Research progress in the diagnosis and treatment of neurotrophic keratitis / 国际眼科杂志(Guoji Yanke Zazhi)

Neurotrophic keratitis(NK)is a degenerative corneal disease caused by impairment of trigeminal innervations. It can lead to spontaneous corneal epithelial defects, corneal ulceration and perforation. Early diagnosis of NK is crucial and requires accurate investigation of clinical history and thorough examination of ocular surface to determine clinical stage. Treatment for NK needs to be divided into stages according to disease severity. In addition to conventional treatments including artificial tears, blepharorrhaphy, and amniotic membrane transplantation, there are also emerging treatments such as targeted drug therapy and corneal neurotization. This article summarized the epidemiology, clinical manifestations and classification, etiology, diagnosis, differential diagnosis and treatment of NK, aiming to provide reference for the early diagnosis and treatment of NK in the future.

Effect of upper lip compression on pain reduction during local anesthesia. A split-mouth randomized clinical trial

Objectives: To evaluate the effect of pressure on the skin of upper lip in decreasing pain perception during a local maxillary anesthetic injection. Material and Methods: A split-mouth crossover randomized clinical trial was designed. Seventy-one volunteer students (23.6±1.9 years old, 53.5% women) were selected. A group chosen at random had their left or right side of upper lip compressed by a wooden clothes peg as the compression instrument and 0.6 ml of lidocaine 2% with epinephrine 1:100,000 was administered at the buccal apex level of the lateral incisors tooth. Two weeks later anesthesia was administered on the opposite side of the lip according to the randomization recorded. The intensity of perceived pain level between the two injections using a 100 mm visual analog scale (VAS) and co-variable effect were compared (Wilcoxon test p < 0.05, RStudio). Results: The average of the perceived pain with and without upper lip compression was 27.6±14.5 mm (range 0-80 mm) and 36.33±17.9 mm (range 10-90 mm) respectively (p= 0.002). No significant differences were recorded according the covariance analysis with the sex (p = 0.55) and age (p = 0.89). Conclusion: The upper lip compression significantly reduces the perception of pain during a local maxillary anesthetic technique.

Trigeminal Neuralgia in COVID-19: A meta-analysis

The trigeminal nerve is the fifth cranial nerve, which transmits facial sensations, and is divided into the ophthalmic, maxillary, and mandibular branches. Damage to this nerve can cause trigeminal neuralgia, a clinical condition that can also present in patients with coronavirus disease 2019 (COVID-19). This meta-analysis reviews the clinical cases of trigeminal neuralgia reported in patients with COVID-19 from 2019 to 2022, describes the anatomical mechanism of pain and its radiation and identifies other associated symptoms. We performed a literature search to identify reports of patients with COVID-19 who developed trigeminal neuralgia and examined these cases for prevalence and any identified source of associated ocular pain. Of the relevant studies identified, 638 patients with COVID-19 developed trigeminal neuralgia out of 7561 total COVID-19 cases (8.4 %). Of the 638 cases, 590 (7.8 %) had known causes of ocular pain, while the cause of ocular pain was unknown in 48 cases (0.6 %). Trigeminal neuralgia developed infrequently in patients with COVID-19, and cases with known causes of ocular pain were more common than cases with unknown causes. Understanding the link between COVID-19 and trigeminal neuralgia may lead to preventing further complications and mortality in these patients, as well as improving care for patients with these conditions in the future. Additionally, understanding these new clinical issues can prepare many types of physicians to protect themselves better in the event of a COVID-19 outbreak among medical staff in different departments of hospitals, such as clinics, wards, emergency rooms, and operating theatres.

