上牙槽前神经管及其副管形态特征的锥形束CT研究

doi:10.13591/j.cnki.kqyx.2023.10.008

摘要/Abstract

摘要：

目的上牙槽前神经管(canalis sinuosus,CS)是从眶下神经管延伸至上颌骨前部的骨管,内含有上牙槽前神经血管束,CS在上颌骨前部出现的解剖变异分支称为副管(accessory canals,ACs)。准确识别CS及其ACs可以降低上颌前部手术时神经血管并发症发生的可能性,改善预后。本研究的目的是评估CS及其ACs的主要形态学和形态计量学特征,以便为种植手术提供解剖学指导。方法收集2021年6月—2022年6月至山西医科大学第一医院口腔科就诊的336例患者的锥形束CT(cone beam computed tomography,CBCT)数据,利用NNT viewer软件测量CS及其ACs的形态计量学特征,根据性别、年龄和鼻腭管(nasopalatine canal,NPC)类型分组进行统计学分析。结果 CBCT测量分析显示ACs发生率为46.73%(157/336),ACs多呈双侧分布,垂直走行,侧切牙(51.77%)和中切牙(22.70%)的腭侧是ACs分布的主要区域。CS距中切牙根尖距离与年龄之间存在显著的线性相关性(R²=0.353,P<0.001)。圆柱型NPC患者的CS直径明显大于香蕉型(P<0.05)、沙漏型(P<0.01)和漏斗型(P<0.01)NPC的患者。沙漏型NPC患者与香蕉型NPC患者对比,CS距中切牙根尖距离的差异有统计学意义(P<0.05)。结论本研究结果表明,ACs在山西人群上颌骨前部有很高的发生率, NPC类型对CS及其ACs的形态计量学特征有显著影响。根据这项研究的结果,同时评估CS及其ACs和NPC是合理的,并有助于预防种植手术过程中的并发症,临床医师在术前应更加仔细评估风险并采取合适的预防措施。

关键词: 上颌前牙美学区, 牙种植体, 上牙槽前神经, 上牙槽前神经管, 锥形束CT

Abstract:

Objective Canalis sinuosus(CS) is a bony canal that extends from the infraorbital nerve canal to the anterior part of the maxilla and contains prealveolar neurovascular bundles. The anatomical variations of CS in the anterior part of the maxilla are called accessory canals (ACs). Accurate identification of CS and ACs can reduce the possibility of neurovascular complications during anterior maxillary surgery and improve the prognosis. The aim of this study was to evaluate the main morphological and morphometric features of CS and its ACs in order to provide anatomical guidance for implant surgery. Methods Cone-beam computed tomography (CBCT) data of 336 patients who visited the Department of Stomatology, the First Hospital of Shanxi Medical University from June 2021 to June 2022 were collected. Software of NNT viewer was used to measure the morphometric characteristics of CS and its ACs. Statistical analysis was performed according to gender, age and nasopalatine canal (NPC) type. Results CBCT measurement analysis showed that the incidence of ACs was 46.73%. Most of the ACs were distributed bilaterally and vertically. The palatal side of lateral incisors (51.77%) and central incisors (22.70%) were the main areas of ACs distribution. There was a significant linear correlation between the distance from CS to the root apex of central incisor and age (R²=0.353, P< 0.001). The CS diameter of cylindrical-type NPC patients was significantly larger than that of banana-type (P<0.05), hourglass-type (P<0.01) and funnel-type (P<0.01) NPC patients. There was significant difference between hourglass-type and banana-type patients in the distance between CS and the root apex of central incisor (P<0.05). Conclusion Results of this study indicate that ACs has a high incidence in the anterior maxilla of the Shanxi population and that NPC types have a significant impact on the morphometric characteristics of CS and its ACs. Based on the results of this study, simultaneous evaluation of CS with its ACs and NPC is reasonable and helpful in preventing complications during implant surgery. Clinicians should assess risks more carefully before surgery and take appropriate preventive measures.

Key words: maxillary esthetic zone, dental implant, anterior superior alveolar nerve, canalis sinuosus, CBCT

中图分类号:

R782.13

程傲然, 王珏, 范亚伟. 上牙槽前神经管及其副管形态特征的锥形束CT研究[J]. 口腔医学, 2023, 43(10): 903-909.

