部性及遠端性等併發症的可能。其中，眼部遠端性併發症非常罕見，目前已知可能的原因是透過翼窩至眼部間之動脈、靜脈、肌筋膜及交感神經節等不同路徑，造成痲痹、瞳孔放大、眼瞼下垂、黑矇、複視以及視線模糊等症狀。若於術前使用25號以上針頭回抽注射位置兩次，同時緩慢注射可降低術後併發症風險。一旦出現眼部併發症，應綜合理學檢查、評估面神經、眼球運動、視力及燒灼感合併監測意識與生命跡象以鑑別並確定診斷。於治療期間應避免侵入性醫療行為，並追蹤觀察。所幸口內局部麻醉術後併發症多數為良性且幾乎可於短暫時間內恢復。

關鍵字

下齒槽神經阻斷術；眼科；遠端性併發症

並列摘要

Inferior alveolar nerve block (IANB) anesthesia is one of the most common procedures during the dental practice. Although this procedure is well known for its safety, untowarded events including systemic, localized and distant complications can still occur. It is proposed that simple diffusion from the pterygomaxillary fossa to the orbital region through defects in the bone or via the vascular, lymphatic and venous networks that link these spaces results in ocular consequences. An distant ocular complication such as amaurosis, blurred vision, enophthalmos, ptosis, mydriasis, miosis or anhidrosis is very rare, but once it happens, comprehensive neuro-ophthalmologic assessment and proper differential diagnosis should be followed by further evaluations of the facial nerve, eye movement, eyesight, blanching, and burning sensation to obtain the definitive diagnosis. Check aspiration at least twice during the procedure using adequate needle size (＞25 gauge), and the anesthetic should be injected slowly to prevent complications. Fortunately, the adverse reactions after IANB anesthesia is most common short lived and symptoms resolved almost completely within a limited time, at which time management is usually supportive to avoid further incidents occurred at the time of treatment or on follow-up evaluation.

並列關鍵字

Inferior alveolar nerve block anesthesia ； ophthalmologic ； distant complication

國際替代計量

下齒槽神經阻斷術後之眼部併發症

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