El nervio trigémino es el quinto par craneal, que transmite las sensaciones faciales, y se divide en las ramas oftálmica, maxilar y mandibular. El daño a este nervio puede causar neuralgia del trigémino, una condición clínica que también puede presentarse en pacientes con enfermedad por coronavirus 2019 (COVID-19). Este metaanálisis revisa los casos clínicos de neuralgia del trigémino informados en pacientes con COVID-19 desde 2019 hasta 2022, describe el mecanismo anatómico del dolor y su radiación e identifica otros síntomas asociados. Realizamos una búsqueda bibliográfica para identificar informes de pacientes con COVID-19 que desarrollaron neuralgia del trigémino y examinamos estos casos en busca de prevalencia y cualquier fuente identificada de dolor ocular asociado. De los estudios relevantes identificados, 638 pacientes con COVID-19 desarrollaron neuralgia del trigémino de un total de 7561 casos de COVID-19 (8,4 %). De los 638 casos, 590 (7,8 %) tenían causas conocidas de dolor ocular, mientras que la causa del dolor ocular era desconocida en 48 casos (0,6 %). La neuralgia del trigémino se desarrolló con poca frecuencia en pacientes con COVID-19, y los casos con causas conocidas de dolor ocular fueron más comunes que los casos con causas desconocidas. Comprender el vínculo entre COVID-19 y la neuralgia del trigémino puede ayudar a prevenir más complicaciones y mortalidad en estos pacientes, así como a mejorar la atención de los pacientes con estas afecciones en el futuro. Además, comprender estos nuevos problemas clínicos puede preparar a muchos tipos de médicos para protegerse mejor en caso de un brote de COVID-19 entre el personal médico en diferentes departamentos de hospitales, como clínicas, salas de emergencia y quirófanos.

Interpretation of Expert Consensus on the Identification, Diagnosis and Treatment of Neurotrophic Keratopathy / 中华实验眼科杂志

Neurotrophic keratopathy (NK) is a relatively rare degenerative corneal disease.Over time, it can cause varying degrees of ocular surface damage, leading to corneal ulcers, perforations and even blindness.The best opportunity to reverse ocular surface damage is in the earliest stage of NK.However, patients experience few typical symptoms and diagnosis is often delayed.In 2021, BMC Ophthalmology published the Expert Consensus on the Identification, Diagnosis and Treatment of Neurotrophic Keratopathy in Volume 21.Through the interpretation of the consensus, this paper hopes to further improve ophthalmologists' understanding of the screening and treatment of NK, and optimize the management norms of NK diagnosis and treatment.

Changes in somatosensory perception induced by trigeminal injury after Maxillofacial Surgical Procedures / Cambios en la percepción somatosensorial inducidos por lesiones trigeminales causadas por procedimientos quirúrgicos maxilofaciales

Abstract Evidence has been reported that shows that somatosensory perception can be altered by a trigeminal injury resulting from maxillofacial surgical procedures. However, the surgical procedures that most frequently cause trigeminal lesions and the risk factors are unknown. In the same way, there is little information on what has been determined in preclinical models of trigeminal injury. This article integrates relevant information on trigeminal injury from both clinical findings and primary basic science studies. This review shows that the age and complexity of surgical procedures are essential to induce orofacial sensory alterations.

Resumen Se han reportado evidencias que demuestran que la percepción somatosensorial puede ser alterada por la lesión trigeminal producto de procedimientos quirúrgicos maxilofaciales. Sin embargo, se desconoce cuáles son los procedimientos quirúrgicos que más frecuentemente producen lesiones trigeminales, y los factores de riesgo. De la misma forma hay poca información sobre lo que se ha determinado en modelos preclínicos de lesión trigeminal. El objetivo de este artículo es integrar información relevante sobre la lesión trigeminal desde los hallazgos clínicos como los principales estudios de ciencia básica. Esta revisión demuestra que la edad y el tipo de procedimiento son fundamentales para inducir alteraciones sensoriales orofaciales, así como los procesos neurobiológicos que subyacen a estos padecimientos.

