CBCT观察下颌骨双侧双副颏孔1例

2019-11-15 宁晔 唐丽宇 龚飞飞 临床口腔医学杂志

下颌骨的颏孔通常含有两个,左右各一,孔内有颏神经和血管通过。临床上涉及到下颌骨颏孔区域的常见手术包括颏部取骨术、颏成形术和前牙区种植体植入术等。在该区域普遍认为进行手术相对安全,不会引起严重的并发症。但也有研究发现术后该区域有不明原因的出血、术后感觉异常及种植体失败等并发症,研究认为可能与术中损伤颏神经和切牙神经有关。现报道CBCT观察下颌骨双侧双副颏孔1例。

下颌骨的颏孔通常含有两个,左右各一,孔内有颏神经和血管通过。临床上涉及到下颌骨颏孔区域的常见手术包括颏部取骨术、颏成形术和前牙区种植体植入术等。在该区域普遍认为进行手术相对安全,不会引起严重的并发症。但也有研究发现术后该区域有不明原因的出血、术后感觉异常及种植体失败等并发症,研究认为可能与术中损伤颏神经和切牙神经有关。现报道CBCT观察下颌骨双侧双副颏孔1例。
 
1.病例报告
 
患者,男,54岁,主诉:右下后牙缺失1年。1年前右下后牙区46、47牙位因重度牙周炎出现Ⅲ度松动,在当地口腔诊所给予拔除并行可摘局部义齿修复。患者否认全身系统性疾病,否认药物过敏史。口腔检查示可摘局部义齿松动,牙龈黏膜红肿,45远中邻面龋坏,未探及穿髓点,探诊疼痛不明显,冷热刺激痛,叩诊无明显不适,牙齿无松动。
 
CBCT示46、47、48缺失,45远中邻面透射影未到髓腔,根尖周未见明显异常。45、46之间根方出现1个颏孔、2个副颏孔呈倒三角形排列;下颌骨左侧也有类似解剖结构(图1)。诊断:下颌牙列缺损(Kennedy第Ⅱ类);45远中邻面浅龋。



图1 CBCT观察图片。A:右侧位;B:正中位;C:左侧位;D:颏神经出颏孔三维模拟
 
2.讨论
 
早在上个世纪80年代就有关于颏孔区的神经血管分布研究,即下颌管在第一或第二前磨牙下方分为颏管和切牙神经管,颏管向后上方走行开口于颏孔,切牙神经管继续向前并于正中联合的外侧上行。近年来,随着临床医师对颏孔区域的手术重视,尤其是口腔种植术的广泛开展,避免损伤下牙槽神经血管束显得尤为重要。
 
下牙槽神经血管束出颏孔前的走行形态可分为两种,即SolarⅠ型和SolarⅡ型。SolarⅠ型:下牙槽神经血管束在出颏孔前形成向外上的袢,颏孔到袢的最前点距离约(4.01±1.20)mm,并将下颌管颏孔到袢的管道距离称为颏管。SolarⅡ型:下颌管中的下牙槽神经血管束没有向前弯曲的袢,其颏神经直接上升出颏孔。下牙槽神经出颏孔前分为2个分支:颏神经和切牙神经。
 
颏神经经颏管直接出颏孔,切牙神经则继续前行,走行于极细的切牙神经管内,在正中联合的外侧上缘发出分支形成神经丛。另外,有研究发现下颌管有96.7%弯曲向后上形成颏管再开口于颏孔,颏孔前缘对应下颌管前端的水平距离为(3.54±0.70)mm,颏孔下缘至下颌管上缘的垂直距离为(3.21±0.90)mm。颏孔的位置可随年龄的增长而逐渐上移和后移。儿童在第一恒磨牙萌出以前,颏孔位于下颌第一乳磨牙的下方,距下颌骨下缘较近。年老或患牙缺失后,牙槽骨萎缩吸收,故颏孔及下颌管相对上移甚至接近下颌骨上缘。
 
原始出处:

宁晔,唐丽宇,龚飞飞.CBCT观察下颌骨双侧双副颏孔1例[J].临床口腔医学杂志,2018(12):705.

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    2020-07-03 xlysu
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    2019-11-17 智慧医人
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    2019-11-17 珙桐
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