下颌骨囊性病变开窗减压术前术后下颌神经管的位移特征分析
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摘要
目的测量分析下颌骨囊性病变术前术后下颌神经管的位移规律。方法回顾性分析2014-01～2017-12期间在我院住院治疗的30例下颌骨囊性病变开窗减压治疗患者的临床资料,在开窗减压前及开窗减压后二次手术前的CBCT上测量下颌神经管的位置,对比分析开窗减压前患侧下颌神经管的位移方向与下颌骨横截面几何中心位置变化之间的关系;对比分析囊性病变区开窗减压前后下颌神经管的位移变化规律。结果下颌骨大型囊性病变可引起下颌神经管显著移位,平均移位距离(7. 48±2. 49) mm。移位方向以下颌骨下缘方向为主,内外方向上的移位与颌骨膨隆方向有关,颌骨向外(颊侧)膨隆者下颌神经管多倾向于向内(舌侧)移位,颌骨向内(舌侧)膨隆者下颌神经管多向外(颊侧)移位。开窗减压术后下颌神经管有一定的向"原始"位置恢复的趋势,与"原始"位置的平均距离约为(6. 07±2. 10) mm,与术前相比差异有统计学意义(P<0. 05),但恢复的距离有限,平均缩短距离为(1. 55±1. 48) mm,缩短距离约占总移位距离的20. 72%。结论下颌骨囊性病变可引起下颌神经管的显著移位,移位方向以下颌骨下缘方向为主,内外方向上倾向于与颌骨膨隆的方向相反。开窗减压术后下颌神经管有复位趋势,但复位距离十分有限。
Objective To analyze the displacement regularity of mandibular nerve canal before and after decompression for mandibular cystic lesions. Methods The clinical data of 30 patients with mandibular cystic lesions in our hospital from January 2014 to December 2017 were retrospectively analyzed. The location of mandibular canal was measured on CBCT before and after decompression. The displacement direction of mandibular canal on the affected side before decompression was compared with the change of the centroid of mandibular cross section. The displacement of mandibular nerve canal before and after decompression in cystic lesions was analyzed.Results Large cystic lesions of the mandible caused significant displacement of the mandibular nerve canal,with an average displacement distance of( 7. 48 ±2. 49) mm. The direction of displacement was mainly to the lower margin of the jaw. The direction of internal and external displacement was related to the direction of jaw swelling. The mandibular nerve canal tended to move inward( lingual displacement) in the outward( buccal) swelling of the jaw,and outward( buccal) in the inward( lingual) swelling of the jaw. After decompression,the mandibular nerve canal tended to relocate to its original position. The average distance from the original position was about( 6. 07 ±2. 10) mm,which was significantly different from that before operation( P < 0. 05). However,the distance of restoration was limited. The average distance of restoration was( 1. 55 ±1. 48) mm,accounting for 20. 72% of the total displacement distance.Conclusion Cystic lesions of the mandible may cause significant displacement of the mandibular nerve canal. The direction of displacement is mainly to the lower margin of the mandible,while the direction of internal and external tends to be opposite to the direction of jaw swelling. After decompression,the mandibular nerve canal tends to relocate to its original position,but the distance of restoration is very limited.
Objective To analyze the displacement regularity of mandibular nerve canal before and after decompression for mandibular cystic lesions. Methods The clinical data of 30 patients with mandibular cystic lesions in our hospital from January 2014 to December 2017 were retrospectively analyzed. The location of mandibular canal was measured on CBCT before and after decompression. The displacement direction of mandibular canal on the affected side before decompression was compared with the change of the centroid of mandibular cross section. The displacement of mandibular nerve canal before and after decompression in cystic lesions was analyzed.Results Large cystic lesions of the mandible caused significant displacement of the mandibular nerve canal,with an average displacement distance of( 7. 48 ±2. 49) mm. The direction of displacement was mainly to the lower margin of the jaw. The direction of internal and external displacement was related to the direction of jaw swelling. The mandibular nerve canal tended to move inward( lingual displacement) in the outward( buccal) swelling of the jaw,and outward( buccal) in the inward( lingual) swelling of the jaw. After decompression,the mandibular nerve canal tended to relocate to its original position. The average distance from the original position was about( 6. 07 ±2. 10) mm,which was significantly different from that before operation( P < 0. 05). However,the distance of restoration was limited. The average distance of restoration was( 1. 55 ±1. 48) mm,accounting for 20. 72% of the total displacement distance.Conclusion Cystic lesions of the mandible may cause significant displacement of the mandibular nerve canal. The direction of displacement is mainly to the lower margin of the mandible,while the direction of internal and external tends to be opposite to the direction of jaw swelling. After decompression,the mandibular nerve canal tends to relocate to its original position,but the distance of restoration is very limited.
引文
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[4]Kolokythas A,Fernandes RP,Pazoki A,et al.Odontogenic keratocyst:to decompress or not to decompress?A comparative study of decompression and enucleation versus resection/peripheral ostectomy[J].J Oral Maxillofac Surg,2007,65(4):640-644.
[5]Anavi Y,Gal G,Miron H,et al.Decompression of odontogenic cystic lesions:clinical long-term study of 73 cases[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2011,112(2):164-169.
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[8]陈欣,卢明星,唐恩溢,等.开窗减压术治疗颌骨大型囊性病变的临床应用[J].实用口腔医学杂志,2015,31(1):73-76.