Modified Sanpiantang in Treatment of Migraine： A Review / 中国实验方剂学杂志

Migraine is a common neurovascular disorder manifested by recurrent severe headaches on one or both sides， occasionally accompanied by nausea， vomiting， photophobia， and phonophobia. It has the characteristics of recurrent attacks and family inheritance. Traditional Chinese medicine （TCM） believes that migraine belongs to the category of "head wind"， which is mostly caused by external wind and is related to the internal stirring of liver wind. Sanpiantang comes from the Record of Syndorme Differentiation·Headache （Bianzhenglu·Toutongmen） created by the physician CHEN Shiduo of the Qing Dynasty. It is composed of Chuanxiong Rhizoma， Angelicae Dahuricae Radix， Pruni Semen， Cyperi Rhizoma， Bupleuri Radix， White Mustard Seed， and Glycyrrhizae Radix et Rhizoma， with the functions of moving Qi to release pain， activating blood and resolving stasis， which is commonly used for the treatment of migraine in clinic. Current clinical studies on the application of Sanpiantang to the treatment of migraine mostly used modified Sanpiantang， either alone or in combination with western medicine/acupuncture. The results of these clinical trials showed that Sanpiantang could significantly lower migraine score， pain visual analog scale and endothelin level， reduce the frequency of painkiller use， and remarkably alleviate migraine symptoms， with few side effects. The animal experiments focused on exploring the mechanism of action of modified Sanpiantang from different anatomical levels of migraine， which mainly included reducing nitric oxide （NO） and nitric oxide synthase （NOS）， reduceing the release of neurotransmitters such as 5 -hydroxyline (5-HT) and neurotipides (NPY)， suppressing neuronal excitation， and blocking the transmission of nociceptive pathways， thereby promoting cerebral blood flow， regulating neurotransmitters and preventing migraine. Based on the pathogenesis of migraine， this paper systematically reviewed the latest progress in clinical application and experimental research of modified Sanpiantang， and summarized its mechanism of action of preventing and treating migraine， which provided new ideas for clinical treatment of migraine.

Trigeminal nerve injuries. Four years' experience at a single Argentine referral center and a literature review / Lesiones del nervio trigémino. Cuatro años de experiencia de un servicio quirúrgico odontológico en Argentina y revisión bibliográfica

ABSTRACT The aim of this retrospective study was to describe the etiology and characteristics of trigeminal nerve injuries referred to a specialized center in Buenos Aires, Argentina. A retrospective analysis was performed of patients referred from February 2016 to January 2020. Age, sex, intervention performed, nerve affected, time elapsed from injury, diagnosis, location, and whether patient had signed informed consent were recorded. A descriptive analysis of the data was made, and 95% confidence intervals were calculated for prevalence. The study sample consisted of 30 subjects (31 nerve injuries), 19 female and 11 male, average age (±SD) 40 ± 17 years. The inferior alveolar nerve was the most frequently injured nerve (74%,) while the lingual nerve accounted for 26%. The most common etiologies were inferior molar extractions (47%), dental implants (20%), and local anesthesia (13%). Other etiologies were autologous mandibular bone grafts for dental implants, removal of cysts associated with the inferior third molar, and endodontic treatment. Dental Institutions at which treatment was provided were found to be significantly associated with patients being warned and asked to sign informed consent (p<0.05), while dentists working at private offices requested fewer consents. The most frequent symptom was paresthesia, and 5 patients suffered spontaneous or evoked pain. Only 2 patients intended to file legal claims. Dentists should be aware of the debilitating effects resulting from trigeminal injuries, the complexity of their resolution and the importance of carefully planning dental procedures to prevent them.

