经颧牙槽嵴入路撕脱上颌神经治疗上颌神经痛的临床应用

摘要

Objective:To explore the feasibilty of maxillary nerve avulsion with minimum invasion via zygomatic alveolar crest to pterygopalatine fossa in the treatment of primary maxillary neuralgia(PMN).Methods:23 patients with PMN were included in this study.The surgeries were performed by nasal mirror and transnasal endoscope,through zygomatic alveolar crest to avulse the maxillary nerve in high position.Post-operative evaluation was done based on Brisman R's method.Results:The follow-up time was 1 year to 3years,21 patients were cured,1 patient had effective outcome.1 patient complained lancinating pain on the operative side of the infraorbital area 13 months after operation,however,lower dose of carbamazepine can effectively control the pain.All patients had numbness symptoms in varying degrees on surgery side,7 cases had trace reaction.Conclusion:Avalsion of maxillary nerve via zygo-maticoalveolar crest approach is effective with minimal invasion and less complication.%目的:探讨经颧牙槽嵴入路进入翼腭窝微创撕脱上颌神经治疗上颌神经痛的可行性.方法:选择原发性上颌神经痛患者23例,术中借助鼻镜和鼻内镜经颧牙槽嵴入路微创高位、撕脱上颌神经,根据Brisman方法评价临床治疗效果.结果:术后随访时间为1～3年,治愈21例,显效1例；有效1例,于术后13个月再次出现术侧眶下区针刺样阵痛,但减量卡马西平可有效控制.术后7例患者出现痕迹反应,所有患者出现术侧面部不同程度的麻木症状,无其他并发症.结论:经颧牙槽嵴入路微创撕脱上颌神经治疗原发性上颌神经痛效果好,创伤小,并发症少.