应用锥形束 CT 和全景片预测下颌阻生磨牙拔除后下齿槽神经损伤的比较

摘要

Objective To compare the predictive effects of the sensory disturbances of inferior alveolar nerve ( IAN) after re-moval of impacted mandibular third molars and IAN exposure during surgery between cone beam computed tomography ( CBCT ) and panoramic radiography ( PAN) .Methods Eighty-six patients with impacted third molars in close relation to the IAN as determined by PAN and judged as a “moderate” risk of IAN damage were divided into CBCT and PAN groups .The sensory disturbances of the IAN af-ter teeth removal and the IAN exposure at surgery were evaluated with CBCT and PAN , respectively .Results Postoperative sensory disturbances occurred in one patient in the CBCT group and one patient in the PAN group .There were no significant differences between the two groups .However ,correct diagnostic rates of neurovascular bundle exposure at the extraction of impacted teeth were 56% and 35%by CBCT and PAN,respectively.The differences were statistically significant (P =0.029).Conclusion CBCT was not superior to PAN in predicting postoperative sensory disturbances but was superior in predicting IAN exposure during third molar removal in cases judged as having “moderate” risk.%目的：比较锥形束CT（CBCT）和口腔全景片对下颌阻生磨牙拔除后下齿槽神经损伤的预测效果和对术中神经管暴露的预测效果。方法选取下颌第三磨牙阻生患者86例（牙），均为全景片显示阻生牙与下颌神经管接近，有中度下颌神经管损伤风险，随机分为两组各43例（牙），分别依据CBCT和全景片图像预测下齿槽神经术后损伤情况和在拔牙术中的暴露情况。结果 CBCT组和全景片组各有1例患者出现术后感觉异常，两组之间差异无统计学意义。 CBCT组的神经暴露预测准确率为56％，全景片组为35％，差异有统计学意义（P ＝0．029）。结论对于有“中度”神经损伤风险的下颌第三磨牙拔除术，CBCT在预测术后神经损伤方面的效果并不优于全景片，但对术中神经管暴露的预测效果较好。