RESUMEN El objetivo de este estudio fue describir la etiología y características de las lesiones del nervio trigémino remitidas a un servicio de referencia especializado en Buenos Aires, Argentina. Se realizó un análisis retrospectivo de los pacientes remitidos desde febrero de 2016 a enero de 2020. Se registraron edad, género, intervención recibida, nervio afectado, tiempo transcurrido desde la lesión, diagnóstico, ubicación y firma del consentimiento informado previo a la intervención Se realizó un análisis descriptivo de los datos y se calcularon intervalos de confianza del 95%. La muestra del estudio consistió en 30 sujetos (31 lesiones nerviosas), 19 mujeres y 11 hombres, con una edad promedio (± DE) de 40 ± 17 años. Aproximadamente 3 de cada 4 lesiones correspondieron al nervio alveolar inferior, representando el resto al nervio lingual. Las etiologías más frecuentes fueron la extracción dentaria (47%), los implantes dentales (20%) y la aplicación anestesia local (13%). Otras etiologías fueron la regeneración ósea para la colocación de implantes mandibulares, la extirpación de quistes asociados al tercer molar inferior y el tratamiento endodóntico. Se encontró que el tipo de establecimiento donde se realizó el procedimiento odontológico que generó la lesión, se asoció significativamente con los pacientes a los que se les advirtió y se les pidió que firmen el consentimiento informado (p<0.05); los odontólogos que trabajan en consultorios privados obtienen una menor proporción de consentimientos que los de las instituciones. El síntoma más frecuente fue la parestesia y 5 pacientes sufrieron dolor espontáneo o evocado. Solo 2 pacientes tenían intención de iniciar acciones legales. Teniendo en cuenta que son lesiones potencialmente permanentes, y de resolución compleja, la comunidad odontológica debe realizar especiales esfuerzos para disminuir esta complicación.

Compresión percutánea del ganglio de Gasser y raíz trigeminal con balón en el tratamiento de la neuralgia del trigémino / Percutaneous compression of the Gasser ganglion and trigeminal root with balloon in the treatment of trigeminal neuralgia

Introducción: Introducción: La compresión percutánea con balón (CPB) es una de las técnicas estándar para el tratamiento de la neuralgia del trigémino. El objetivo de este estudio es evaluar la eficacia de la compresión percutánea con balón (CPB) del ganglio de Gasser y raíz trigeminal en el tratamiento de la neuralgia del trigémino (TN). Métodos: Se usó un estudio observacional analítico de cohorte prospectivo. Un total de 293 pacientes con neuralgia del trigémino fueron tratados con la CPB entre octubre de 2008 y octubre de 2019 en Lima, Perú. Los datos fueron obtenidos de los registros hospitalarios y entrevistas. La CPB se realizó bajo sedación con propofol y remifentanilo. Se administróoxígeno a través de cánula nasal y se monitorizó la frecuencia cardíaca y la presión arterial durante todo el procedimiento. Elprocedimiento se realizó usando fluoroscopia con arco en C para facilitar la introducción de la aguja 14 G hasta que se ingresaal agujero oval y la visualización del catéter Fogarty 4F inflado en el cavum de Meckel. En la posición correcta, generalmenteaparece claramente definido una forma de pera o de reloj de arena después de la inyección de 0.5-1 ml de material decontraste. Resultados: La edad media fue de 64.2 años (rango 27-90). Treinta y seis pacientes (12%) tuvieron otros procedimientosquirúrgicos previos. Doscientos sesenta y dos pacientes (89.4%) experimentaron un alivio inmediato de la neuralgia despuésdel procedimiento. Se obtuvo un balón con forma de pera en 162 casos (55.3%), reloj de arena 73 (24.9%) y oval 58 (19.8%). En 245 pacientes (83.6%) el balón se mantuvo inflado durante 60 - 90 segundos. Es crucial obtener una forma de pera o de reloj de arena porque este es probablemente el factor más importante para obtener un buen alivio del dolor y duradero. Todo el procedimiento dura unos 15 minutos. La hipoestesia hemifacial después del procedimiento fue moderada o severa en el 76.5% de los pacientes. A los tres meses, la mayoría de los pacientes tienen una recuperación significativa en la sensibilidad facial, que continúa recuperándose con el tiempo. Todos los pacientes tuvieron alguna dificultad transitoria para masticar en el lado afectado. Se observó recurrencia en 26 pacientes (9.2%) en un tiempo de seguimiento de 6 meses a 11 años (5.75 años). La forma más común de balón asociada con recurrencia fue la oval (65.4%).Conclusiones: La CPB es técnicamente simple, bien tolerada por los pacientes. La tasa de éxito de la operación es alta. Los pacientes con balón en forma de pera o de reloj de arena obtuvieron los mejores resultados.

