硬腭前份神经支配增龄性变化的临床研究

doi:10.7518/hxkq.2021.02.007

华西口腔医学杂志 ›› 2021, Vol. 39 ›› Issue (2): 170-174.doi: 10.7518/hxkq.2021.02.007

硬腭前份神经支配增龄性变化的临床研究

李秀芬¹(), 刘畅², 刘济远², 曲涛², 潘韦霖², 潘剑², 华成舸²()

^1.浙江省立同德医院口腔科，杭州 310012
^2.口腔疾病研究国家重点实验室国家口腔疾病临床医学研究中心四川大学华西口腔医院口腔颌面外科，成都 610041

收稿日期:2020-06-08 修回日期:2021-01-12 出版日期:2021-04-01 发布日期:2021-04-09
通讯作者: 华成舸 E-mail:843189113@qq.com;huacg@163.com
作者简介:李秀芬，硕士，E-mail：843189113@qq.com
基金资助:
四川省重点研发项目(2018SZ0181)

Clinical study of age-related sensory innervation of the anterior hard palate

Li Xiufen¹(), Liu Chang², Liu Jiyuan², Qu Tao², Pan Weilin², Pan Jian², Hua Chengge²()

^1.Dept. of Stomatology, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China
^2.State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2020-06-08 Revised:2021-01-12 Online:2021-04-01 Published:2021-04-09
Contact: Hua Chengge E-mail:843189113@qq.com;huacg@163.com
Supported by:
Key Research and Development Foundation of Sichuan Province(2018SZ0181)

摘要/Abstract

摘要： 目的

通过对替牙列期和恒牙列期患者硬腭前份麻醉效果的观察，研究硬腭前份的神经支配以及与个体发育和年龄的关系，为临床前腭部局部麻醉方式的选择以及颌面部神经发育研究提供参考。

方法

182例替牙列期患者随机分为鼻腭组和腭大组，分别采用鼻腭神经阻滞麻醉和腭大神经阻滞麻醉。219例恒牙列期患者分为青少年组（13~18岁）和成人组（19岁以上），均行腭大神经阻滞麻醉。以Von Frey测痛仪检测麻醉前后硬腭前份黏膜痛觉变化来评价麻醉效果。

结果

替牙列期患者中，除切牙乳头区外，双侧腭大神经麻醉效果优于鼻腭神经麻醉（P<0.05）。青少年组与成人组患者腭大神经阻滞麻醉效果差异无统计学意义（P>0.05），而替牙列期患者腭大神经麻醉效果显著优于恒牙列期患者（13岁以上者）（P<0.05）。

结论

替牙列期患者硬腭前份可能主要由腭大神经支配，但随着上颌骨的发育和牙列替换，鼻腭神经逐渐发挥作用，并在硬腭前份感觉神经支配中起主要作用，这提示支配硬腭前部的感觉神经随着上颌骨的发育存在二次发育的可能。

关键词: 鼻腭神经, 腭大神经, 神经支配, 局部麻醉, 神经发育

Abstract: Objective

The present study aimed to explore the innervation of the anterior hard palatine and its relationship with individual development stage. Specifically, the effects of anesthesia on patients of different ages were observed, and neurodevelopment in the maxillofacial region was invesitgated. References that are helpful in selecting local anesthesia were provided.

Methods

A total of 182 patients with mixed dentition were randomly divided into the nasopalatine nerve block and greater palatine nerve block groups. Then, 219 patients with permanent dentition were divided into an adolescent group (13-18 years old) and adult group (over 19 years old), all of whom underwent bilateral greater palatine nerve block. Palatal mucosal pain sensation was tested pre- and post-anesthesia with Von Frey hairs.

Results

Among the children with mixed dentition, bilateral greater palatine nerve block tended to result in better anesthetic effects than nasopalatine nerve block (P<0.05), except in the incisive papilla. No difference in anesthetic effect was observed between adolescents and adults (P>0.05). The bilateral greater palatine nerve block was more effective in inducing an anesthestic effect in the anterior hard palatine in mixed dentition than in permanent dentition (over 13 years old; P<0.05).

Conclusion

The sensation of the anterior hard palatine seems mainly dominated by the greater palatine nerve until mixed dentition and gradually shifted to the nasopalatine nerve in conjunction with maxillary development and tooth replacement. Hence, the innervation of the anterior hard palatine induce a secondary development during the development of the maxilla.

Key words: nasopalatine nerve, greater palatine nerve, innervation, local anesthesia, nerve development

中图分类号:

R 782.05⁺4

李秀芬, 刘畅, 刘济远, 曲涛, 潘韦霖, 潘剑, 华成舸. 硬腭前份神经支配增龄性变化的临床研究[J]. 华西口腔医学杂志, 2021, 39(2): 170-174.

Li Xiufen, Liu Chang, Liu Jiyuan, Qu Tao, Pan Weilin, Pan Jian, Hua Chengge. Clinical study of age-related sensory innervation of the anterior hard palate[J]. West China Journal of Stomatology, 2021, 39(2): 170-174.

图/表 4

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表 1

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表 3

参考文献 13

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检测位点	鼻腭组（n=91）		腭大组（n=91）		χ²值	P值
检测位点	有效	无效	有效	无效	χ²值	P值
13和23	18	164	165	17	237.469	0.000*
12和22	38	144	142	40	118.871	0.000*
11和21	63	119	115	67	29.729	0.000*
IP	57	34	35	56	10.639	0.001*

检测位点	腭大组（n=91）		青少年组（n=100）		成人组（n=119）		χ²值	P值
检测位点	有效	无效	有效	无效	有效	无效	χ²值	P值
13和23	165	17	102	98	103	135	105.459	0.000*
12和22	142	40	71	129	74	164	105.185	0.000*
11和21	115	67	46	154	43	195	108.217	0.000*
IP	35	56	8	92	4	115	55.278	0.000*

组间比较		检测位点
组间比较		13和23	12和22	11和21	IP
OR	A2和A1	88.43（44.04，177.58）*	13.45（8.15，22.20）*	3.24（2.11，4.98）*	0.37（0.20，0.68）*
	B和A2	0.11（0.06，0.19）*	0.16（0.10，0.24）*	0.17（0.11，0.27）*	0.14（0.06，0.32）*
	C和A2	0.08（0.04，0.14）*	0.13（0.08，0.20）*	0.13（0.08，0.20）*	0.06（0.02，0.16）*
	C和B	0.73（0.50，1.07）	0.82 （0.55，1.22）	0.74（0.46，1.18）	0.40（0.12，1.37）
RR	A2和A1	9.17（5.90，14.25）*	3.74（2.79，5.01）*	1.83（1.45，2.29）*	0.61（0.45，0.83）*
	B和A2	0.56（0.49，0.65）*	0.46（0.37，0.56）*	0.36（0.28，0.48）*	0.21（0.10，0.42）*
	C和A2	0.48（0.41，0.56）*	0.40（0.32，0.49）*	0.29（0.21，0.38）*	0.09（0.03，0.24）*
	C和B	0.85（0.70，1.04）	0.88（0.67，1.14）	0.79（0.54，1.14）	0.42（0.13，1.35）

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硬腭前份神经支配增龄性变化的临床研究

Clinical study of age-related sensory innervation of the anterior hard palate

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