拔牙术中牙根意外进入下颌管的处理

doi:10.7518/hxkq.2025.2025298

华西口腔医学杂志 ›› 2025, Vol. 43 ›› Issue (6): 789-796.doi: 10.7518/hxkq.2025.2025298

• 特约述评 • 上一篇

拔牙术中牙根意外进入下颌管的处理

苏莉雯(), 赵吉宏()

口颌系统重建与再生全国重点实验室，口腔生物医学教育部重点实验室，口腔医学湖北省重点实验室，武汉大学口腔医（学）院，武汉 430079

收稿日期:2025-07-20 修回日期:2025-10-09 出版日期:2025-12-01 发布日期:2025-11-27
通讯作者: 赵吉宏 E-mail:1500974285@qq.com;jhzhao988@163.com
作者简介:苏莉雯，主治医师，硕士，E-mail：1500974285@qq.com|赵吉宏，武汉大学口腔医院口腔外科主任医师、牙槽外科首席专家、医学伦理委员会主任，湖北省政府专项津贴专家。中华口腔医学会牙及牙槽外科专业委员会主任委员、口腔美学专业委员会常务委员、口腔颌面外科专业委员会常务委员；中国整形美容学会口腔整形美容分会副会长；湖北省口腔医学会常务理事、牙槽外科及镇静镇痛联合专业委员会前任主任委员、口腔美学专业委员会前任主任委员；湖北省药物和器械评价学会常务理事；武汉市口腔颌面外科专业委员会前任主任委员。

Management of accidental tooth root displacement into the mandibular canal during tooth extraction

Su Liwen(), Zhao Jihong()

State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China

Received:2025-07-20 Revised:2025-10-09 Online:2025-12-01 Published:2025-11-27
Contact: Zhao Jihong E-mail:1500974285@qq.com;jhzhao988@163.com

摘要/Abstract

摘要：

牙根意外进入下颌管是口腔外科拔牙术中的严重并发症之一，常直接影响下牙槽神经血管束结构与功能的完整性。本文围绕下颌管、下牙槽神经血管束、相关牙根的解剖学特征，分析牙根意外进入下颌管的高危因素及易发部位，阐述了术中牙根意外进入下颌管的临床表现与影像学特征、处理原则、手术方法及技巧、下牙槽神经损伤治疗及预后评估等。以期借此为临床医生面对牙根意外进入下颌管时提供参考，并提高手术成功率、减少手术并发症。

关键词: 下颌管, 牙根移位, 下牙槽神经, 并发症, 手术

Abstract:

The accidental displacement of tooth roots into the mandibular canal is a serious complication during tooth extractions in oral and maxillofacial surgery, often resulting in direct damage to the structural and functional integrity of the inferior alveolar neurovascular bundle (IANB). This article reviews the anatomical features of the mandibular canal, the IANB, and adjacent tooth roots; identifies high-risk factors and anatomically vulnerable sites for root displacement; and outlines the clinical manifestations and radiographic characteristics of intraoperative root intrusion into the mandibular canal. Furthermore, management principles, surgical approaches and techniques, inferior alveolar nerve injury treatment, and prognostic considerations are discussed. The aim of this review is to provide a comprehensive clinical reference for improving surgical outcomes, and reducing postoperative complications.

Key words: mandibular canal, root displacement, inferior alveolar nerve, complication, surgery

中图分类号:

R782.1

苏莉雯, 赵吉宏. 拔牙术中牙根意外进入下颌管的处理[J]. 华西口腔医学杂志, 2025, 43(6): 789-796.

Su Liwen, Zhao Jihong. Management of accidental tooth root displacement into the mandibular canal during tooth extraction[J]. West China Journal of Stomatology, 2025, 43(6): 789-796.