Introduction: Percutaneous balloon compression (PBC) is one of the standards techniques for the treatment of trigeminal neuralgia.The objective of this study is to evaluate the efficacy of PBC of the Gasserian ganglion and trigeminal rootlets as treatment for trigeminal neuralgia (TN). Methods: A prospective cohort analytical observational study was used. A total of 293 patients with trigeminal neuralgia were treated with PBC between october 2008 and October 2019 in Lima, Perú. The data were obtained from hospital records and interviews. PBC was performed under sedation with propofol and remifentanil. Oxygen was administered through nasal cannula and the heart rate and blood pressure were monitored throughout the procedure. The procedure is carried out with C-arm fluoroscopy to facilitate the introduction of the 14 G needle until the foramen oval is entered and the visualization of the inflated catheter Fogarty 4F in the Meckel ́s cave. Once in the right position, a clearly defined pear shape or hourglass is seen after injection of 0.5 ­ 1 mL of contrast material. Results: The mean age was 64.2 years (range, 27-90). Thirty-six patients (12%) had other previous surgical procedures. Two hundred sixty-two patients (89.4%) experienced immediate relief from neuralgia following the procedure. A pear-shaped balloon was obtained in 162 cases (55.3%), hourglass 73 (24.9%) and oval 58 (19.8%). In 245 patients (83.6%) the balloon is kept inflated for 60­90 seconds. It is crucial to obtain a pear shape or hourglass because this probably is the most significant factor for obtaining good, long-lasting pain relief. The whole procedure takes 15 minutes. Following the procedure, hemifacial hypoesthesia was moderate or severe in 76.5% of patients. Most patients have a significant recovery in facial sensitivity at three months post-procedure and continue to improve over time. All patients faced some transient difficulty chewing in the affected side. Recurrence was observed in 26 patients (9.2%) during a follow-up time of 6 months to 11 years (5.75 years). The most common form of balloon associated with recurrence was oval (65.4%).Conclusions: PBC is a technically simple, well tolerated by patients. The operation success rate is high. Patients with pear or hourglass shape balloon obtained the best results.

Nervios olfatorio, trigémino, facial, glosofaríngeo y vago: vínculos con sars-cov-2 y prospectivas neurosemiológicas / Olfactory, trigeminal, facial, glossopharyngeal and vagus nerves: links with sars-cov-2 and neurosemiological prospects

Se presenta una breve revisión los nervios olfatorio, trigémino, facial, glosofaríngeo y vago, el primero funcionalmente relacionado con la inervación quimiosensitiva olfativa en la mucosa nasal, los siguientes para el registro de dolor endocraneal y para la mucosa orofaríngea, a efectos de transducción sensitiva gustativa. Estos nervios se vinculan con los síntomas en pacientes positivos para Covid-19, que manifiestan como dolor de cabeza, disosmia, anosmia, disgeusia, ageusia entre otras características neurosemiológicas. Se concluye que estas características semiológicas se puedan deber a mecanismos neurotrópicos y transinápticos por lo que se debe realizar un examen neurológico más riguroso sobre síntomas y signos de pacientes con Covid-19.

A brief review of olfactory, facial, glossopharyngeal and vagus nerves is presented, the first one functionally related to odoriferous chemosensory innervation in the nasal mucosa, the following four cranial nerves to endocranial headache and oropharyngeal mucosa for purposes of gustatory sensory transduction. These nerves are associated with symptoms in Covid-19 positive patients, which dysosmia, anosmia, dysgeusia, ageusia manifestation, among other neurosemiological characteristics. It is concluded that these semiological characteristics may be due to neurotropic and transynaptic mechanisms, therefore a more rigorous neurological examination should be performed on symptoms and signs of Covid-19 patients.

Effects of low-dose baclofen adjuvant therapy on patients with trigeminal neuralgia and its effects on inflammatory factors and oxidative stress / 中国临床药理学与治疗学

AIM: To study the effect of low-dose baclofen on inflammatory factors and oxidative stress in patients with trigeminal neuralgia. METHODS: A total of 112 patients with trigeminal neuralgia treated in our hospital from Jan. 2017 to Jan. 2019 were selected as the subjects; they were divided into test group (n=56) and control group (n=56) according to random number table method. The control group was treated with oxcarbazepine, while the test group was treated with low-dose baclofen on the basis of the control group; the clinical total effective rate, visual analogue scale (VAS), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) levels and the incidence of adverse reactions were compared between the two groups. RESULTS:The clinical total effective rate of the test group was significantly higher than that of the control group (P0.05). CONCLUSION:Low-dose baclofen adjuvant therapy has good clinical efficacy for patients with trigeminal neuralgia, which can effectively relieve pain, reduce inflammation and oxidative stress.

