Maxillofacial Plastic and Reconstructive Surgery

  • 제30권2호
  • /
  • Pages.165-171
  • /
  • 2008
  • /
  • 2288-8101(pISSN)
  • /
  • 2288-8586(eISSN)
대한악안면성형재건외과학회 (Korean Association of Maxillofacial Plastic and Reconstructive Surgeons)
권호 표지

파노라마 방사선사진상의 위험 징후와 하악 제3 대구치 발치 후 하치조신경 손상

INFERIOR ALVEOLAR NERVE INJURY FOLLOWING REMOVAL OF MANDIBULAR THIRD MOLAR AND PANORAMIC RADIOLOGICAL RISK SIGN

  • 이용인 (가톨릭대학교 임상치과학대학원 구강악안면외과학과) ;
  • 김창수 (성균관대학교 삼성서울병원 구강악안면외과) ;
  • 홍종락 (성균관대학교 삼성서울병원 구강악안면외과) ;
  • 이준휘 (성균관대학교 삼성서울병원 구강악안면외과) ;
  • 신창훈 (성균관대학교 삼성서울병원 구강악안면외과) ;
  • 표성운 (가톨릭대학교 의과대학 치과학교실 구강악안면외과)
  • Lee, Yong-In (Department of Oral and Maxillofacial Surgery, Graduate School of Clinical Dental Science, The Catholic University of Korea) ;
  • Kim, Chang-Soo (Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University) ;
  • Hong, Jong-Rak (Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University) ;
  • Lee, Jun-Hee (Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University) ;
  • Shin, Chang-Hun (Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University) ;
  • Pyo, Sung-Woon (Department of Oral and Maxillofacial Surgery, College of Medicine, The Catholic University of Korea)
  • 발행 : 2008.03.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

The aim of this study was to evaluate the incidence of panoramic radiological risk signs related with mandibular third molar extraction, and the relationship between these risk signs and inferior alveolar nerve (IAN) injury after tooth extraction. Cases were defined as 1000 mandibular third molars extracted by surgical approach at Samsung Medical Center during the period from March 2001 to December 2006. Seven radiological risk signs were assessed on the panoramic radiogram by three expert oral surgeons. Clinical demographic data and severity of IAN injury were examined on medical records. Bivariate analyses were completed to assess the relationship between radiological risk signs and IAN injury. The radiological risk signs showed in 381 cases(38.1%). The incidence of each radiological risk signs were; interruption of IAN white line, 152 cases(15.2%); deflected roots, 141 cases(14.1%); darkening root, 119 cases(11.9%); diversion of IAN, 57 cases(5.7%) ; IAN narrowing, 37 cases(3.7%); root narrowing, 17 cases(1.7%); dark and bifid apex, 10 cases(1.0%). The incidence of IAN injury in cases with risk signs were: in the case of any sign, 3.6%; interruption of IAN white line, 2.6%; deflected roots 5.7%; darkening root. 3.4%; diversion of IAN, 5.7%; IAN narrowing, 3.7%; root narrowing, 5.9%; dark and bifid apex, 0%. No IAN injury was showed in 619 cases without risk sign (p<0.05). In conclusion, the presence of panoramic risk signs was associated with an increased risk for IAN injury during mandibular third molar extraction, whereas the absence of risk signs was associated with a minimal risk of nerve injury.

