Inferior alveolar nerve paraesthesia after overfilling into the mandibular canal, confirmed by cone-beam computed tomography: a case report / Parestesia do nervo alveolar inferior após extravasamento de material obturador para o canal mandibular, confirmado por meio da tomografia computadorizada de feixe cônico: relato de caso

The filling material should be restricted to the root canal, and not extend to the periradicular tissues. Overextension occurs when there is an overflow of gutta-percha and sealer, whereas overfilling refers to the overflow only of sealer beyond the apical foramen. Both may cause several negative clinical consequences. Nevertheless, an accurate diagnosis of where they occurred cannot always be performed by conventional radiographic examination, because of the two-dimensional aspect of the image. This paper describes a clinical case of labiomandibular paraesthesia after overfilling into the mandibular canal (MC), as diagnosed by cone-beam computed tomography (CBCT), later used to perform the treatment planning. A 34-year-old Caucasian female patient sought a private dental clinic complaining of pain in the right mandibular posterior region. After taking the anamnesis and performing clinical and radiographic exams, the patient was diagnosed with pulp necrosis in the second right mandibular molar, and underwent root canal treatment. The final radiography showed overextension or overfilling, probably into the MC. About 2 hours after the procedure, the patient reported paraesthesia of her lower right lip and chin. A CBCT confirmed a small overfilling into the MC. For this reason, vitamin B12 was prescribed as the first treatment option. After 7 days, the patient reported a significant decrease in paraesthesia, and was completely normal after 15 days. This case report shows that CBCT is an effective radiographic diagnostic tool that can be used as an alternative in clinical cases of labiomandibular paraesthesia caused by overextension or overfilling (AU)

O material obturador deve preencher todo o canal sem extravasar para os tecidos perirradiculares. O extravasamento de guta-percha e cimento além do forame apical, denomina-se sobrextensão, enquanto o termo sobreobturação refere-se ao extravasamento de cimento endodôntico. Ambos podem causar consequências clínicas negativas, porém um preciso diagnóstico nem sempre é logrado somente a partir do exame radiográfico convencional em razão de sua natureza bidimensional. O presente relato descreve um caso clínico de parestesia de lábio inferior e mento após o extravasamento de cimento obturador para o canal mandibular (CM), diagnosticado por meio da tomografia computadorizada de feixe cônico (TCFC), também utilizada para o planejamento do tratamento. Paciente do gênero feminino, 34 anos, leucoderma, procurou atendimento odontológico particular queixando-se de dor odontogênica na região posterior direita da mandíbula. Finalizados a anamnese e o exame clínico-radiográfico, diagnosticou-se a necrose pulpar do segundo molar inferior direito, ulteriormente submetido ao tratamento endodôntico. A radiografia final evidenciou provável extravasamento de material obturador para o interior do CM. Aproximadamente 2 horas após, a paciente relatou parestesia no lábio inferior direito e no queixo, e a TCFC confirmou a presença de pequena quantidade de cimento obturador no CM. Por conseguinte, a prescrição de vitamina B12 foi o tratamento de escolha. Decorridos 7 dias, a paciente referiu significativa diminuição da parestesia e após 15 dias os padrões de normalidade estavam completamente restabelecidos. O presente relato de caso demonstra que a TCFC é uma ferramenta de diagnóstico potencialmente empregada em casos de parestesia labiomandibular causada por sobrextensão ou sobreobturação (AU)

Prevalence of mental nerve injury in facial fractures: a 3 year retrospective study

Background: Mandibular fracture is the most common facial bone fracture. Fractures occurring at the Para symphysis region frequently results in mental nerve injury, due to which anaesthesia or paraesthesia of the skin and mucous membrane within the distribution of mental nerve may be observed and may cause reduced quality of life for patients. Aim of this study was to retrospectively analyse and evaluate the prevalence rate of mental nerve injury in patients that reported to the department of oral and maxillofacial surgery, managed conservatively or open reduction and internal fixation method during the last 3 yearsMethods: Patients with neurosensory deficit following para symphysis fracture were recorded, statistically analyzed and results and observation were prepared from it.Results: The patients with age group 21-30 diagnosed with para symphysis fracture constituted 25% of all operated case and were found to be more associated with midface and angle fracture. Etiology behind the trauma was mostly as a result of RTA. Neurosensory disturbances as a result of mental nerve injury were found to be associated in 20.89% case, out of which in most of the cases, it gradually recovered within a duration of 7-15 days.Conclusions: RTA’s have been a prime cause for para symphysis fracture, which may at times accompany neurosensory deficit following trauma or may occur post-surgery, has been found to cause troublesome sequelae and reduced quality of life. Moreover, further research study needs to be carried out over a larger time span having a larger group of patients.

