根管治療中次氯酸鈉溶液意外擠入根尖牙周組織引發之嘴唇麻痺－病例報告

根管治療中修形過程必須合併使用根管沖洗溶液以達到徹底的根管清創效果，這是根管治療的重要步驟，也是確保根管治療成功的關鍵。目前臨床上，次氯酸鈉(sodium hypochlorite)與EDTA溶液仍然是廣泛使用的根管沖洗溶液，其中次氯酸鈉與EDTA配合使用不但具備有良好的殺菌，溶解壞死組織能力，而且可移除塗抹層。不過，根管沖洗溶液使用方式不正確或輕忽其破壞性而滲透至牙根周圍組織中，將會造成嚴重的組織反應，甚至於會引發劇烈疼痛或急性感染等併發症狀。本病例報告是兩例有關根管治療過程中，因治療過程不愼使根尖孔破壞與穿孔，並將根管沖洗溶液次氯酸鈉擠壓至牙根周圍組織中，造成急性疼痛、牙齦腫脹、蜂窩組織炎，甚至有局部性的嘴唇麻痺現象等劇烈組織反應。經過緊急處理步驟如根管沖洗稀釋濃度，膿腫切開引流，抗生素，類固醇及止痛藥等藥物治療約一週後，大部份的症狀均消褪，嘴唇麻痺範圍也縮小，三個月後臨床症狀回復至正常狀況，後續追蹤並無明顯治療後遺症。根管治療沖洗液的正確使用方式及臨床使用注意事項，不可忽略！

關鍵字

根管沖洗溶液；次氯酸鈉；根尖孔破壞與穿孔；蜂窩組織炎；嘴唇麻痺

並列摘要

The process of root canal preparation must be combined with irrigants to achieve complete debridement. This is an important part of the root canal treatment procedure and the key to success. The most-frequently used irrigants are sodium hypochlorite and EDTA or a combination of them both. In particular, sodium hypochlorite is effective against a broad spectrum of bacteria, and dissolves vital and necrotic tissue. Inadvertent injection of sodium hypochlorite beyond the apical foramen leads to a severe tissue reaction, intense pain, or infection. This report presents 2 cases of inadvertent injection of sodium hypochlorite into the periradicular tissue because of apical constriction destruction and canal perforation. Acute severe pain, gingival swelling, cellulites, and even parathesis over the circumscribed region of the upper lip were noted. Supporting treatment including infiltration anesthesia, analgesics, antibiotic treatment combined with cold compression, and the root canal was left open for drainage. When the acute symptoms have resolved or diminished, endodontic treatment may be completed. More than 3 months later, mild parathesis of the circumscribed region of the lip had resolved and no other sequelae were noted.

並列關鍵字

irrigants ； sodium hypochlorite ； apical perforation ； cellulitis ； lip parathesis

國際替代計量

根管治療中次氯酸鈉溶液意外擠入根尖牙周組織引發之嘴唇麻痺－病例報告

全文下載

主題瀏覽