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参考文献 29

[1]	Mohanty R, Rout P, Singh V. Preoperative anatomic evaluation of the relationship between inferior alveolar nerve canal and impacted mandibular third molar in a population of Bhubaneswar, Odisha, using CBCT: a hospital-based study[J]. J Maxillofac Oral Surg, 2020, 19(2): 257-262.
[2]	Kang F, Sah MK, Fei G. Determining the risk relationship associated with inferior alveolar nerve injury following removal of mandibular third molar teeth: a systematic review[J]. J Stomatol Oral Maxillofac Surg, 2020, 121(1): 63-69.
[3]	Leung YY. Management and prevention of third molar surgery-related trigeminal nerve injury: time for a rethink[J]. J Korean Assoc Oral Maxillofac Surg, 2019, 45(5): 233-240.
[4]	Kilic C, Kamburoğlu K, Ozen T, et al. The position of the mandibu lar canal and histologic feature of the inferior alveolar nerve[J]. Clin Anat, 2010, 23(1): 34-42.
[5]	Iwanaga J, Anand MK, Jain MN, et al. Microsurgical anatomy of the superior wall of the mandibular canal and surrounding structures: suggestion for new classifications for dental implantology[J]. Clin Anat, 2020, 33(2): 223-231.
[6]	Matani JD, Kheur MG, Kheur SM, et al. The anatomic inter relationship of the neurovascular structures within the inferior alveolar canal: a cadaveric and histological study[J]. J Maxillofac Oral Surg, 2014, 13(4): 499-502.
[7]	Gu L, Zhu C, Chen K, et al. Anatomic study of the position of the mandibular canal and corresponding mandibular third molar on cone-beam computed tomography images[J]. Surg Radiol Anat, 2018, 40(6): 609-614.
[8]	Oliveira ACS, Candeiro GTM, Pacheco da Costa FFN, et al. Distance and bone density between the root apex and the mandibular canal: a cone-beam study of 9 202 roots from a Brazilian population[J]. J Endod, 2019, 45(5): 538-542.e2.
[9]	Chen Y, Liu J, Pei J, et al. The risk factors that can increase possibility of mandibular canal wall damage in adult: a cone-beam computed tomography (CBCT) study in a Chinese population[J]. Med Sci Monit, 2018, 24: 26-36.
[10]	Sah KM, 张雪明, 王佐林.下颌埋伏第三磨牙拔除中导致断根风险的相关因素分析[J]. 口腔颌面外科杂志, 2016, 26(1): 25-30.
	Sah KM, Zhang XM, Wang ZL. The risk factors associated with root fracture during the removal of impacted mandibular third molar[J]. J Oral Maxillofac Surg, 2016, 26(1): 25-30.
[11]	任建岗, 赵吉宏. 第三磨牙全周期健康管理刍议[J]. 中华口腔医学杂志, 2024, 59(8): 753-758.
	Ren JG, Zhao JH. Preliminary discussion on the whole life-cycle management of third molars health[J]. Chin J Stomatol, 2024, 59(8): 753-758.
[12]	Cai Y, Sun R, Zhao JH. Flapless boning to increase space by piezosurgery: a novel mini-invasive strategy for teeth extraction. A retrospective study[J]. Medicine (Baltimore), 2018, 97(27): e11398.
[13]	孙睿, 蔡育, 赵吉宏. 超声骨刀在口腔颌面外科的临床应用进展[J]. 中国口腔颌面外科杂志, 2018, 16(1): 89-92.
	Sun R, Cai Y, Zhao JH. Clinical progress of piezosurgery in oral and maxillofacial surgery[J]. China J Oral Maxillofac Surg, 2018, 16(1): 89-92.
[14]	王竟楠, 赵吉宏. 从微创到功能:牙槽外科的必由之路[J]. 中华口腔医学研究杂志(电子版), 2023, 17(6): 381-385.
	Wang JN, Zhao JH. From minimally invasive surgery to functional surgery: the inevitable path of alveolar surgery[J]. Chin J Stomatol Res (Electronic Edition), 2023, 17(6): 381-385.
[15]	Wang B, Sun R, Li T, et al. Does the “Root Removal First” strategy prevent postoperative complications in the surgical removal of impacted mandibular third molars in the Pell and Gregory class C and horizontal position—a randomized clinical trial[J]. BMC Oral Health, 2023, 23(1): 391.