A prospective study of clinical manifestations of snake bite in government general hospital

Background: Snake bite is an occupational and rural hazard because India has always been a land of exotic snakes. Although full burden of human suffering attributable to snake bite remains obscure, hundreds of thousands of people are known to be envenomed and tens of thousands are killed or maimed by snakes every year. This study is aimed at studying the clinical manifestations in snake bite at government general hospital.Methods: This Prospective Observational study was done from March 2019 to August 2019 in Government General Hospital Nalgonda. A total of 60 cases male and female admitted with snake bite were studied based on inclusion and exclusion criteria. All patients were done routine investigations, ECG was done to rule out cardiac anomalies. Patients below 12 years, pregnant women and patients with previous heart ailments were excluded from the study. The study was carried out in all patients fulfilling the inclusion and exclusion criteria.Results: A total of 60 patients 35 females and 25 males presented during the study period. Most of the patients presented with pain at the site 40(66%), Nausea 30(50%), Swelling 25(42%), Paraesthesia 25(42%), Bleeding 15(25%), Ptosis 15(25%), Sweating 10(17%), Cellulitis 10(17%) and dyspnoea 5(9%). Among the ECG manifestations- Tachycardia- 30(50%), Ischaemia 5(9%), Sinus arrythmia 2(4%), Myocardial Infarction-0.Conclusions: It was Observed from the study that the pt. had more of Haemolytic presentation than neuroparalytic presentation. Pain at the site was the most common presentation followed by nausea. Some patients developed neuroparalytic symptoms like cellulitis, and paraesthesia. Further it was observed that timely shifting to the Hospital and administration of Anti-Snake venom prevented major manifestations in the patients.

Study Of Pattern Of Distribution Of Mylohyoid Bridging And Their Clinical Implications

Background: The occurrence of mylohyoid bridges in mandible resulting compression of inferior alveolar andmylohyoid nerves, and vessels, is important cause of neuropathy in this region.Aim and objective: The present study was aimed at analyzing influence of sex and laterality in the occurrence ofmylohyoid bridging in Indian population, and establishing a clue to the underlying causes of paraesthesia ofidiopathic origin, in the territory of inferior alveolar and mylohyoid nerves.Methods: We studied 300 human mandibles (141 female and 159 male) for location and degree of mylohyoidbridging.Results: We found mylohyoid bridges in 15.66% mandibles. The proximal bridging was found more frequentlythan the distal bridging. The mylohyoid bridges were found in 7.8% female and 13.2% in male mandibles studied.We found mylohyoid bridges on 5% on right side and 5.66% on the left side, bilateral bridging was found in 5.33%mandibles.Conclusion: The frequency of occurrence of mylohyoid bridging was higher in male; however, laterality was not tobe significant amongst the mandibles studied. The location and degree of mylohyoid bridging are one of theimportant etiological factors of paraesthesia in the region of inferior alveolar and mylohyoid nerves distribution.

Incidence of neurosensory deficits following surgical removal of mandibular third molars: a prospective clinical study

Background: The aim of this prospective study was to determine the incidences of inferior alveolar nerve and lingual nerve deficit following surgical removal of impacted mandibular third molars and to evaluate the risk factors responsible for these postoperative neurosensory deficits.Methods: A total of 80 patients who reported to department of oral and maxillofacial surgery, Meenakshi Ammal Dental College, Chennai, Tamil Nadu, India requiring surgical removal of impacted mandibular third molar were included in this cross-sectional study. Standard surgical procedure was performed. All patients were reassessed one week post-surgery. Subjectively reported altered sensations were recorded and objective assessments were performed with light touch test, two-point discrimination threshold and pin-pick pain threshold. The collected data was analyzed using the chi square test to find out any clinical relevance.Results: There was no inferior alveolar nerve related neurosensory deficits and 6 (7.5%) resulted in lingual nerve related neurosensory deficits. The incidence of LN deficit for mesioangular, horizontal, distoangular was 1.3%, 3.8% and 2.5% respectively. Type of impaction assumed a mild statistical significance (p = 0.050).Conclusions: This study highlights the importance of careful preoperative clinical and radiographic assessment of patients where third molar surgery is planned. The surgical technique of third molar removal is also likely to have great impact on the outcome.

