Question
下顎の親知らずを抜歯した後、知覚神経障害が起こる可能性があると聞きました。詳しく教えてください。
Answer
下顎智歯抜歯後には、舌神経で0.1～22%、下歯槽神経で0.26～8.4%の頻度で知覚障害が生じたという報告があります1)-9)。
予後については、下歯槽神経の96%、舌神経の87%の障害は、手術後4～8週間以内に回復し、その回復率は性別に関係なく、年齢と僅かに関連があることが報告されています10)。
また、下顎智歯抜歯後の下歯槽神経障害の大多数は6カ月以内に回復するという報告もあります11)。手術後6カ月を過ぎると回復率は非常に低くなりますが5)、1年以上経過した後に回復した症例の報告があります12)、13)。
1) Bataineh, A. B.: Sensory nerve impairment following mandibular third molar surgery. J. Oral Maxillofac. Surg., 59 :1012 – 1017, 2001
2) Brann, C. R. et al.: Factors influencing nerve damage during lower third molar surgery. Br. Dent. J., 186: 514,1999
3) Bruce, R. A, et al.: Age of patients and morbidity associated with mandibular third molar surgery. J.A.D.A., 101: 240,1980
4) Carmichael, F. A. and McGowan, D. A.: Incidence of nerve damage following third molar removal: A West of Scotland Oral Surgery Research Group study. Br. J. Oral Maxillofac. Surg., 30: 78 – 82,1992
5) Kipp, D. P. et al.: Dysesthesia after mandibular third molar surgery: A retrospective study and analysis of 1,377 surgical procedures. J.A.D.A., 100 :185 – 192,1980
6) Leung, Y. Y. and Cheung, L. K.: Risk factors of neurosensory deficits in lower third molar surgery A literature review of prospective studies. mnt. J. Oral Maxillofac. Surg., 40 :1,2011
7) Lopes, V. et al.: Third molar surgery: An audit of the indications for surgery, post – operative complaints and patient satisfaction. Br. J. Oral Maxillofac. Surg., 33: 33,1995
8) Mason, D. A.: Lingual nerve damage following lower third molar surgery. mt. J. Oral Maxillofac. Surg., 17: 290,1988
9) Rud, J.: The split – bone technic for removal of impacted mandibular third molars. J. Oral Surg., 28: 416,1970
10) Hillerup. S. and Stoltze, K.: Lingual nerve injury in third molar surgery. I. Obeservations on the recovery of sensation with spontaneous healing. Int. J. Oral Maxiltofac Surg., 36: 884 – 889, 2007
11) Queral – Godoy,E. et al. : Incidence and evolution of inferior alveolar nerve lesions following lower third molar extraction. OS.OM.OP.OR. Endod., 99: 259-264,2005
12) Van Sickels, J. E. et al.: Effects of age, amount of advancement, and genioplasty on neurosensory disturbance after a bilateral sagittal split osteotomy. J. Oral Maxillofac. Surg., 60: 1012 – 1017, 2002
13) Alling,C.C. III : Dysesthesia of the lingual and inferior alveolar nerves following third molar surgery. J. Oral Maxillofac. Surg., 44: 454-457,1986
※参考書籍
「ORAL MEDICINEの臨床」 飯塚 哲夫 著 株式会社ストマ