CHENG Aoran, WANG Jue, FAN Yawei. Analysis of morphological and morphometric characteristics of canalis sinuosus and its accessory canals: A cone-beam CT study[J]. Stomatology, 2023, 43(10): 903-909.

图/表 11

图1

图2

表1

性别和年龄组ACs的检出情况"

组别	检出	未检出	$χ ?$	P
性别
男性	74	84	0.001	0.970
女性	83	95
年龄组
18~37岁	77	91	2.267	0.322
38~57岁	65	63
58岁以上	15	25

表1

表2

图3

图4

表3

图5

图6

图7

图8

参考文献 24

[1]	李志进, 郭家平. 鼻腭管区种植的研究进展[J]. 中国口腔种植学杂志, 2019, 24(2):92-97.
[2]	Botermans A, Lidén A, de Carvalho Machado V, et al. Immediate implant placement in the maxillary aesthetic zone:A cone beam computed tomography study[J]. J Clin Med, 2021, 10(24):5853. doi: 10.3390/jcm10245853
[3]	俞琼, 黄廷贲, 杨国利. 原位取骨技术在上前牙种植中的应用[J]. 口腔医学, 2021, 41(7):649-653.
[4]	Jones FW. The anterior superior alveolar nerve and vessels[J]. J Anat, 1939, 73(Pt 4):583-591. pmid: 17104781
[5]	Rusu MC, Iacov-Crǎiţoiu MM, Sǎndulescu M, et al. Constant features of the adult maxillary bone in the site of the premaxillary suture:The suturanotha, Macalister’s foramina, Parinaud’scanal, and the second angle of the canalis sinuosus of Wood Jones[J]. Rom J Morphol Embryol, 2019, 60(4):1097-1103.
[6]	de Oliveira-Neto OB, Barbosa FT, de Lima FJC, et al. Prevalence of canalis sinuosus and accessory canals of canalis sinuosus on cone beam computed tomography:A systematic review and meta-analysis[J]. Int J Oral Maxillofac Surg, 2023, 52(1):118-131. doi: 10.1016/j.ijom.2022.06.011
[7]	von Arx T, Lozanoff S, Sendi P, et al. Assessment of bone channels other than the nasopalatine canal in the anterior maxilla using limited cone beam computed tomography[J]. Surg Radiol Anat, 2013, 35(9):783-790. doi: 10.1007/s00276-013-1110-8 pmid: 23539212
[8]	Vasiljevic M, Milanovic P, Jovicic N, et al. Morphological and morphometric characteristics of anterior maxilla accessory canals and relationship with nasopalatine canal type-A CBCT study[J]. Diagnostics (Basel), 2021, 11(8):1510.
[9]	Bliggenstorfer S, Chappuis V, von Arx T. Misinterpretation of a periapical radiograph:The canalis sinuosus mimicking a root resorption[J]. Swiss Dent J, 2021, 131(12):999-1005. pmid: 34854290
[10]	Milanovic P, Selakovic D, Vasiljevic M, et al. Morphological characteristics of the nasopalatine canal and the relationship with the anterior maxillary bone-a cone beam computed tomography study[J]. Diagnostics (Basel), 2021, 11(5):915.
[11]	Tomrukçu DN, Köse TE. Assesment of accessory branches of canalis sinuosus on CBCT images[J]. Med Oral Patol Oral Cir Bucal, 2020, 25(1):e124-e130.
[12]	Arruda JA, Silva P, Silva L, et al. Dental implant in the canalis sinuosus:A case report and review of the literature[J]. Case Rep Dent, 2017, 2017:4810123.
[13]	Ghandourah AO, Rashad A, Heiland M, et al. Cone-beam tomographic analysis of canalis sinuosus accessory intraosseous canals in the maxilla[J]. Ger Med Sci, 2017, 15:Doc20.
[14]	Orhan K, Gorurgoz C, Akyol M, et al. An anatomical variant:Evaluation of accessory canals of the canalis sinuosus using cone beam computed tomography[J]. Folia Morphol (Warsz), 2018, 77(3):551-557. doi: 10.5603/FM.a2018.0003 pmid: 29345719
[15]	de C Machado V, Chrcanovic BR, Felippe MB, et al. Assessment of accessory canals of the canalis sinuosus:A study of 1 000 cone beam computed tomography examinations[J]. Int J Oral Maxillofac Surg, 2016, 45(12):1586-1591. doi: 10.1016/j.ijom.2016.09.007
[16]	Aoki R, Massuda M, Zenni LTV, et al. Canalis sinuosus:Anatomical variation or structure?[J]. Surg Radiol Anat, 2020, 42(1):69-74. doi: 10.1007/s00276-019-02352-2
[17]	Lello RIE, Bornstein MM, Suter VGA, et al. Assessment of the anatomical course of the canalis sinuosus using cone beam computed tomography[J]. Oral Surg, 2020, 13(3):221-229. doi: 10.1111/ors.v13.3
[18]	de Oliveira-Santos C, Rubira-Bullen IRF, Monteiro SAC, et al. Neurovascular anatomical variations in the anterior palate observed on CBCT images[J]. Clin Oral Implants Res, 2013, 24(9):1044-1048. doi: 10.1111/clr.2013.24.issue-9
[19]	Shan TT, Qu Y, Huang XY, et al. Cone beam computed tomography analysis of accessory canals of the canalis sinuosus:A prevalent but often overlooked anatomical variation in the anterior maxilla[J]. J Prosthet Dent, 2021, 126(4):560-568. doi: 10.1016/j.prosdent.2020.05.028
[20]	Yeap CW, Danh D, Chan J, et al. Examination of canalis sinuosus using cone beam computed tomography in an Australian population[J]. Aust Dent J, 2022, 67(3):249-261. doi: 10.1111/adj.12910 pmid: 35285958
[21]	Anatoly A, Sedov Y, Gvozdikova E, et al. Radiological and morphometric features of canalis sinuosus in Russian population:Cone-beam computed tomography study[J]. Int J Dent, 2019, 2019:2453469.
[22]	黄佳诚, 吴夏怡, 陈丹莹, 等. 下颌前牙种植并发口底血肿的预防[J]. 口腔疾病防治, 2020, 28(8):519-524.
[23]	Volberg R, Mordanov O. Canalis sinuosus damage after immediate dental implant placement in the esthetic zone[J]. Case Rep Dent, 2019, 2019:3462794.
[24]	黄湘雅, 蔡艳玲, 韦曦. 显微根尖手术的全周期管理[J]. 口腔疾病防治, 2021, 29(10):649-655. doi: 10.12016/j.issn.2096-1456.2021.10.001