Mandibular involvement as a first sign in Multiple Myeloma: a case report / Envolvimento mandibular como primeiro sinal clínico em mieloma múltiplo: relato de caso

Objective: To report a case of Multiple myeloma (MM) in mandible with paraesthesia. Material and Methods: The present case report highlights the occurrence of a swelling in the left posterior mandibular region in a 70-year old female patient and draws attention to the first clinical sign of a widespread systemic disease manifesting in the head and neck region. Results: The initial presumptive diagnosis was invalidated by the histopathological examination and other diagnostic tests that revealed the features characteristic for MM. Conclusion: Being a rare disease, MM should be kept on forefront of differential diagnosis for jaw lesions in a geriatric patient with paraesthesia. (AU)

Objetivo: Relatar um caso de mieloma múltiplo (MM) na mandíbula com parestesia. Material e Métodos: O relato de caso descreve a ocorrência de um inchaço na região mandibular posterior esquerda em uma paciente de 70 anos e chama a atenção para o primeiro sinal clínico de uma doença sistêmica disseminada que se manifesta na região da cabeça e pescoço. Resultados: O diagnóstico presuntivo inicial foi invalidado pelo exame histopatológico e outros testes diagnósticos que confirmaram as características do MM. Conclusão: Sendo uma doença rara, o MM deve ser considerado como uma primeira alternativa de diagnóstico diferencial de lesões mandibulares em pacientes geriátricos com parestesia. (AU)

Indenização por danos estéticos e morais decorrentes de fratura mandibular ocasionada por acidente de trabalho - relato de perícia odontológica trabalhista / Indemnity for aesthetic and moral damages resulting mandibular fracture for work accident - reporting dental labor expertise

Introdução: a perícia trabalhista odontológica visa verificar e quantificar as lesões no aparelho estomatognático, e suas repercussões, decorrentes de trauma produzidos durante a atividade laborativa. Nos casos onde as lesões geram danos estéticos e/ou funcionais, cabe ao expert reportar a presença dasmesmas, seu aspecto estático e dinâmico, e as consequências para o trabalhador. Objetivo: relatar um caso de perícia odontológica trabalhista em que mesmo havendo trauma facial com sequela estética de pequena monta, houve condenação do empregador para pagamento de danos morais e estéticos. Relatode Caso: um trabalhador foi soterrado durante a sua atividade laboral e, em decorrência do trauma,fraturou a mandíbula (fratura não exposta) e ficou com parestesia nesta região. Em primeira instância, foideterminada uma avaliação médica, onde o perito médico não verificou lesões e/ou sequelas que inviabilizassem o exercício da atividade do reclamante e/ou que fosse digno de reparação. Após orecurso, foi anulada a sentença inicial e determinada uma nova perícia, porém, nomeou-se um expertespecialista em Odontologia Legal que encontrou evidências da referida parestesia, bem como, que amesma era de caráter permanente e irreversível, caracterizando-se nexo causal, o que levou o magistrado a sentenciar o pagamento de danos estéticos e morais. Conclusão: conclui-se com o referidorelato de caso pericial que uma alteração estética de pequena monta na face, decorrente de fratura mandibular não exposta, associada a prejuízos funcionais e sensoriais no complexo maxilomandibular pode resultar em danos estéticos indenizáveis, cabendo ao perito judicial expor adequadamente estasalterações para que o magistrado possa julgar e fazer justiça em cada caso.

Introduction: labor dental expertise aims to verify and quantify injuries and impacts on stomatognathicsystem resulting from trauma suffered at work. In cases where injuries cause aesthetic and/or functionaldamages, the expert must report them as well as their static and dynamic aspect and the consequencesfor the worker. Objective: to report a case of labor dental expertise in which even having facial trauma withslight aesthetic sequel, there was employer condemnation for payment of moral and aesthetic damages.Case Report: a worker was buried during his labor activity, and as a result of trauma, he fractured hismandible (unexposed fracture) staying with paresthesia in this region. In the first instance, it was made amedical evaluation and the medical expert found no injuries and/or sequels that made it impossible toexercise the claimant's activity and/or it was worthy of indemnity. After the appeal, the initial sentence wasoverturned and another expertise determined, but with a new expert, a specialist in forensic dentistry, whofound evidence of permanent and irreversible paresthesia, establishing causal link and leading themagistrate to sentence the payment of aesthetic and moral damages. Conclusion: it is concluded that aslight facial aesthetic alteration resulting from unexposed mandibular fracture, associated with functionaland sensory impairments of maxilomandibular complex, can result in compensable aesthetic damages,falling to the court expert to properly expose these alterations so that the magistrate can judge and dojustice in each case.

