舌神经切断吻合后菌状乳头味蕾再生的实验研究

目的：了解舌神经损伤后味蕾的变化，以及切断的舌神经用神经外膜吻合修复后舌菌状乳头和味蕾的再生能力。方法：模拟临床将SD大鼠一侧舌神经钳夹或切断损伤，即刻用神经外膜吻合的方法修复切断的舌神经．分别于术后20d和100d时用体视显微镜、组织显微镜、扫描电镜观察鼠舌菌状乳头和味蕾的形态和数目。结果：术后20d时，无论钳夹损伤或切断舌神经，切断的舌神经无论是否用神经吻合修复，舌神经损伤侧的菌状乳头和味蕾均萎缩、退化，数目明显减少；术后100d时，舌神经钳夹损伤和舌神经切断后即刻吻合修复的动物，退化、萎缩的菌状乳头和味蕾已完全再生，形态和数目恢复正常。而舌神经切断后未吻合的动物，萎缩、退化的菌状乳头和味蕾无明显再生恢复。结论：钳夹损伤舌神经，萎缩、退化的菌状乳头和味蕾可以自行再生恢复；切断舌神经，萎缩、退化的菌状乳头和味蕾不能自行再生恢复；用神经外膜吻合修复后，萎缩、退化的菌状乳头和味蕾可以再生恢复。舌菌状乳头和味蕾形态、数目的再生恢复，可以作为舌神经修复成功的客观指标。     

鼠舌神经损伤后菌状乳头变化的扫描电镜研究

目的 :了解舌神经损伤后菌状乳头的变化和再生能力。方法 :将成年SD大鼠的一侧舌神经模拟临床损伤后 ,用体视显微镜结合扫描电镜 ,定量观察大鼠舌菌状乳头的变化。结果 :(1)舌神经被钳夹或切断后 ,同侧的菌状乳头萎缩 ,消失 ,数目明显减少 ,味孔消失。 (2 )舌神经被钳夹后 65天 ,萎缩消失的菌状乳头明显再生 ,形态和数目恢复正常 ;(3)舌神经被切断后90天 ,萎缩消失的菌状乳头仍然没有再生迹象。结论 :(1)菌状乳头及其味蕾对舌神经具有依赖性 ;(2 )菌状乳头有很强的再生能力 ,能否再生与舌神经的损伤程度和修复有关 ;(3)舌神经不仅有支配和营养菌状乳头及其味蕾的作用 ,而且还有抑制菌状乳头向丝状乳头异化的功能。     

失神经对下颌骨骨代谢的影响

目的探讨失神经对于下颌骨骨密度和高度的影响。方法对34例单侧下牙槽神经、舌神经及颊神经缺失的患者,使用标准化数字式曲面体层机,分别于术前1天和术后1个月、6个月、1年、2年和3年摄取标准化数字式全景片,分别测量失神经侧和正常侧的下颌骨的高度和密度。结果手术前失神经组和正常组的灰度值差异无统计学意义,术后6个月、1年、2年和3年,失神经组的灰度值明显低于正常组,差异有统计学意义(P<0.05)。手术前失神经组和正常组的下颌骨高度差异无统计学意义,术后1年、2年和3年失神经组的下颌骨高度明显低于正常组,差异有统计学意义(P<0.05)。结论下颌神经去除后,下颌骨密度和高度比手术前均显著降低,影响了骨质的代谢。标准化数字式曲面体层片作为临床上检测下颌骨骨密度和骨高度是简单而高效的。     

舌瓣相关舌动脉走行的CTA定位测量研究

目的：应用CTA影像测量舌动脉位置与走行以及双侧舌动脉的位置关系,为舌瓣手术提供临床指导,避免因损伤舌动脉造成出血等并发症。方法：选择50名正常成人舌动脉CTA扫描图像,应用ADW4．2图像处理软件测量双侧舌动脉的三维解剖位置关系。结果：舌动脉由后向前走行双侧间距逐渐变窄,舌静止位时后部双侧舌动脉之间的宽度为（31．42±3．82）mm。是一个相对安全手术区。结论：没有舌神经血管走行的区域为舌瓣提供了足够的手术安全区。参照测量所获得的数据为舌瓣手术提供手术安全范围,可避免损伤舌动脉。     

舌神经第三磨牙区段存在神经元胞体

从22具成人尸体中采取了44侧舌神经第三磨牙区段标本,经切片和HE染色后行组织学观察,结果发现有40侧(90.91%)舌神经第三磨牙区段中含有散在的或聚集成神经节状的神经元胞体和神经元胞体集团。其中18个个体(81.82%)双侧标本中均可见神经元胞体,4个个体(18.18%)单侧(两左两右)标本中含神经元胞体。作者提示:鉴于在每一区段长约1cm的标本中     