[16]	朱天双, 蔡育. 左侧下颌管内断根取出术1例[J]. 口腔医学研究, 2022, 38(11): 1098-1100.
	Zhu TS, Cai Y. Extraction of fractured root in the left mandibular canal: a case report[J]. J Oral Sci Res, 2022, 38(11): 1098-1100.
[17]	刘云通, 刘畅, 高丽钞, 等. 术后下牙槽神经功能障碍的研究进展[J]. 国际口腔医学杂志, 2023, 50(4): 479-484.
	Liu YT, Liu C, Gao LC, et al. Research progress on the postoperative inferior alveolar neurosensory disturbance[J]. Int J Stomatol, 2023, 50(4): 479-484.
[18]	叶立, 陈娅飞, 裴君, 等. 四川地区成年人群中分叉下颌管的锥形束CT研究[J]. 华西口腔医学杂志, 2017, 35(1): 82-88.
	Ye L, Chen YF, Pei J, et al. Cone beam computed tomography evaluation of bifid mandibular canals in the adult population in Sichuan Province[J]. West China J Stomatol, 2017, 35(1): 82-88.
[19]	赵怡芳. 口腔疾病诊疗并发症[M]. 武汉: 武汉大学出版社, 2023: 138-149.
	Zhao YF. Complications of oral disease diagnosis and treatment[M]. Wuhan: Wuhan University Press, 2023: 138-149.
[20]	Vetromilla BM, Moura LB, Sonego CL, et al. Complications associated with inferior alveolar nerve repositioning for dental implant placement: a systematic review[J]. Int J Oral Maxillofac Surg, 2014, 43(11): 1360-1366.
[21]	Jiang J, Chen K, Wang E, et al. Endoscopically-assisted extraction of broken roots or fragments within the mandibular canal: a retrospective case series study[J]. BMC Oral Health, 2024, 24(1): 456.
[22]	Devine M, Hirani M, Durham J, et al. Identifying criteria for diagnosis of post-traumatic pain and altered sensation of the maxillary and mandibular branches of the trigeminal nerve: a systematic review[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2018, 125(6): 526-540.
[23]	金乾瑞, 谢志坚. 下牙槽神经损伤的病因、评估与治疗[J]. 口腔医学, 2021, 41(6): 551-556.
	Jin QR, Xie ZJ. Causes, assessment and treatment of inferior alveolar nerve injuries[J]. Stomatology, 2021, 41(6): 551-556.
[24]	Teerijoki-Oksa T, Forssell H, Jääskeläinen SK. Validation of diagnostic methods for traumatic sensory neuropathy and neuropathic pain[J]. Muscle Nerve, 2019, 59(3): 342-347.
[25]	Li T, Sui Z, Matsuno A, et al. Fabrication and evaluation of a xenogeneic decellularized nerve-derived material: preclinical studies of a new strategy for nerve repair[J]. Neurotherapeutics, 2020, 17(1): 356-370.
[26]	Gao YB, Liu ZG, Lin GD, et al. Safety and efficacy of a nerve matrix membrane as a collagen nerve wrapping: a randomized, single-blind, multicenter clinical trial[J]. Neural Regen Res, 2021, 16(8): 1652-1659.
[27]	Kogan M, Lee KC, Chuang SK, et al. Outcomes of direct lingual nerve repair after an injury: a systematic review[J]. J Oral Maxillofac Surg, 2021, 79(3): 697-703.
[28]	Daware SN, Balakrishna R, Deogade SC, et al. Assessment of postoperative discomfort and nerve injuries after surgical removal of mandibular third molar: a prospective study[J]. J Family Med Prim Care, 2021, 10(4): 1712-1717.
[29]	Hosseini K, Akhondian S, Jafarpour K, et al. Management and treatment modalities of inferior alveolar nerve injuries: review of literature[J]. Oral Sci Int, 2025, 22(1): e1272.

分级	痛觉与触觉	两点辨别觉/mm	电生理特征
S0	支配区感觉完全丧失	无法检测	无动作电位
S1	深部痛觉存在	-	潜伏期延长>6 ms
S2	表浅痛觉/触觉部分恢复	>15	传导速度<30 m/s
S2+	感觉过敏伴痛觉异常	>15	异常自发电位
S3	触觉恢复伴定位障碍	7~15	传导速度30~40 m/s
S3+	精细触觉部分恢复	≤6	传导速度40~50 m/s
S4	感觉完全正常	≤3	传导速度＞50 m/s

拔牙术中牙根意外进入下颌管的处理

Management of accidental tooth root displacement into the mandibular canal during tooth extraction

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