Učestalost i faktori rizika za povredu donjeg alveolarnog nerva u toku hirurške ekstrakcije impaktiranih donjih trećih molara
Sažetak
Apstrakt
Uvod/Cilj. Povreda donjeg alveolarnog nerva prilikom hirurške ekstrakcije donjeg impaktiranog umnjaka, praćena poremećajem senzibiliteta, za pacijenta je izuzetno neprijatna komplikacija. Cilj ovog istraživanja je bio da se utvrdi učestalost ove komplikacije posle hirurškog vađenja impaktiranih donjih umnjaka, zavisno od položaja donjeg umnjaka i njegovog odnosa prema mandibularnom kanalu. Metode. U studiju je bilo uključeno ukupno 800 hirurški ekstrahovanih impaktiranih donjih umnjaka. Preoperativno je analizom digitalnog ortopantomografskog snimka evidentiran položaj impaktiranih umnjaka prema Winter-ovoj klasifikaciji, kao i odnos njihovih vrhova korenova prema mandibularnom kanalu primenom klasifikacije Tanaka-e i saradnika, kao i Rooda-e i Shehaba-e. Rezultati. Učestalost poremećaja senzibiliteta iznosila je 2,25%, najčešće kada je umnjak bio u mezioangularnom položaju. Imajući u vidu klasifikaciju Tanaka-e i saradnika, uočen je značajno veći broj povreda u slučajevima kada mandibularni kanal superponira više od polovine korena impaktiranog umnjaka (p = 0,001). Praćenjem rendgenoloških znakova preporučenih od strane Rooda i Shehaba, veća učestalost povreda donjeg alveolarnog nerva zapažena je u slučajevima kada je postojalo rasvetljenje u predelu vrhova korenova i gubitak linijskog zasenčenja „krova” i „poda” mandibularnog kanala ili kada je zapaženo skretanje kanala ili defleksija korenova, ali bez statističke značajnosti. Zaključak. Superpozicija mandibularnog kanala sa korenovima donjeg trećeg molara na ortopantomografskom snimku može povećati mogućnost povrede donjeg alveolarnog nerva. Angulacija impaktiranih donjih umnjaka, kao odnos vrhova njihovih korenova prema sadržaju mandibularnog kanala, ne utiču značajno na učestalost povrede nerva.
Reference
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