猕猴舌下-舌神经移位移植的电生理研究

目的：对再造舌肌肉电生理和剩余舌肌动力性恢复的研究。方法：本文通过猕猴动物实验，采用自身对比设计，对舌下神经与舌神经移位移植进行了电生理研究。结果：（１）神经传导速度随时间延长不断恢复；术后３、６、１２月其恢复率分别为：舌前份５０．８３％，７３．８７％，８２．７９％，舌中份７７．９６％，９６．６０％，９２．３４％，术后６月神经传导速度基本上恢复可正常范围内，舌前份为２．２０ｍ／ｓ，舌中份３．５６ｍ／ｓ；（２）对照侧动作电位幅度：舌前份＞舌中份。（３）神经移位移植术后３，６，１２月中实验侧动作电位幅度也随时间延长呈不断恢复趋势；（４）对照侧与实验侧之间无运动神经交叉支配。结论：电生理检测提示舌剩余肌动力性可以重建电生理检测技术不失为评价周围神经再生的一种有效的方法。     

~(60)Co照射对大鼠舌菌状乳头及味蕾的影响

目的　研究临床治疗剂量60Co照射头颈部恶性肿瘤后,舌菌状乳头及其味蕾的形态学变化和再生能力。方法　模拟临床治疗剂量,根据多次照射剂量归一的原则,一次大剂量60Co照射30只SD大鼠头颈部,照射后观察大鼠舌菌状乳头和味蕾的变化。结果　照射后大鼠舌菌状乳头和味蕾第5天明显萎缩、退化、消失,第10~20天达到最高峰,第30天有少量菌状乳头和味蕾开始再生,第60天菌状乳头和味蕾明显再生,有部分菌状乳头仍呈萎缩状,未见到再生的味蕾。结论　治疗剂量的60Co照射头颈部,舌菌状乳头和味蕾的损伤是极其严重的,这些损伤能够再生,但不完全。     

正畸舌侧保持器和透明压膜保持器对牙周组织的影响

目的：研究正畸舌侧保持器和透明压膜保持器对下前牙舌侧牙周健康的影响。方法选择新疆医科大学第二附属医院固定矫治结束后患者30人（男14,女16）,随机分成2组,每组15人。A组戴用舌侧固定保持器,B组戴用透明压模保持器。于戴入后1周、1个月、3个月和6个月分别检查记录下前牙的舌侧菌斑指数（PI）、牙龈指数（GI）、牙石指数（CI）和硫化物水平（SUL）,并作统计学分析。结果保持器戴入6个月后与1周时比较,2组PI、CI和SUL指数均显著增加,差异有统计学意义（P<0.05）,但2组的GI差异无统计学意义（P>0.05）。CI在3个月时A组显著大于B组（P<0.05）;SUL在6个月时B组显著大于A组（P<0.05）。结论保持器使口腔自洁作用减弱,对牙周组织有一定的影响,且硫化物引起的口臭影响社交,6个月时应进行必要的刮治去除菌斑和牙石,维护牙周健康。     

4-硝基喹啉-1-氧化物诱导大鼠舌癌过程中Notch1的表达特点

目的：研究 Notch1在大鼠舌癌模型发生发展过程中的表达变化。方法：将40只 SD 大鼠随机分为对照组（A 组10只）和实验组（B、C、D组各10只）,使用质量百分比浓度为0．004％的4-硝基喹啉-1-氧化物（4-nitroquinoline-1-oxide,4NQO）饮用水喂养实验组 SD大鼠,用蒸馏水喂养对照组 SD大鼠。B、C、D组分别于8、16、24周取大鼠舌体组织;A 组在8、16、24周同时各取3只、3只、4只作为正常对照。行常规组织学观察,并使用免疫组织化学法检测 Notch1在病变不同阶段的舌粘膜内的表达。结果：4NQO可以有效诱导大鼠舌黏膜鳞状细胞癌的发生。在不同的给药时间点,可以诱导大鼠舌黏膜产生不同程度的癌前病变。Notch1在正常舌黏膜、癌前病变、舌鳞癌中的表达逐渐增高（P＜0．01）。随着异常增生程度的增加,阳性表达部位逐渐由基底层向表层扩展,且 Notch1的膜型表达逐渐增多。结论：Notch1的高表达及其在细胞膜上的集中表达可能与舌癌的发生、发展过程相关。     