Reflejo trigémino cardíaco durante artroscopia de la articulación temporomandibular. Reporte de caso clínico / Trigeminocardiac reflex during arthroscopy of the temporomandibular joint. Clinical case report

Introducción: el reflejo trigémino cardíaco es una respuesta fisiológica parasimpática repentina, que ocasiona alteraciones cardiovasculares importantes durante la esti-mulación nerviosa en el trayecto del V par craneal, generalmente ocurre al realizar procedimientos quirúrgicos en cirugía oral y maxilofacial, neurocirugía, oftalmología y dermatología. La artroscopia de la articulación temporomandibular ha sido tradicional-mente considerada un procedimiento quirúrgico seguro, mínimamente invasivo, aun así, esta técnica no está exenta de complicaciones neuro y cardiovasculares. Objetivo:presentar un caso clínico que durante una artroscopia de la articulación temporo-mandibular en la fase de instrumentación del espacio articular superior, y que, bajo monitoreo continuo del anestesiólogo, reportó una bradicardia súbita. Conclusión: el diagnóstico intraoperatorio de reflejo trigémino cardíaco, fue descrito por el servicio de anestesiología recibiendo un tratamiento farmacológico temprano para esta condi-ción, lo que permitió obtener una adecuada evolución trans y postoperatoria

Background: Trigeminocardiac reflex is a sudden parasympathetic physiological response causing significant cardiovascular disturbances during nerve stimulation in the path of the fifth cranial nerve, generally during surgical procedures in oral and maxillofacial surgery, neurosurgery, ophthalmology, and dermatology. Arthroscopy of the temporomandibular joint has traditionally been considered a safe, minimally invasive surgical procedure, yet this technique is not without neuro and cardiovascular complications. Objective: To present a clinical case that during an arthroscopy of the temporomandibular joint in the instrumentation phase of the superior joint space, and under continuous monitoring by the anesthetist, report sudden bradycardia Conclusion: The intraoperative diagnosis of trigeminocardiac reflex was described by the anesthesiology service, receiving early pharmacological treatment of this condition, allowing an adequate trans and postoperative evolution.

Delayed trigeminocardiac reflex after maxillofacial surgery: case report / Reflexo trigêmino-cardíaco tardio após cirurgia buco-maxilo-facial: relato de caso

Abstract Background: Trigeminocardiac reflex is a physiological phenomenon that may occur in head and neck surgery, and is usually benign. However, it may present with exaggerated responses with severe morbidity. Case report: Male patient, 26 years old, candidate for surgical treatment of zygomatic-orbital complex fracture. The surgery with bilateral nasal packing placed at the end of the procedure was uneventful. After being admitted to the post-anesthesia care unity, the patient complained of shortness of breath and nausea. Pulse oximetry fell below 90% in ambient air, and 100% O2 was then offered through a Hudson mask. He showed no improvement in oximetry and presented with worsening dyspnea, diffuse wheezing, reduced heart rate, and blood pressure. Atropine was given, which raised the heart rate, but without resolution of hypotension and bronchospasm. Our suspicion was of a trigeminal-cardiac reflex, and then the removal of the nasal packing was done with complete remission of the signs and symptoms. Discussion: Florian Kratschmer (1870) was the first to describe the influences of nasal mucosal reflexes on respiration and circulation, which became known as Kratschmer's reflex. It is a reflex arc whose afferent originates in the nerve endings of the trigeminal nerve. The clinical presentation of trigeminocardiac reflex is the occurrence of sudden bradycardia, hypotension, apnea, and gastric hypermotility. Conclusion: Trigeminocardiac reflex may be a protective neurogenic, oxygen-conserving response with low morbidity, however, exacerbated in certain situations. The interaction between surgeon and anesthesiologist, together with a careful monitoring of blood pressure and heart rate are fundamental for diagnosis and treatment.

