Correlating cognition and cortical excitability with pain in fibromyalgia: a case control study

Abstract Background: Fibromyalgia is a chronic pain disorder characterized by widespread musculoskeletal symptoms, primarily attributed to sensitization of somatosensory system carrying pain. Few reports have investigated the impact of fibromyalgia symptoms on cognition, corticomotor excitability, sleepiness, and the sleep quality — all of which can deteriorate the quality of life in fibromyalgia. However, the existing reports are underpowered and have conflicting directions of findings, limiting their generalizability. Therefore, the present study was designed to compare measures of cognition, corticomotor excitability, sleepiness, and sleep quality using standardized instruments in the recruited patients of fibromyalgia with pain-free controls. Methods: Diagnosed cases of fibromyalgia were recruited from the Rheumatology department for the cross-sectional, case-control study. Cognition (Mini-Mental State Examination, Stroop color-word task), corticomotor excitability (Resting motor threshold, Motor evoked potential amplitude), daytime sleepiness (Epworth sleepiness scale), and sleep quality (Pittsburgh sleep quality index) were studied according to the standard procedure. Results: Thirty-four patients of fibromyalgia and 30 pain-free controls were recruited for the study. Patients of fibromyalgia showed decreased cognitive scores (p = 0.05), lowered accuracy in Stroop color-word task (for color: 0.02, for word: 0.01), and prolonged reaction time (< 0.01, < 0.01). Excessive daytime sleepiness in patients were found (< 0.01) and worsened sleep quality (< 0.01) were found. Parameters of corticomotor excitability were comparable between patients of fibromyalgia and pain-free controls. Conclusions: Patients of fibromyalgia made more errors, had significantly increased reaction time for cognitive tasks, marked daytime sleepiness, and impaired quality of sleep. Future treatment strategies may include cognitive deficits and sleep disturbances as an integral part of fibromyalgia management.(AU)

Radical resection of giant ameloblastoma mandible with free fibula reconstruction: a case report and review of literature

The ameloblastoma is a rare odontogenic tumor of the oral cavity. It is slow growing, locally invasive benign tumor affecting mandible more than maxilla mostly in age group 30-60 years. It grows in bone and soft tissue causing facial disfigurement. Treatment is surgical taking wide margins. This case report describes the treatment of a 30-year-old female having right side jaw swelling since two years, fine needle aspiration cytology was suggestive of ameloblastoma. Right hemi mandibulectomy was done by head and neck surgery team and reconstruction was done by plastic surgery team using free fibula flap. The free fibula osteocutaneous flap is the most versatile and reliable option for microsurgical reconstruction of large mandibular defects.

Interpositional arthroplasty with temporalis myofascial flap reconstruction in a case of temporomandibular joint bony ankylosis: a case report and review of literature

The report describes the treatment of a 30 year old female patient having unilateral right temporomandibular joint (TMJ) bony ankylosis whose mouth opening was restricted to 5 mm and had additional mandibular retrognathism causing severe mastication problems besides speech difficulties and low morale. The ankylosis had resulted in facial asymmetry due to bony hard swelling in front of right tragus. The patient was taken up for right interpositional arthroplasty with temporalis myofascial flap reconstruction by pre auricular approach and left coronoidectomy by intraoral approach as a preferred technique. A satisfactory mouth opening of 33 mm was achieved in immediate post-operative. Patient was followed up with aggressive mouth opening exercises in postoperative period.