Treatment of paraesthesia following root canal treatment by intentional tooth replantation: A review of the literature and a case report.

Background: Some endodontic procedures may cause damage to the inferior alveolar nerve, leading to paraesthesia. When such complication is due to extrusion of obturation material beyond the apex, it can be managed by intentional replantation (IR). IR consists of the removal of a tooth and its re-insertion into the socket after performing a proper root end manipulation. It is a relatively conservative procedure aimed at preserving the tooth and, with correct case selection, can provide a predictable outcome. Aims: The aim of the present paper is to report a case of paraesthesia following endodontic treatment of second mandibular molar successfully treated by intentional replantation. Results and Conclusion: In our opinion this treatment modality may be considered when the extrusion of root canal filling material causes irritation to the periapical tissues and endodontic retreatment is unfeasible.

Instrumentos de avaliação da neuropatia periférica induzida por quimioterapia: revisão integrativa e implicações para a prática de enfermagem oncológica / Chemotherapy-induced peripheral neurotoxicity assessment: integrative review and implications for the practice of oncology nursing / Instrumentos para la medición de la neuropatía periférica inducida por quimioterapia: revisión integradora e implicaciones para la práctica de la enfermería oncológica

A neuropatia periférica induzida por quimioterapia (NPIQ) é uma toxicidade comum decorrente do uso antineoplásicos potencialmente neurotóxicos. Seus sintomas têm importante impacto sobre as Atividades Instrumentais da Vida Diária (AVDs) dos pacientes oncológicos, por isso a monitorização de seus sintomas torna-se fundamental para a implementação de uma assistência de enfermagem efetiva. Com o objetivo de levantar e discutir os principais métodos utilizados para a monitorização da NPIQ e alguns aspectos relevantes para atuação do enfermeiro, realizou-se uma revisão integrativa da literatura entre os meses de novembro de 2009 e agosto de 2010. As seguintes etapas foram seguidas: estabelecimento dos critérios para seleção da amostra, registro do instrumento avaliado na pesquisa original, análise dos dados, interpretação dos resultados e apresentação da revisão. Os resultados mostraram que alguns instrumentos têm sido elaborados por médicos e enfermeiros, com diferentes vantagens e limitações, e têm sido publicados com o propósito de padronizar essa avaliação. Dentre eles, a eletroneuromiografia é considerada padrão ouro para a avaliação da NPIQ, e instrumentos como FACT/GOG-Ntx, PNQ e QANPIA ainda vêm sendo avaliados em diferentes idiomas, populações ou delineamento de estudos. Concluiu-se que não há ainda um consenso sobre a melhor maneira de avaliar a gravidade dessas alterações, assim como não há um protocolo de enfermagem estabelecido para essa avaliação. Sugere-se que desenvolvimento de ferramentas eficazes possibilitará melhor avaliação dessa neuropatia e poderá facilitar a descoberta de futuras intervenções.

Chemotherapy Induced Peripheral Neuropathy (CIPN) is a common toxicity result of using potentially neurotoxic antineoplastic agents. Its symptoms have an important impact on instrumental activities of daily living (IADLs) and, therefore, monitoring its symptoms is fundamental for the implementation of an effective nursing care. In order to raise and discuss the main methods used for monitoring CIPN and some aspects relevant to nurses' performance, an integrative literature review was carried out between November 2009 and August 2010. The following steps were followed: establishment of a sample selection criteria; registration of instruments assessed at the original research; data analysis; interpretation and presentation of results. The results demonstrated that doctors and nurses developed instruments that, with their advantages and/or limitations, were published in order to standardize assessments. Among them electroneuromyography is "gold standard" for assessing CIPN. Instruments such as FACT/GOG-Ntx, the PNQ and QANPIA are still being evaluated in different languages, populations and study designs. In conclusion there is still no agreement on the best way to assess the severity of the alterations, as there is no nursing protocol established for evaluation. The development of effective tools would enable a better assessment of neuropathy and the discovery of new interventions.