Resumo Justificativa: O reflexo trigêmino-cardíaco é um fenômeno fisiológico passível de ocorrer em cirurgias da cabeça e pescoço, e normalmente é benigno. Contudo, pode apresentar respostas exageradas, com grave morbidade. Relato de caso: Paciente masculino, 26 anos, candidato a tratamento cirúrgico de fratura do complexo zigomático-orbitário. Ato cirúrgico sem intercorrências com tamponamento nasal bilateral ao final. Após admitido na sala de recuperação pós-anestésica, queixou-se de "falta de ar" e náusea. A oximetria de pulso caiu abaixo 90% em ar ambiente e foi ofertado então O2 a 100% sob máscara de Hudson. Não houve melhora da oximetria e apresentou piora da dispneia, com sibilos difusos, redução da frequência cardíaca e da pressão arterial. Administrada atropina, que elevou a frequência cardíaca, mas sem resolução da hipotensão arterial e broncoespasmo. Aventamos a hipótese de reflexo trigêmino-cardíaco e então foi feita a remoção do tamponamento nasal com remissão completa dos sinais e sintomas. Discussão: Florian Kratschmer (1870) foi o primeiro a descrever as influências de reflexos da mucosa nasal na respiração e na circulação, o que ficou conhecido como reflexo de Kratschmer. Trata-se de um arco reflexo cuja aferência é originária nas terminações nervosas do nervo trigêmeo. A apresentação clínica do reflexo trigêmino-cardíaco é a ocorrência de súbita bradicardia, hipotensão, apneia e hipermotilidade gástrica. Conclusão: O reflexo trigêmino-cardíaco pode ser uma resposta neurogênica protetora, oxigênio-conservadora, de baixa morbidade, contudo exacerbada em determinadas situações. A interação entre cirurgião e anestesiologista, aliada à monitoração criteriosa da pressão arterial e do ritmo cardíaco, é fundamental para o diagnóstico e o tratamento.

Variant anatomy of the buccal nerve / 대한해부학회지

Knowledge of the anatomy and variations of the nerves of the oral cavity is important to surgeons who operate this region. Herein, we report a rare case of a buccal nerve with two distinct roots. The anatomy of this case and its clinical applications is discussed.

Management and prevention of third molar surgery-related trigeminal nerve injury: time for a rethink

Trigeminal nerve injury as a consequence of lower third molar surgery is a notorious complication and may affect the patient in long term. Inferior alveolar nerve (IAN) and lingual nerve (LN) injury result in different degree of neurosensory deficit and also other neurological symptoms. The long term effects may include persistent sensory loss, chronic pain and depression. It is crucial to understand the pathophysiology of the nerve injury from lower third molar surgery. Surgery remains the most promising treatment in moderate-to-severe nerve injuries. There are limitations in the current treatment methods and full recovery is not commonly achievable. It is better to prevent nerve injury than to treat with unpredictable results. Coronectomy has been proved to be effective in reducing IAN injury and carries minimal long-term morbidity. New technologies, like the roles of erythropoietin and stem cell therapy, are being investigated for neuroprotection and neural regeneration. Breakthroughs in basic and translational research are required to improve the clinical outcomes of the current treatment modalities of third molar surgery-related nerve injury.

Trigeminocardiac reflex: sudden severe bradycardia during open reduction for temporomandibular joint dislocation: A case report

BACKGROUND: The trigeminocardiac reflex (TCR), which occurs after stimulation of the territory of the trigeminal nerve, is very rarely reported to be caused by stimulation of the mandibular branch. We report a case of TCR in open reduction for temporomandibular joint (TMJ) dislocation. CASE: A 74-year-old female presented for TMJ dislocation. During open reduction of TMJ under general anesthesia, severe bradycardia (15 beats/min) occurred. Immediately 0.5 mg atropine was administered intravenously, and the surgical manipulation was stopped. After 30 seconds, heart rate normalized. During surgery, severe bradycardia occurred one more time. It disappeared spontaneously as soon as surgical manipulation was stopped. The surgery was completed uneventfully. CONCLUSIONS: Because of the possibility of profound bradycardia, asystole, or even death when evoked, it is important to be aware of the trigeminocardiac reflex during manipulation of the mandibular divisions, especially during surgical stimulation of the TMJ.