舌神经至不同磨牙牙龈缘距离的相关性研究

目的:研究舌神经至不同磨牙牙龈缘的距离,并分析其相关性,为临床手术提供解剖学依据.方法:随机选用1980～2006年收集的30具成人头部防腐固定标本进行解剖,测量左、右舌神经至下颌第一、二、三磨牙远中龈缘水平方向、远中舌侧牙龈角向下后45°方向、舌侧龈缘中点垂直向下方向的距离,SPSS 13.0统计软件进行统计学处理及相关性分析.结果:左、右舌神经至下颌第一、二、三磨牙牙龈远中龈缘水平方向、远中舌侧牙龈角向下后45°方向、舌侧龈缘中点垂直向下方向的距离,无统计学意义(P>0.05).舌神经至下颌第三磨牙远中舌侧牙龈角向下后45°方向与舌侧龈缘中点垂直向下方向的距离有相关性(P=0.023<0.05,r=0.293);舌神经至下颌第一磨牙与第二磨牙牙龈缘远中龈缘水平方向的距离存在相关性(P=0.00<0.05,r=0.637).结论:左、右舌神经具有相同的解剖结构及特点;舌神经至下颌第三磨牙远中舌侧牙龈角向下后45°方向与舌侧龈缘中点垂直向下方向的距离存在相关性,但相关程度一般;舌神经至下颌第一磨牙与第二磨牙牙龈远中龈缘水平方向的距离存在相关性,并且相关程度好.     

舌神经修复效果及评价方法的初步研究

本研究目的是评价舌神经吻合后舌前２／３感觉和味觉恢复的情况。应用神经外膜吻合修复舌神经损伤１４例，初步研究结果表明：①舌神经重度损伤后，患侧舌前２／３菌状乳头大多萎缩、消失，感觉和味觉严重障碍；②神经外膜吻合修复舌神经，菌状乳头可以再生，术后一年，５０％患者感觉恢复正常，３５．７１％患者味觉恢复正常；③感觉功能检查、味觉功能测定、菌状乳头及其味孔定量观察评价舌神经的损伤和修复，结果是客观、准确、可靠的。     

Neuropeptide expression following ligation of the ferret lingual nerve

Previous studies on the ferret inferior alveolar nerve found a close association between the spontaneous neural activity generated at a site of nerve injury, and the accumulation of neuropeptides in the injured axons. More recent electrophysiological studies on the lingual nerve revealed high levels of spontaneous activity 3 days after injury, a decline at 3 weeks and a late rise at 3 months. In the present study we have used immunocytochemical techniques to see whether this time course of spontaneous activity is again paralleled by an accumulation of neuropeptides. In 20 anaesthetised adult ferrets the left lingual nerve was ligated and sectioned distally, and the animals left to recover for 3 days, 3 weeks or 3 months. The tissue was processed using indirect immunofluorescence and image analysis was used to quantify levels of the neuropeptides; calcitonin gene-related peptide (CGRP), substance P (SP), vasoactive intestinal polypeptide (VIP), galanin (GAL), enkephalin (ENK) and neuropeptide Y (NPY). Immunoreactivity to all of the neuropeptides was present proximal to the ligature 3 days after injury, and these high levels of expression had decreased considerably by 3 weeks. By 3 months ENK and NPY expression had almost disappeared proximal to the ligature, but levels of CGRP, SP, VIP and GAL had increased slightly. This was also accompanied by an accumulation of all of the neuropeptides, except NPY, in the portion of nerve immediately distal to the ligature. This late accumulation of certain neuropeptides coincides with the increase in spontaneous activity seen in our previous electrophysiological studies and supports the suggestion that neuropeptides may play a role in the aetiology of sensory disorders after nerve injury.     

An unnamed branch of the lingual nerve: gingival branch

Our main aim was to study the mylohyoid nerve, but during cadaveric dissections an unnamed branch of the lingual nerve was encountered incidentally. Dissections of sublingual and pterygomandibular spaces on 13 cadavers preserved in formalin showed an unnamed branch present bilaterally in 11 specimens, which had not been identified before in any of the anatomical textbooks. The branch extended horizontally from the medial mandibular cortex at the level of the retromolar pad to mesial of the lower first molars-second premolars. It was supplying the lingual periosteum, gingiva, and mucosa that were overlying the medial alveolar process. The mean (SD) diameter of the left and right branches was 0.66 (0.1) mm at the branching side. The mean (SD) length of the right and left sides was 28.7 (4.4) mm. The mean (SD) distance from the alveolar crest was 5.8 (0. 9) mm. The lingual nerve supplies the lingual soft tissues; however, none of the anatomical textbooks mention such a subdivision or a branch supplying that part of the oral cavity. We describe the site and the morphological characteristics of this unnamed branch, and recommend that it be named "the gingival branch of the lingual nerve".     

