上颌前份埋伏多生牙的临床处理及效果观察

Clinical and curative effects of embedded supernumeraries in the anterior maxilla

目的探讨不同年龄段患者的上颌前份多生牙拔除术手术复杂程度和麻醉效果,并初步探讨不同年龄段上颌前份神经支配的差异。方法 240例埋伏多生牙患者,术前拍摄锥形束CT以了解埋伏多生牙的数目、形态、位置、与邻近组织的关系及邻牙牙根的发育情况等,以确定手术方案,术中探查麻醉后前腭部的痛觉,记录手术时间,术后随访记录前腭部的感觉变化。结果术中均未损伤邻牙牙根,79.2%患者腭侧入路手术,18岁以下患者手术时间明显短于成人。12岁以下患者腭大神经阻滞麻醉后前腭部麻醉时约78%的患者无痛感。离断鼻腭神经者约58.8%的患者腭前份无麻木感。患者术后恢复良好。结论患者年龄越小手术操作难度越小,部分患者(尤其是少儿)腭大神经在前腭的神经支配中有重要作用,鼻腭神经受损后,其支配区域感觉可恢复,年龄越小,恢复越快。

Objective This study aimed to investigate the complexity and anesthetic effects of the extraction of embedded supernumeraries and discuss innervation in the maxillary anterior region of differently aged individuals. Methods Data of 240 cases of embedded supernumeraries in the maxillary anterior region were collected. Cone-beam computed tomography was used to analyze the number, location, shape, and three-dimensional position of the supernumeraries. Algesthesia in the anterior region of the palate was investigated after greater palatine nerve block. The operation time and the alteration in sensation of the palatal anterior region were recorded. Results The percentage of patients who were operated from the palatal side was 79.2%. The operation time of patients aged 〈18 years old was shorter than that of adults. About 78% of patients aged 〈12 years old felt lethargic after accepting anterior palatal anesthetization following greater palatine nerve block. As a result of surgical division of the nasopalatine nerve, nearly 58.8% of the patients produced no sensory deficit. All patients recovered well after operation. Conclusion Surgical procedures conducted on younger patients were easier than those on older patients. Among all patients（particularly the children）, the great palatine nerve may play an important role in the sensation of the mucosa of the anterior hard palatine. In patients whose nasopalatine nerves were transected, the sensation of the anterior palatine gradually recovered. The recovery periods were shorter in younger patients.