歯内療法における水酸化カルシウムの滲出による下歯槽神経の偶発的損傷：症例報告

Accidental injury of the inferior alveolar nerve due to the extrusion of calcium hydroxide in endodontic treatment: a case report.

抄録

歯内療法の臨床では，根尖部より先にX線不透過性の充填物が見つかることが多い．その際，水酸化カルシウムの流出により下歯槽神経を損傷し，知覚異常や持続的な炎症反応が生じることがある．本症例は，水酸化カルシウムの流出と外科的手術を含む治療法について報告する．症例は48歳女性で，歯内療法中に左下顎の下歯槽管にCalcipex IIが滲出した．左下顎第一大臼歯の歯内療法終了後，全身麻酔下で外科的治療を行った．皮質骨骨切り，デブライドマン後，神経腫切除，神経切開を行い，予後を観察した．しかし，20ヶ月後の手術後も知覚神経の改善は認められなかった．本症例では，下歯槽管の損傷や薬液の流出に注意が必要であった．また，水酸化カルシウムの注射は，神経を傷つけないように注意しなければならない．下顎骨後方臼歯部では，Lentulo spiralなどの代替デリバリー法が提案された．

During clinical endodontic treatment, we often find radiopaque filling material beyond the root apex. Accidental extrusion of calcium hydroxide could cause the injury of inferior alveolar nerve, such as paresthesia or continuous inflammatory response. This case report presents the extrusion of calcium hydroxide and treatment procedures including surgical intervention. A 48 yr old female patient experienced Calcipex II extrusion in to the inferior alveolar canal on left mandibular area during endodontic treatment. After completion of endodontic treatment on left mandibular first molar, surgical intervention was planned under general anesthesia. After cortical bone osteotomy and debridement, neuroma resection and neurorrhaphy was performed, and prognosis was observed. But no improvement in sensory nerve was seen following surgical intervention after 20 mon. A clinician should be aware of extrusion of intracanal medicaments and the possibility of damage on inferior alveolar canal. Injectable type of calcium hydroxide should be applied with care for preventing nerve injury. The alternative delivery method such as lentulo spiral was suggested on the posterior mandibular molar.