中国实用口腔科杂志

中国实用口腔科杂志 ›› 2023, Vol. 16 ›› Issue (2): 179-186.DOI: 10.19538/j.kq.2023.02.011

• 论著 • 上一篇    下一篇

基于锥形束CT的颏孔区解剖结构分析

许哲欣，陈雅萍，崔啸尘，杨    威   

  1. 河北医科大学第二医院口腔颌面外科，河北  石家庄  050000
  • 出版日期:2023-03-30 发布日期:2023-04-19

  • Online:2023-03-30 Published:2023-04-19

摘要： 目的    利用锥形束CT（cone beam CT，CBCT）对颏孔区解剖结构进行观察测量及分析，为临床颏部手术的术前规划及安全实施提供详细数据支持。方法    收集2018年6月至2020年6月于河北医科大学第二医院口腔科就诊的290例患者（580侧下颌骨）的影像学资料行回顾性分析，对不同性别及各年龄段患者的颏孔位置、横径、纵径、距下颌骨下缘的距离（MF-MLB），下牙槽神经前襻的发生率、长度，副颏孔的发生率、位置分类、横径、纵径、距下颌骨下缘的距离（AMF-MLB）及其中心至颏孔中心距离（MF-AMF），侧方舌侧孔的发生率、纵径、距下颌骨下缘的距离（LLF-MLB）进行测量和分析。结果    ①580侧下颌骨中能精确定位553个颏孔，71.07%（393/553）位于第二前磨牙根尖区；其中，男性患者颏孔的横径、纵径及MF-MLB均大于女性患者，50 ~ 59岁和≥ 60岁患者的MF-MLB大于其他年龄段患者，差异均具有统计学意义（均P < 0.05）。②237例患者存在下牙槽神经前襻（392个），其发生率为81.7%（237/290），其长度为（3.3 ± 0.6）mm；其中，男性患者下牙槽神经前襻发生率及长度均大于女性患者，差异有统计学意义（均P < 0.05）；而各年龄段患者下牙槽神经前襻长度比较，差异无统计学意义（P > 0.05）。③31例患者存在副颏孔（38个），其发生率为10.7%（31/290），第Ⅲ类副颏孔占比最大为44.7%（17/38）；副颏孔的横径、纵径分别为（1.3 ± 0.3）、（1.2 ± 0.2）mm，AMF-MLB、MF-AMF分别为（15.3 ± 2.2）、（4.9 ± 0.9）mm；不同性别及各年龄段患者的副颏孔发生率及各项测量指标比较，差异均无统计学意义（均P > 0.05）。④202例患者存在侧方舌侧孔（320个），其发生率为69.7%（202/290），侧方舌侧孔纵径为（0.8 ± 0.2）mm，LLF-MLB为（7.2 ±1.2）mm；其中，男性患者LLF-MLB大于女性患者，50 ~ 59岁患者侧方舌侧孔纵径小于其他年龄段患者，差异均有统计学意义（均P < 0.05）。结论    颏孔区下牙槽神经前襻和侧方舌侧孔具有较高的发生率，且均有较大的解剖结构变异。建议在颏孔区行牙种植术或其他颌面外科手术时，术前常规行CBCT检查，以减少术中及术后并发症。

关键词: 颏孔, 下牙槽神经前襻, 副颏孔, 侧方舌侧孔, 锥形束CT

Abstract: Objective    To observe，measure and analyze the anatomical structure of the mental foramen area using cone beam CT（CBCT），and to provide detailed data support for the preoperative planning and safe implementation of clinical chin surgery. Methods    The imaging data of 290 patients（580 mandibules）who were treated in the Department of Stomatology，the Second Hospital of Hebei Medical University，from June 2018 to June 2020 were collected and retrospectively analyzed. The position，transverse diameter，vertical diameter，distance from the lower edge of the mandible（MF-MLB），the incidence and length of the anterior loop of inferior alveolar nerve，and the length of the mental foramen of different genders and ages were compared. The incidence，location，transverse diameter，longitudinal diameter，distance from the lower edge of the mandible （AMF-MLB），the distance from the center of the mental foramen to the center of the accessory mental foramen（MF-AMF），and the incidence，longitudinal diameter，and distance from the lower edge of the mandible to the lateral lingual foramen（LLF-MLB）were measured and analyzed. Results    ①A total of 553 mental foramina could be accurately located in 580 mandibles，and 71.07%（393/553）of them were located in the apical area of the second premolar. The transverse diameter，vertical diameter and MF-MLB of male patients were larger than those of female patients，and the MF-MLB of patients aged 50-59 years and ≥ 60 years was larger than that of patients in other age groups，and the differences were statistically significant（all P < 0.05）. ②There were 392 anterior loops of the mental nerve in 237 patients，and the incidence was 81.7%（237/290）. The length of anterior loops of the mental nerve was（3.3 ± 0.6）mm. The incidence and length of the anterior loop of the mental nerve in male patients were larger than those in female patients，and the differences were statistically significant（all P < 0.05）. However，the length of the anterior loop of the mental nerve was no significant difference in patients of different ages（all P > 0.05）. ③Accessory mental foramen was found in 31 patients（38 accessory mental foramen），the incidence was 10.7%（31/290），and the proportion of type Ⅲ accessory mental foramen was the largest（44.7%，17/38）. The transverse and vertical diameters of accessory mental foramen were（1.3 ± 0.3）mm and（1.2 ± 0.2）mm，respectively. The AMF-MLB and MF-AMF were（15.3 ± 2.2）mm and（4.9 ± 0.9）mm，respectively. There was no significant difference in the incidence of accessory mental foramen or the measurement indexes between different genders and ages（all P > 0.05）. ④There were 320 lateral lingual foramen in 202 patients，and the incidence was 69.7%（202/290）. The vertical diameter of lateral lingual foramen was（0.8 ± 0.2）mm，and LLF-MLB was（7.2 ± 1.2）mm. The LLF-MLB in male patients was larger than that in female patients，and the vertical diameter of the lateral lingual foramen in patients aged 50-59 years was smaller than that in patients of other ages，and the differences were statistically significant（all P < 0.05）. Conclusion    The anterior loop and lateral lingual foramen have a high incidence in the mental foramen area，and both have large anatomical structure variation. It is recommended to perform CBCT examination before dental implantation or other maxillofacial surgery in the mental foraminal region to reduce intraoperative and postoperative complications.

Key words: mental foramen, anterior loop, accessory mental foramen, lateral lingual foramen, cone beam CT