Atypical Cavernous Hemangioma of the Trigeminal Nerve:Report of One Case / 中国医学科学院学报

Extracerebral cavernous hemangioma typically occurs in cavernous sinus in middle cranial fossa,showing iso-or hypointensity on T1WI,obvious hyperintensity on T2WI,and evident enhancement after contrast administration during magnetic resonance imaging(MRI).In this article we report one case of atypical cavernous hemangioma of the trigeminal nerve,with atypical MRI findings including isotense or slight long T2 signal,dotty short T1 signal,and non-enhancement on T1WI.

Trigeminal somatosensory evoked potential test as an evaluation tool for infraorbital nerve damage

BACKGROUND: Neurosensory changes are frequently observed in the patients with mid-face fractures, and these symptoms are often caused by infraorbital nerve (ION) damage. Although ION damage is a relatively common phenomenon, there are no established and objective methods to evaluate it. The aim of this study was to test whether trigeminal somatosensory evoked potential (TSEP) could be used as a prognostic predictor of ION damage and TSEP testing was an objective method to evaluate ION injury. METHODS: In this prospective TSEP study, 48 patients with unilateral mid-face fracture (only unilateral blow out fracture and unilateral zygomaticomaxillary fracture were included) and potential ION damages were enrolled. Both sides of the face were examined with TSEP and the non-traumatized side of the face was used as control. We calculated the latency difference between the affected and the unaffected sides. RESULTS: Twenty-four patients recovered within 3 months, and 21 patients took more than 3 months to recover. The average latency difference between the affected side and unaffected side was 1.4 and 4.1 ms for the group that recovered within 3 months and the group that recovered after 3 months, respectively. CONCLUSION: Patients who suffered ION damage showed prolonged latency when examined using the TSEP test. TSEP is an effective tool for evaluation of nerve injury and predicting the recovery of patients with ION damage.

Horner's syndrome and paresthesia in the trigeminal nerve territory secondary to epidural analgesia for labor / Síndrome de Horner e parestesia do território do nervo trigêmeo secundário a analgesia peridural para trabalho de parto

Abstract Currently, epidural analgesia is a common procedure for labor analgesia. Although it is considered a safe technique, it is not without complications. Horner's syndrome and paresthesia within the trigeminal nerve distribution are rare complications of epidural analgesia. We report a case of a pregnant woman who developed Horner's syndrome and paresthesia within the distribution of the trigeminal nerve following epidural analgesia for the relief of labor pain.

Resumo A analgesia peridural é hoje em dia um procedimento comum para analgesia do trabalho de parto. Embora seja considerada uma técnica segura, não está isenta de complicações. A síndrome de Horner e a parestesia do território do nervo trigêmeo são complicações raras da analgesia peridural. Relatamos um caso de uma grávida que desenvolveu a síndrome de Horner e parestesia do território do nervo trigêmeo após analgesia peridural para o alívio da dor do trabalho de parto.

Bifid mandibular canal ­an anesthetic challenge for maxillofacial surgeons­ case report

Bifid mandibular canal is a variation of the normal anatomy. such anomalies can result in difficult anesthesia while performing surgeries of the posterior mandible under local anesthesia. moreover there is a high chance of damaging the neurovascular bundle leading to complications. here we present a case of a bifid mandibular canal which posed difficulty in achieving appropriate anesthesia. the inferior alveolar nerve is of special interest for maxillofacial and oral surgeons. its relation with mandibular third molar plays an important role while performing disimpaction surgery, in cases of bilateral sagittal split osteotomy, prosthesis placement in resorbed ridges, mandibular trauma procedures, and may be traumatized by penetration of the implant drill.