下颌前牙种植并发口底血肿的预防  

Prevention of hematoma on the floor of the mouth during dental implant surgery in the anterior mandible

作　　者：黄佳诚[1] 吴夏怡[2] 陈丹莹 唐志英[2] 刘泉[2] HUANG Jiacheng;WU Xiayi;CHEN Danying;TANG Zhiying;LIU Quan(Department of Prosthodontics,Zhong⁃shan People′s Hospital,Zhongshan 528400,China;Zhujiang Newtown Dental Clinic,Hospital of Stomatology,Guanghua School of Stomatology,Sun Yat⁃sen University,Guangdong Provincial Key Laboratory of Stomatology,Guang⁃zhou 510627,China)

机构地区：[1]中山市人民医院口腔分院修复科,广东中山528400 [2]中山大学光华口腔医学院·附属口腔医院·珠江新城门诊,广东省口腔医学重点实验室,广东广州510627

出　　处：《口腔疾病防治》2020年第8期519-524,共6页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(NSFC 81901055);广东省自然科学基金博士启动项目(2017A030310207);广东省基础与应用基础研究基金联合基金青年项目(2019A1515110854)。

摘　　要：目的探讨下颌前牙种植并发口底血肿的原因及预防措施。方法对预防1例下前牙种植病例的口底血肿发生的处理及效果,并结合文献复习进行分析。结果该病例术前检查发现4个下颌舌侧管,其中有2个直径较大(1.4 mm和1.0 mm)且位于颏棘上方靠近牙槽嵴顶。术中对这两个较粗的穿支血管进行解剖并结扎,患者术后即刻与术后3 d复查时均无明显血肿。文献复习结果提示下颌舌侧骨板穿支血管的发生率为90%~100%。下颌舌侧血管分布变异程度高,紧邻下颌舌侧骨板,种植手术不慎损伤下颌舌侧骨板血管容易导致口底出血或血肿。结论熟悉口底血管解剖结构,下前牙种植术前行三维影像学检查,术中翻瓣检查下颌骨唇舌侧骨壁血管走行,避免损伤下前牙舌侧血管束,从而预防口底血肿发生。Objective To explore the cause and preventive measures of floor⁃of⁃mouth hematoma after dental im⁃plant placement.Methods The prevention of hematoma of the floor of the mouth in a case of lower anterior teeth im⁃plant placement was analyzed,and the literature was reviewed.Results Four mandibular vascular canals were found on the lingual side of the anterior mandible before dental surgery in the reported case.Two of them were quite thick(1.4 mm and 1.0 mm,respectively)and were located adjacent to the crest of the alveolar bone and superior to the mental spine.These two thick endosseous branches from the sublingual artery were dissected and ligated,and there was no obvious he⁃matoma in the patients immediately after the operation and at the postoperative 3 d review.The results of the literature re⁃view show that the incidence of endosseous branches from the lingual vascular canal of the mandible is 90%⁃100%.The distribution of the vessels on the lingual side of the mandible is highly variable and adjacent to the lingual cortical plate.Accidental injury of the lingual cortical plate during implant surgery would probably lead to bleeding or hematoma on the floor of the mouth.Conclusion Mastering the anatomy of blood vessels on the floor of the mouth,elaboratively examin⁃ing preoperative three⁃dimensional radiographic imaging,and cautiously exploring the lower jaw bone morphology after flap elevation are preventive measures to avoid damage to the arterial supply on the lingual side of the anterior lower jaw and to prevent complications of hematoma in the floor of the mouth.

关 键 词：口腔种植外科 下颌舌侧血管 舌侧正中孔 舌侧副孔 血管吻合支 并发症 口底血肿 预防 

分 类 号：R782[医药卫生—口腔医学]