經口內視鏡輔助取出意外進入翼下顎間隙之下顎第三大臼齒移位根—病例報告

Endoscopy-assisted Intraoral Management of Accidentally Displaced Mandibular Third Molar Root into the Pterygomandibular Space: A Case Report

10.6200/TCMJ.202412_21(4).0006

余育霖(Yu-Lin Yu)；陳立愷(Li-Kai Chen)；賴智信(Chih-Hsin Lai)

拔牙 ； 第三大臼齒 ； 移位根 ； tooth extraction ； third molar ； displaced root

北市醫學雜誌

21卷4期（2024 / 12 / 30）

357 - 363

繁體中文;英文

拔牙時第三大臼齒或部分齒質意外移位進入鄰近組織間隙是棘手的併發症。由於下顎第三大臼齒靠近舌側，尤其阻生齒之牙根可能穿透骨板，拔牙時易移位進入顎下間隙（submandibular space）或翼下顎間隙（pterygomandibular space）中。取出過程常伴隨嚴重的傷害，應謹慎處理。局部麻醉口內翻瓣取出移位根是最簡單且低侵入性的術式。足夠的光源、適當的通路與良好的視線是成功取出的關鍵。如果口內翻瓣無法取出，建議全身麻醉口外開刀處理。本案例做法：以錐束電腦斷層（cone-beam computed tomography，CBCT）定位移位根，口內舌側翻瓣，內視鏡（endoscope）支撐工作空間，微型器械取出移位根，對組織損傷較小。

Accidental displacement of the third molar tooth or root fragment into different anatomical spaces is a severe complication of tooth extraction. The root of the mandibular third molar, especially the impaction, is located near the lingual side and may penetrate the lingual plate, making it prone to falling into submandibular or pterygomandibular space during tooth extraction. Removal of displaced tooth fragments often causes severe tissue damage and should be handled with care. Intraoral flap under local anesthesia is the simplest and least invasive technique for displaced root removal. Adequate light source, proper access, and visual field are essential for a successful removal. Oral surgery under general anesthesia is recommended if the intraoral flap approach fails. In the current case, we arranged a preoperative cone beam computed tomography (CBCT) to locate the displaced root, then elevated the lingual flap, and removed the displaced root with a micro-instrument under the guidance of an endoscope. These procedures cause less damage to the tissues.

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