La neuropatía periférica inducida por la quimioterapia (NPIQ) es resultado común del uso de agentes antineoplásicos potencialmente neurotóxicos. Sus síntomas tienen un impacto importante en la ADL de los pacientes con cáncer y, por lo tanto, el control de sus síntomas es fundamental para la implementación de una efectiva atención de enfermería. Con el fin de plantear y discutir los principales métodos utilizados para el monitoreo de la NPIQ y algunos aspectos relevantes para el desempeño de las enfermeras, se llevó a acabo una revisión de la literatura de integración entre los meses de noviembre de 2009 y agosto de 2010. Se observaron los siguientes pasos: el establecimiento de criterios para la selección de la muestra, registro del instrumento valorado en la investigación original, análisis de datos, interpretación y presentación de los resultados. Algunos de los instrumentos han sido desarrollados por médicos y enfermeras, con diferentes ventajas y limitaciones, y se han publicado con el fin de estandarizar la evaluación. Se considera la Electroneuromiografía con el estándar de oro para evaluar NPIQ e instrumentos como FACT/GOG-NTx, QANPIA y PNQ se están evaluando en diferentes idiomas, poblaciones y en diferentes diseños de estudios. Se concluyó que aún no hay consenso sobre la mejor manera de evaluar la severidad de estos cambios, ya que no existe un protocolo de enfermería establecido para esta evaluación. Se sugiere que el desarrollo de herramientas eficaces llevará a una mejor evaluación de la neuropatía y puede facilitar el descubrimiento de futuras intervenciones.

Complications Related to Orthognathic Surgery

Etiological analysis and individualized treatment of pharyngeal paraesthesia / 临床耳鼻咽喉头颈外科杂志

Objective:To analyze the nosazontology of pharyngeal paraesthesia and investigate the treatment. Method: Two hundred and twelve misdiagnosed pharyngeal paraesthesia patients were investigated by history inquiry,routine examination, 24-hour esophageal pH monitoring, barium X-ray of the oesophagus, anxietas-athy-mia private measuring scale, coefficient of variation of the R-R(CVR-R), bioavailable testosterone detection(Bio-T), erection experiment and questionnaire about man climacteric syndrome. The concomitant symptoms and positions of pharyngeal paresthesia were also studied. We adopted individuallied sequential multi-therapy for every patient according to the cause of disease. Result:The cause of disease within 212 cases of pharyngeal paraesthesia included 62 psychictrauma,32 endocrine system disease,106 upper gastrointestinol disease, circulatory disease,9 circulatory disease,3 idiopathic. With individualized treatment, 110 cases had fully recovered, 63 cases excellence and 31 cases utility,and the efficiency rate was 96.23%. Conclusion:Pharyngeal paraesthesia can be caused by several factors. Thorough examination and comprehensive analysis should be applied to those incurable patient who has been treated for a long time. Short course of treatment and irrational drug use are the main causes of short term recurrence and unsatisfactory curative effect.

Analysis the Concomitance Symptom and Region of Refractoriness Paraesthesia Pharyngis / 医学研究杂志

Objective Analysis the concomitance symptom and region of refractoriness paraesthesia pharynges.Methods Investigated 219 misdiagnosed pharyngeal paraesthesia patients with their history,routine examination,24 hours pH value determined of esophagus,esophago-barium visualization,anxietas-athymia private measuring scale,erectexperiment,coefficient of variation of the R-R(CVR-R) and man climacteric syndrome 10 questionnaire.according to the cause of disease we adopted Sequence therapy and individualized combined treatment for every patient.Results In the cases of219,169 were cured,29 were effective,with total effective rate of 90.41 %.21(9.59%) cases were not cured.Eighty three(37.90 %) of them with the type of a mental scar had a 89.16%(74/83).Among 42(19.18 %) cases of climacteric syndrome and menst rual disordertype,41 cases were cured with a 97.62 % effective rate.Eleven(5.02 %) cases of the type of functionaldisturbance of independence nerve were whole cured.Ninteen(8.68 %) of them with the type of reflux esophagitis had 89.47 %(17) effective rate.Sixty four(29.22%) cases of the type of Laryngopharyngeal reflux had 85.94%(55) effective rate.There were 94 menstrual disorder,73 sleep disorders,29 dreaminess,32 hypodynamia,71 heart disorders,11 chest distress,63 digestive tract symptom with heartburn、stomac discomfort etc.73 were breastbone of midline cervix and position permanent ;91 were not constant and migrationed.Conclusions There were obvious relation between the following symptom and the spot ofparaesthesia pharynges and their causa morbi,To clinical diagnosis the causa morbi of paraesthesia pharynges and treatment have the extremely important guiding sense for carefull inquirying the following symptom and spot of paraesthesia pharynges.

Facial nerve palsy after sagittal split ramus osteotomy in severemandibular prognathism: a case report