키워드

참고문헌

  1. McCallum CA, Walker RV, Wallace WR et al : The manpower survey of oral surgery in 1974. Part 1 of two parts 4. Services rendered, sources of referred patients, consultations, and waiting periods for elective hospitalization of patients. J Oral Surg Aug;Spec No : A55, 1977
  2. Chiapasco M, De Cicco L, Marrone G : Side effects and complications associated with third molar surgery. Oral Surg Oral Med Oral Pathol 76 : 412, 1993 https://doi.org/10.1016/0030-4220(93)90005-O
  3. Sisk AL, Hammer WB, Shelton DW et al : Complications following removal of impacted third molars: the role of the experience of the surgeon. J Oral Maxillofac Surg 44 : 855, 1986 https://doi.org/10.1016/0278-2391(86)90221-1
  4. Tulloch JF, Antczak-Bouckoms AA : Decision analysis in the evaluation of clinical strategies for the management of mandibular third molars. J Dent Educ 51 : 652, 1987
  5. Robert RC, Bacchetti P, Pogrel MA : Frequency of trigeminal nerve injuries following third molar removal. J Oral Maxillofac Surg 63 : 732, 2005 https://doi.org/10.1016/j.joms.2005.02.006
  6. Schultze-Mosgau S, Reich RH : Assessment of inferior alveolar and lingual nerve disturbances after dentoalveolar surgery, and of recovery of sensitivity. Int J Oral Maxillofac Surg 22 : 214, 1993 https://doi.org/10.1016/S0901-5027(05)80638-1
  7. Tay AB, Go WS : Effect of exposed inferior alveolar neurovascular bundle during surgical removal of impacted lower third molars. J Oral Maxillofac Surg 62 : 592, 2004 https://doi.org/10.1016/j.joms.2003.08.033
  8. Wofford DT, Miller RI : Prospective study of dysesthesia following odontectomy of impacted mandibular third molars. J Oral Maxillofac Surg 45 : 15, 1987 https://doi.org/10.1016/0278-2391(87)90080-2
  9. Blaeser BF, August MA, Donoff RB et al : Panoramic radiographic risk factors for inferior alveolar nerve injury after third molar extraction. J Oral Maxillofac Surg 61 : 417, 2003 https://doi.org/10.1053/joms.2003.50088
  10. Smith AC, Barry SE, Chiong AY et al : Inferior alveolar nerve damage following removal of mandibular third molar teeth. A prospective study using panoramic radiography. Aust Dent J 42 : 149, 1997 https://doi.org/10.1111/j.1834-7819.1997.tb00111.x
  11. Rood JP, Shehab BA : The radiological prediction of inferior alveolar nerve injury during third molar surgery. Br J Oral Maxillofac Surg 28 : 20, 1990 https://doi.org/10.1016/0266-4356(90)90005-6
  12. Kipp DP, Goldstein BH, Weiss WW : Dysesthesia after mandibular third molar surgery: a retrospective study and analysis of 1,377 surgical procedures. J Am Dent Assoc 100 : 185, 1980 https://doi.org/10.14219/jada.archive.1980.0074
  13. Seward GR : Radiology in general dental practice: VII - Assessment of lower third molars. Br Dent J 115 : 45, 1963
  14. Stockdale CR : The relationship of the roots of mandibular third molars to the inferior dental canal. Oral Surg Oral Med Oral Pathol 12 : 1061, 1959 https://doi.org/10.1016/0030-4220(59)90314-7
  15. Rud J : Third molar surgery: relationship of root to mandibular canal and injuries to the inferior dental nerve. Tandlaegebladet 87 : 619, 1983
  16. Poyton HG : Oral Radiology, 1st ed. Baltimore, Williams and Wilkins co, 1982, p.166
  17. Howe GL, Poyton HG : Prevention of damage to the inferior dental nerve during the extraction of mandibular third molars. Br Dent J 109 : 109 353, 1960
  18. Noma H, Sasaki K : Disturbance and regeneration of the inferior alveolar nerves, 1st ed. Tokyo, Ishiyaku, 2001, p.87
  19. Tantanapornkul W, Okouchi K, Fujiwara Y et al : A comparative study of cone-beam computed tomography and conventional panoramic radiography in assessing the topographic relationship between the mandibular canal and impacted third molars. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103 : 253, 2007 https://doi.org/10.1016/j.tripleo.2006.06.060
  20. Better H, Abramovitz I, Shlomi B et al : The presurgical workup before third molar surgery: how much is enough? J Oral Maxillofac Surg 62 : 689, 2004 https://doi.org/10.1016/j.joms.2003.12.009
  21. Azaz B, Shteyer A, Piamenta M : Radiographic and clinical manifestations of the impacted mandibular third molar. Int J Oral Surg 5 : 153, 1976 https://doi.org/10.1016/S0300-9785(76)80037-3
  22. Tammisalo T, Happonen RP, Tammisalo EH : Stereographic assessment of mandibular canal in relation to the roots of impacted lower third molar using multiprojection narrow beam radiography. Int J Oral Maxillofac Surg 21 : 85, 1992 https://doi.org/10.1016/S0901-5027(05)80538-7
  23. Sedaghatfar M, August MA, Dodson TB : Panoramic radiographic findings as predictors of inferior alveolar nerve exposure following third molar extraction. J Oral Maxillofac Surg 63 : 3, 2005
  24. Seddon HJ, Medawar PB, Smith H : Rate of regeneration of peripheral nerves in man. J Physiol 102 : 191, 1943 https://doi.org/10.1113/jphysiol.1943.sp004027
  25. Lee JY, Lee JH, Kim CH : Assessment of inferior alveolar nerve damage using digital infrared thermography. J Kor Oral Maxillofac Surg 30 : 488, 2004
  26. Robinson PP, Loescher AR, Yates JM et al : Current management of damage to the inferior alveolar and lingual nerves as a result of removal of third molars. Br J Oral Maxillofac Surg 42 : 285, 2004
  27. Monaco G, Montevecchi M, Bonetti GA et al : Reliability of panoramic radiography in evaluating the topographic relationship between the mandibular canal and impacted third molars. J Am Dent Assoc 135 : 312, 2004 https://doi.org/10.14219/jada.archive.2004.0179
  28. Loescher AR, Robinson PP : The effect of surgical medicaments on peripheral nerve function. Br J Oral Maxillofac Surg 36 : 327, 1998 https://doi.org/10.1016/S0266-4356(98)90642-8
  29. Pogrel MA, Bryan J, Regezi J : Nerve damage associated with inferior alveolar nerve blocks. J Am Dent Assoc 126 : 1150, 1995 https://doi.org/10.14219/jada.archive.1995.0336