[9]李文超,阮宁,徐江.保留第二磨牙的开窗减压术治疗单囊型成釉细胞瘤[J].国际口腔医学杂志,2017,44(2):157-160.
[10]车银富,杜洪亮,陶峰,等.开窗减压术在不同颌骨囊性病变中的疗效观察[J].实用口腔医学杂志,2018,34(5):636-639.
[11]牛刚,林李嵩,吴烨,等.颌骨囊性病变开窗减压引流术后二次手术方法的研究与探讨[J].实用口腔医学杂志,2018,34(5):640-643.
[12]Asutay F,Atalay Y,Turamanlar O,et al.Three-dimensional volumetric assessment of the effect of decompression on large mandibular odontogenic cystic lesions[J].J Oral Maxillofac Surg,2016,74(6):1159-1166.
[13]Covello P,Buchbinder D.Recent trends in the treatment of benign odontogenic tumors[J].Curr Opin Otolaryngol Head Neck Surg,2016,24(4):343-351.
[14]Cakarer S,Isler SC,Keskin B,et al.Treatment for the large aggressive benign lesions of the jaws[J].J Maxillofac Oral Surg,2018,17(3):372-378.
[15]Allon DM,Allon I,Anavi Y,et al.Decompression as a treatment of odontogenic cystic lesions in children[J].J Oral Maxillofac Surg,2015,73(4):649-654.
[16]Bodner L,Woldenberg Y,Bar-Ziv J.Radiographic features of large cystic lesions of the jaws in children[J].Pediatr Radiol,2003,33(1):3-6.
[17]Bodner L,Bar-Ziv J.Characteristics of bone formation following marsupialization of jaw cysts[J].Dentomaxillofac Radiol,1998,27(3):166-171.
[18]Jeong HG,Hwang JJ,Lee SH,et al.Effect of decompression for patients with various jaw cysts based on a three-dimensional computed tomography analysis[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2017,123(4):445-452.
[2]Sumer M,Bas B,Yildiz L.Inferior alveolar nerve paresthesia caused by a dentigerous cyst associated with three teeth[J].Med Oral Patol Oral Cir Bucal,2007,12(5):e388-390.
[3]Giuliani M,Grossi GB,Lajolo C,et al.Conservative management of a large odontogenic keratocyst:report of a case and review of the literature[J].J Oral Maxillofac Surg,2006,64(2):308-316.
[4]Kolokythas A,Fernandes RP,Pazoki A,et al.Odontogenic keratocyst:to decompress or not to decompress?A comparative study of decompression and enucleation versus resection/peripheral ostectomy[J].J Oral Maxillofac Surg,2007,65(4):640-644.
[5]Anavi Y,Gal G,Miron H,et al.Decompression of odontogenic cystic lesions:clinical long-term study of 73 cases[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2011,112(2):164-169.
[6]Castro-Nunez J.Decompression of odontogenic cystic lesions:past,present,and future[J].J Oral Maxillofac Surg,2016,74(1):e101-109.
[7]牛刚,林李嵩,吴烨,等.开窗减压术治疗颌骨巨大囊性病变的临床研究[J].口腔医学研究,2011,27(2):153-154.
[8]陈欣,卢明星,唐恩溢,等.开窗减压术治疗颌骨大型囊性病变的临床应用[J].实用口腔医学杂志,2015,31(1):73-76.
[9]李文超,阮宁,徐江.保留第二磨牙的开窗减压术治疗单囊型成釉细胞瘤[J].国际口腔医学杂志,2017,44(2):157-160.
[10]车银富,杜洪亮,陶峰,等.开窗减压术在不同颌骨囊性病变中的疗效观察[J].实用口腔医学杂志,2018,34(5):636-639.
[11]牛刚,林李嵩,吴烨,等.颌骨囊性病变开窗减压引流术后二次手术方法的研究与探讨[J].实用口腔医学杂志,2018,34(5):640-643.
[12]Asutay F,Atalay Y,Turamanlar O,et al.Three-dimensional volumetric assessment of the effect of decompression on large mandibular odontogenic cystic lesions[J].J Oral Maxillofac Surg,2016,74(6):1159-1166.
[13]Covello P,Buchbinder D.Recent trends in the treatment of benign odontogenic tumors[J].Curr Opin Otolaryngol Head Neck Surg,2016,24(4):343-351.
[14]Cakarer S,Isler SC,Keskin B,et al.Treatment for the large aggressive benign lesions of the jaws[J].J Maxillofac Oral Surg,2018,17(3):372-378.
[15]Allon DM,Allon I,Anavi Y,et al.Decompression as a treatment of odontogenic cystic lesions in children[J].J Oral Maxillofac Surg,2015,73(4):649-654.
[16]Bodner L,Woldenberg Y,Bar-Ziv J.Radiographic features of large cystic lesions of the jaws in children[J].Pediatr Radiol,2003,33(1):3-6.
[17]Bodner L,Bar-Ziv J.Characteristics of bone formation following marsupialization of jaw cysts[J].Dentomaxillofac Radiol,1998,27(3):166-171.
[18]Jeong HG,Hwang JJ,Lee SH,et al.Effect of decompression for patients with various jaw cysts based on a three-dimensional computed tomography analysis[J].Oral Surg Oral Med Oral Pathol Oral Radiol,2017,123(4):445-452.