组别	A/mm	B/mm	C/mm	D/mm	E/mm	F/mm	∠α/(°)	G/mm	H/mm	I/mm
18~37岁	8.70(7.13,9.82)	5.35±1.72	1.95(1.50,2.40)	3.15(1.95,4.46)	1.17±0.37	8.03±1.97	16.20(9.58,21.81)	0.92(0.80,1.43)	1.38±0.57	1.40(1.08,2.15)
38~57岁	8.44(7.83,9.60)	6.01±1.46	2.26(1.50,3.00)	3.88(3.08,4.42)	1.27±0.37	11.76±3.14^a	17.30(14.55,24.78)	0.90(0.72,1.09)	1.51±0.59	1.09(0.90,2.48)
58岁以上	9.30(7.20,9.45)	6.84±1.46	3.00(1.95,3.45)	4.20(4.05,4.50)	1.10±0.21	12.13±2.55^a	12.70(1.10,28.15)	1.10(1.10,1.25)	2.18±0.85^ab	0.80(0.50,2.40)
H/F	0.080	2.102	2.886	4.167	0.722	13.063	1.047	2.421	3.456	1.461
P	0.961	0.134	0.236	0.125	0.491	0.000^**	0.592	0.298	0.041^*	0.482
男性	8.70(8.04,9.90)	6.02±1.40	2.10(1.50,2.70)	3.67±1.24	1.24±0.34	10.49±3.58	17.78±9.07	0.91(0.90,1.20)	1.51±0.61	1.30(0.90,2.50)
女性	8.04(6.60,9.38)	5.48±1.93	2.40(1.95,3.23)	3.65±0.79	1.16±0.38	9.64±2.58	17.56±5.75	0.92(0.70,1.20)	1.57±0.71	1.15(0.85,2.18)
Z/t	-1.299	1.128	-1.578	0.054	0.877	0.919	0.100	-0.696	-0.330	-0.190
P	0.194	0.265	0.115	0.957	0.385	0.363	0.921	0.487	0.743	0.849