使用骨劈開術移除深部阻生第二大臼齒－病例報告

Bone Split Technique Approach Deep Impacted Tooth-A Case Report

李欣霖(Hsin-Lin Lee) ； 邱國洲(Guo-Zhou Qiu) ； 吳契璁(Chi-Tsung Wu) ； 王宜斌(Yi-Bin Wang) ； 謝義興(Yi-Shing Shieh) ； 陳元武(Yuan-Wu Chen)

《中華民國家庭牙醫學雜誌》 9卷2期 (2014/09) Pp. 33-41

https://doi.org/10.6566/JFD/2014.9(2).33

摘要

移除下顎之深度阻生齒時，下齒槽神經損傷是手術中嚴重的併發症之一，術前如何準確定位出阻生齒和神經之間的關係位置，與降低對神經的傷害是重要的議題。環口X光片是臨床上用來評估阻生齒和神經之間的相關位置，但影像資訊只有2度空間遠少於錐形束電腦斷層掃描（cone-beam computed tomography, CBCT）可提供3度空間之相關位置。本病例中為一患者右側下顎有一深度阻生第二大臼齒，環口X光片檢查可見阻生齒貼附在第一大臼齒牙根下，影像模糊難辨，無法判斷其和神經之關係。而錐形束電腦斷層掃描可清楚發現第二大臼齒的近心舌側牙根往遠心彎曲成C形且附跨在下齒槽神經上。有別於傳統的齒切手術，使用了骨劈開術（Bone split technique）來建立骨窗（Bone window），進而移除這顆阻生齒而沒有造成神經麻痺等後遺症，並且在經過六個月的追蹤後，沒有任何的併發症出現。

關鍵字

深部阻生齒 ； 下齒槽神經 ； 神經麻痺

並列摘要

The inferior alveolar nerve damage is one of the most common complications followed by removing deep impacted teeth of mandible. Exploring the position of the deep impacted teeth and minimizing nerve damage are important. Panorex are usually for assessing the relation between target tooth and nerve, but less information is provided compared to cone-beam computed tomography (CBCT). This case revealed the impacted tooth had located beneath first molar on right mandible. Panorex was showed that the deep impacted tooth was attached to the first molar root and strode across inferior alveolar nerve. Especially, the image of CBCT was also presented the mesiolingual clawing root adhered to inferior alveolar nerve. We used bone split technique approach this deep impacted tooth without nerve damage. No complication was happened after 6 months follow up.

並列關鍵字

Deep impacted tooth ； inferior alveolar nerve ； lip paralysis