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Neurovascular plexus theory for“escape pain phenomenon”in lower third molar surgery

Plastic and Aesthetic Research 2015年第1期2卷 107-110页

作者： Gururaj Arakeri Mandeep Gill Sagoo Peter A.Brennan Department of Oral and Maxillofacial Surgery Navodaya Dental College and HospitalRaichur 584101KarnatakaIndia Department of Anatomy and Human Sciences King’s CollegeLondon WC2R 2LSUK Department of Oral and Maxillofacial Surgery Queen Alexandra HospitalPortsmouth PO63LYUK

pain during extraction of impacted mandibular third molars which can occur despite adequate local anesthesia is termed as“escape pain phenomenon”.Recently,it was described during elevation of a mesioangular impacted mandibular third molar and also while curetting an extracted third molar *** phenomenon has been overlooked,as it was previously considered secondary to pressure effect on the inferior alveolar neurovascular bundle(IANB).However,it is unlikely that the pain impulses originate from direct pressure on the IANB,as the nerve is blocked more proximally at its entry into the *** authors speculated that the occasional presence of a neurovascular plexus(NVP)independent of the IANB causes the escape of a pain impulse upon stimulation by root pressure or *** validate the presence of such a plexus,a meticulous literature search and review were *** search revealed evidence of the occasional presence of a NVP consisting of auriculotemporal and/or retromolar neural *** plexus may be present around the inferior alveolar artery or embedded within the IANB,and does not innervate the *** plexus likely propagates pain impulses only upon stimulation by compression or instrumentation in the apical area of the tooth *** theory explains the absence of pain during tooth sectioning and bone guttering in the presence of a complete inferior alveolar nerve block.

关键词： Inferior alveolar nerve inferior dental plexus escape pain phenomenon third molar surgery

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