应用超声骨刀舌侧去骨拔除舌侧位下颌阻生第三磨牙

Lingual split technique with piezosurgery in removal of lingually positioned and deeply impacted mandibular third molar

目的 ：探讨应用超声骨刀舌侧去骨在拔除舌侧位阻生下颌第三磨牙中的截骨设计和手术效果。方法 ：将符合纳入标准的22颗舌侧位阻生下颌第三磨牙用超声骨刀舌侧去骨拔除。其截骨设计为1条矢状向和2条横向的截骨线,以去除面和舌侧的骨板。记录手术成功率、去骨方式、手术时间、伤口愈合情况和并发症,评价应用效果。结果：所有牙均顺利拔除,平均用时13.92 min（6~24 min）。9例（40.9%）为整体去骨拔除,6例（27.3%）为分块去骨拔除,4例（18.2%）为牙-骨连体拔除,3例（13.6%）为去骨分牙拔除。22例（100%）创口均一期愈合。2例（9.09%）出现暂时性舌神经功能障碍,1例（4.55%）出现暂时性下牙槽神经功能障碍。服用神经营养药物后,均在术后2个月内恢复。结论：使用超声骨刀舌侧去骨拔除舌侧位阻生下颌第三磨牙,成功率高,手术时间短,手术创伤小,并发症发生率低。

PURPOSE： This retrospective study was aimed to introduce lingual split technique with piezosurgery in removal of lingually positioned and deeply impacted mandibular third molar, and evaluate the short-term outcomes.METHODS： Twenty-one patients with 22 lingually positioned and deeply impacted mandibular third molar were extracted by piezoelectric device through lingual split technique. We proposed the osteotomy design for lingual and occlusal bone removal： one sagittal osteotomy line and two transverse osteotomy line. The success rate, osteotomy method,operation time, wound healing and major complications were recorded and compared. RESULTS： All impacted mandibular third molars were successfully removed. The average time of operation was 13.92 min（range from 6-24 min）.Twenty-two extraction sites（100%） were primarily healed. There were 2 extractions（9.09%） with temporary lingual nerve injury and 1 extraction（4.55%） with temporary inferior alveolar nerve injury, all the patients recovered within 2 months by neurotrophic drug treatment. CONCLUSIONS： Piezosurgery through lingual split technique provides an effective way for extraction of lingually positioned and deeply impacted mandibular third molar, which improves surgical efficiency and reduces morbidity rates effectively.