外科的親知らず抜歯後の感覚障害の発生率、危険因子および経過観察。1,106例の研究

[Incidence, risk factors and follow-up of sensation disorders after surgical wisdom tooth removal. Study of 1,106 cases].

抄録

臼歯部手術後の下歯槽と舌神経の知覚障害のリスクを明らかにするための研究が行われた。687人の患者に合計1103本の下顎智歯と3本の下顎第二大臼歯の衝撃が除去され、術前の知覚が変化していない患者ばかりであった。各症例の臨床的，放射線学的，および外科的要因を記録した．術後の唇と舌の知覚障害は，神経学的検査によって評価された．経過観察は最長で35週間行った．下歯槽神経の知覚異常は3.57％の発生率であった。舌神経は2.1％の患者に損傷した。最初に報告された感覚の変化のほとんどは、フォローアップ期間内に消失した。下歯槽神経の知覚異常は0.91％に，舌神経の知覚異常は0.37％に持続した．しかし、長期化した障害の程度は一般に軽微であった。記録された因子が知覚異常の発生率に及ぼす影響を分析した．下歯槽神経については，高齢者，歯根が完全に発達した歯，深い埋伏歯，歯根と下歯槽管のX線的関係，難しい手術，術中の神経露出が有意に影響することが明らかになった．また，術者と麻酔は舌側感覚障害に大きな影響を与えた．

A study was carried out to determine the risk of dysesthesia of the inferior alveolar and of the lingual nerve after molar surgery. A total of 1103 impacted lower wisdom teeth and 3 impacted lower second molars were removed in 687 patients, all of whom with unaltered sensibility preoperatively. Clinical, radiological, and surgical factors of each case were recorded. Postoperative disturbances in the sensibility of the lip and tongue were evaluated by neurological examination. Follow-up was carried out for a maximum of 35 weeks. Dysesthesia of the inferior alveolar nerve occurred with an incidence of 3.57%. The lingual nerve was injured in 2.1% of patients. Most of the initially reported alterations in sensation resolved within the follow-up period. Dysesthesia of the inferior alveolar nerve persisted in 0.91%, and of the lingual nerve in 0.37%. However, the extent of the prolonged impairment was slight in general. The effect of the documented factors on the incidence of dysesthesia was analyzed. For the inferior alveolar nerve, analysis revealed significant effects in older patients, for completely developed roots, for deeply impacted teeth, in the radiological relationship of the roots and the inferior alveolar canal, for difficult surgery, and for intraoperative exposure of the nerve. The surgeon and the anesthesia had a significant influence on lingual dysesthesia.