The number and distribution of fungiform papillae and taste buds after lingual nerve injuries in cats

Taste buds and the papillae that carry them are trophically dependent upon an intact innervation. The number and size of fungiform papillae and the number of taste buds on their surface were determined 3 months after crushing or sectioning the combined trunk of the chorda tympani and lingual nerves. After crushing there were fewer fungiform papillae but their size and the number of taste buds were similar to that on the unoperated side. After nerve section there were considerably fewer recognizable fungiform papillae on the operated side and each carried a reduced number of taste buds.     

An electrophysiological study into the effect of neurotrophin-3 on functional recovery after lingual nerve repair

OBJECTIVE: Neurotrophin-3 (NT-3) is known to ameliorate central changes that result from peripheral nerve injury and may promote regeneration of myelinated axons. We have assessed its role in the functional recovery of sensory afferents and autonomic efferents after repair of the chorda tympani and lingual nerves in the cat. DESIGN: Six months after entubulation repair, with or without the incorporation of NT-3 at the repair site, the recovery of secretomotor and vasomotor efferents was determined by recording salivary flow from the submandibular gland and temperature changes on the tongue surface, each evoked by stimulation of the repaired nerve. Electrophysiological recordings from the lingual and chorda tympani nerves proximal to the repair allowed characterisation of mechanosensitive, thermosensitive and gustatory afferents. RESULTS: When compared with data from uninjured control animals, both repair groups showed persistent reductions in conduction velocity, receptor sensitivity, spontaneous discharge, proportion of gustatory and thermosensitive units, and rate of salivary secretion. Comparisons between the two repair groups revealed that in the NT-3 group, salivary secretion rate was lower and the activity evoked in the chorda tympani by gustatory or thermal stimuli was lower, but the spontaneous discharge rate was higher. Mechanosensitive units in the lingual nerve had slower conduction velocities but the mechanoreceptive field size, adaptation time and discharge frequency had increased. CONCLUSIONS: Despite its known trophic role in the lingual somatosensory system, NT-3 did not enhance functional recovery from injury and had a negative effect on the long-term outcome for sensory and autonomic fibres.     

Should we be giving bilateral inferior alveolar and lingual nerve blocks for third molar surgery?

Extraction of mandibular third molars is one of the most common procedures in oral and maxillofacial surgery, and it is normal practice to extract both teeth at one visit under general anaesthesia. However, when both teeth are extracted under local anaesthesia, bilateral inferior alveolar and lingual nerve blocks are required, which is a subject of debate among clinicians. Much of the controversy surrounds the safety and efficacy of bilateral anaesthesia even though many surgeons use local anaesthetic solutions for perioperative and postoperative pain relief after day case general anaesthesia with no reports of unwanted effects. The evidence presented in this review explores published research for and against the use of unilateral and bilateral inferior alveolar and lingual nerve blocks.     

Systematic review of lingual nerve retraction during surgical mandibular third molar extractions

The lingual nerve is at risk of damage during mandibular third molar (M3M) surgery. Current trends to avoid lingual retraction and prevent injury to the nerve run counter to the surgical principles of locating and protecting important structures. To our knowledge, the last review of this subject only considered repurposed lingual retractors such as the Howarth. Other studies have reported the use of purpose-built retractors with improved outcomes for lingual nerve injuries. This systematic review aims to assess the current view regarding lingual nerve retraction in M3M surgery. A search of PubMed and Web of Science using the key words “lingual”, “nerve”, “retractor”, and “retraction” returned 118 results, 10 of which were selected for inclusion (nine original research papers and one systematic review). The data comprised 16,133 M3M extractions using no lingual retractor, repurposed, and purpose-built retractors. No lingual retraction showed a 0.60% risk of temporary and a 0.08% risk of permanent injury to the nerve. Repurposed retractors showed a 7.9% risk of temporary and 0.41% risk of permanent injury, and purpose-built retractors a 0.56% risk of temporary injury. No reported cases of permanent injury were associated with the use of purpose-built instruments. The evidence suggests that whilst the use of repurposed retractors increases the risk of injury to the nerve, there is no such risk with purpose-built retractors. Current data sets are confounded by the limitations of non-randomised, non-blinded studies, but trends show that lingual nerve retraction with purpose-built retractors may help to prevent permanent injury to the lingual nerve.