口腔颌面外科医生经常面临异物移位到口腔周围组织和头颈部软组织的临床挑战。这主要是由于外伤或在牙科治疗期间无意中发生的。除了上颌窦,牙科治疗期间医源性异物移位可能发生在头颈部16个不同的筋膜间隙之一。与牙科治疗有关的常见移位的异物包括牙根或碎片,局部麻醉针,植入物和修复。移位的异物的临床后遗症取决于其大小,形状,解剖位置和靠近重要结构。尽管患者可能在相当长的时间内保持无症状,残留的异物会导致持续的疼痛,由于炎症引起的软组织反复感染和疤痕,所有这些都可能使延迟检索复杂化。除了历史,诸如平片和计算机断层扫描(CT)之类的成像方式有助于定位移位的异物及其随后的检索。可以通过口内尝试手术取回,经宫颈和内镜入路。此外,手术可以通过实时成像,如透视辅助。本报告旨在详细介绍正畸微型螺钉意外移位的情况,通常用作临时锚固装置(TAD),进入咽部外侧空间,同时尝试放置在下颌磨牙后区域。病例报告还描述了使用口内方法并使用C臂射线照相成像进行荧光透视检查的TAD螺钉的手术取出程序。该病例在相关文献综述的同时进行了报道,因为它不仅解释了正畸微型螺钉放置的罕见并发症,而且还详细说明了从头颈部筋膜间隙中去除移位异物的方式,否则直接无法访问。
Oral and maxillofacial surgeons are often faced with the clinical challenge of foreign body displacement into the perioral tissues and soft tissues of the head and neck. This mainly occurs either because of trauma or inadvertently during dental treatment. In addition to the maxillary sinus, iatrogenic foreign body displacement during dental treatment could happen into one of the 16 distinct fascial spaces of the head and neck region. Commonly displaced foreign bodies related to dental treatment include tooth roots or fragments, local anesthetic needles, implants and restorations. The clinical sequelae of a displaced foreign body depend on its size, shape, anatomic location and proximity to vital structures. Although patients may remain asymptomatic for a considerable amount of time, retained foreign bodies result in persistent pain, recurrent infection and scarring of soft tissue due to inflammation, all of which may complicate delayed retrieval. In addition to the history, imaging modalities such as plain radiographs and computed tomography (CT) help in locating the displaced foreign body and its subsequent retrieval. Surgical retrieval may be attempted through intraoral, transcervical and endoscopic approaches. Additionally, surgery may be aided by real-time imaging such as fluoroscopy. The present report aims to detail a case of inadvertent displacement of an orthodontic mini-screw, commonly used as a temporary anchorage device (TAD), into the lateral pharyngeal space, while attempting placement in the mandibular retromolar area. The case report also describes the surgical retrieval procedure of the TAD screw using an intraoral approach and with fluoroscopy guidance using C-Arm radiographic imaging. This case is reported along with the pertinent
review of literature, as it not only explains a rare complication of orthodontic mini-screw placement but also details a modality to remove displaced foreign bodies from fascial spaces of the head and neck, which are otherwise directly inaccessible.