下颌前牙区种植术后血管神经损伤防治策略  

Strategies for prevention and treatment of vascular and nerve injuries in mandibular anterior implant surgery

作　　者：马海鹰 娄依婷 孙哲渊 王柏翔 俞梦飞[1] 王慧明[1] MA Haiying;LOU Yiting;SUN Zheyuan;WANG Baixiang;YU Mengfei;WANG Huiming(The Stomatology Hospital,Zhejiang University School of Medicine,Zhejiang University School of Stomatology,Zhejiang Provincial Clinical Research Center for Oral Diseases,Zhejiang Provincial Key Laboratory of Oral Biomedical Research,Zhejiang University Cancer Center,Zhejiang Provincial Engineering Research Center of Oral Biomaterials and Devices,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属口腔医院,浙江大学口腔医学院,浙江省口腔疾病临床医学研究中心,浙江省口腔生物医学研究重点实验室,浙江大学癌症研究院口腔生物材料与器械浙江省工程研究中心,浙江杭州310006

出　　处：《浙江大学学报（医学版）》2024年第5期550-560,共11页Journal of Zhejiang University(Medical Sciences)

基　　金：国家自然科学基金(82020108011);浙江省基础公益研究计划(LY22H140002);浙江大学医学院附属口腔医院探索与研发项目(RD2022JCEL20)。

摘　　要：下颌前牙区种植术中可能损伤下颌切牙管、舌孔、口底血管等重要解剖结构,从而导致患者口底血肿、窒息、疼痛、感觉异常等症状发生,严重者可危及生命。下颌前牙区相对不足的颌骨空间和血管神经的解剖变异是种植术中血管神经损伤高风险的原因。一旦血管损伤,应当进行气道控制和止血;神经损伤则应采取移除种植体以及早期药物治疗等措施。种植医生应熟悉下颌前牙区的解剖结构,术前行锥形束计算机断层扫描并进行合理设计,术中借助数字技术实现精准植入种植体,以避免下颌前牙区种植术中血管神经损伤。本文通过文献回顾下颌前牙区的解剖结构及其变异,探讨下颌前牙区种植术中血管神经损伤的防治策略,为临床提供参考。Important anatomical structures such as mandibular incisive canal,tongue foramen,and mouth floor vessels may be damaged during implant surgery in the mandibular anterior region,which may lead to mouth floor hematoma,asphyxia,pain,paresthesia and other symptoms.In severe cases,this can be life-threatening.The insufficient alveolar bone space and the anatomical variation of blood vessels and nerves in the mandibular anterior region increase the risk of blood vessel and nerve injury during implant surgery.In case of vascular injury,airway control and hemostasis should be performed,and in case of nerve injury,implant removal and early medical treatment should be performed.To avoid vascular and nerve injury during implant surgery in the mandibular anterior region,it is necessary to be familiar with the anatomical structure,take cone-beam computed tomography,design properly before surgery,and use digital technology during surgery to achieve accurate implant placement.This article summarizes the anatomical structure of the mandibular anterior region,discusses the prevention strategies of vascular and nerve injuries in this region,and discusses the treatment methods after the occurrence of vascular and nerve injuries,to provide clinical reference.

关 键 词：种植牙 下颌前牙区 应用解剖学 出血 神经损伤 数字技术 综述 

分 类 号：R78[医药卫生—口腔医学]