Síndrome de la boca ardiente: revisión de la literatura / Burning mouth syndrome: literature review

Resumen El síndrome de la boca ardiente (SBA) es una condición de dolor crónico en la cavidad oral, que se presenta mayoritariamente en mujeres de edad media. Diversas causas locales y sistémicas pueden producirlo en forma secundaria, o bien, puede representar un cuadro primario, sin etiología específica identificable. Su etiopatogenia y evolución clínica es poco comprendida. Las opciones terapéuticas son variadas y en general es necesario un tratamiento multidisciplinario. A continuación, se presenta una revisión de la literatura respecto a esta patología para difusión en nuestro medio.

Abstract Burning mouth syndrome (BMS) is a chronic pain condition of the oral cavity, which occurs more frequently in middle-aged women. It can be secondary to different local and systemic causes, or represent a primary condition, with no specific identifiable etiology. Its etiopathogenesis and clinical evolution are poorly understood. Therapeutic options are multiple and a multidisciplinary treatment is necessary. We present a review of the literature regarding BMS, to provide information relevant to our area of expertise.

Relationship between peri-incisional dysesthesia and the vertical and oblique incisions on the hamstrings harvest in anterior cruciate ligament reconstruction / Relação da disestesia peri-incisional com os acessos vertical e oblíquo na retirada dos tendões flexores na reconstrução do ligamento cruzado anterior do joelho

ABSTRACT OBJECTIVE: To compare the incidence of peri-incisional dysesthesia according to the skin incision technique for hamstring tendon graft harvest in anterior cruciate ligament reconstruction. METHODS: Thirty-three patients with ACL rupture were separated in two groups: group 1, with 19 patients submitted to the oblique skin incision to access the hamstrings and group 2-14 patients operated by vertical skin incision technique. The selected patients were assessed after surgery. Demographic data and prevalence of dysesthesia was measured by digital pressure around the skin incision and classified according to the Highet scale. RESULTS: The total rate of dysesthesia was 42% (14 patients). Five patients (26%) on the oblique incision group reported dysesthesia symptoms. On the group submitted to the vertical incision technique, the involvement was 64% (nine patients). On the 33 knees evaluated, the superior lateral area was the most affected skin region, while the superior medial and inferior medial regions were affected in only one patient (7.1%). No statistical differences between both groups were observed regarding patients' weight, age, and height¸ as well as skin incision length. CONCLUSION: Patients who underwent reconstruction of the anterior cruciate ligament using the oblique access technique had five times lower incidence of peri-incisional dysesthesia when compared with those in whom the vertical access technique was used.

RESUMO OBJETIVO: Comparar a incidência de disestesia peri-incisional de acordo com o tipo de incisão para retirada de enxerto flexor na reconstrução do ligamento cruzado anterior do joelho. MÉTODOS: Foram divididos em dois grupos 33 pacientes: Grupo 1, composto por 19 pacientes operados pela técnica com incisão oblíqua para o acesso aos flexores, e Grupo 2, composto por 14 pacientes operados pela técnica com incisão vertical. Os pacientes selecionados foram examinados no pós-operatório. Dados demográficos e a prevalência da disestesia foram avaliados por meio de digitopressão em torno da região incisada e a prevalência foi classificada de acordo com a escala de Highet. RESULTADOS: A taxa total de disestesia foi de 42% (14 pacientes). Cinco pacientes (26%) do grupo da incisão oblíqua apresentaram sintomas de disestesia. No grupo submetido à técnica com incisão vertical, o acometimento foi de 64% (nove pacientes). Nos 33 joelhos avaliados, a região superior-lateral foi a área mais acometida, enquanto as regiões superior-medial e inferior-medial foram afetadas em apenas um paciente (7,1%). Não foram observadas diferenças estatísticas entre os dois grupos em relação ao peso, à idade e à altura dos pacientes, bem como o tamanho da incisão. CONCLUSÃO: Os pacientes submetidos à reconstrução do ligamento cruzado anterior do joelho com a técnica com acesso oblíquo apresentaram incidência de disestesia peri-incisional cinco vezes menor em relação àqueles que foram submetidos à técnica com acesso vertical.

Alteración de las fibras finas A-delta por entrampamiento del nervio mediano en la muñeca utilizando el período silente cutáneo / The impairment of A-delta fibers in median nerve compression at the wrist, using the cutaneous silent period

El síndrome del túnel carpiano (STC) es una neuropatía por entrampamiento a nivel de la muñeca que cursa con dolor, parestesias y disestesias dolorosas. El diagnóstico electrofisiológico se basa en el estudio de la neuroconducción de las fibras gruesas. Nuestra hipótesis consiste en la existencia del compromiso de las fibras nerviosas finas y que este compromiso se correlaciona con el grado de gravedad. Se evaluaron retrospectivamente 69 manos correspondientes a 47 pacientes, varones y mujeres (edad media 53.8, rango 22-87 años) y como grupo contro, 21 manos correspondientes a los lados asintomáticos de estos casos. Se realizaron estudios de neuroconducción motora, sensitiva y ondas F para clasificar a las manos según el grado de gravedad. Se realizó el período silente cutáneo (PSC) en todas las manos. Se evaluaron latencias medias y duraciones medias del PSC. Las latencias medias se hallaron significativamente prolongadas en las manos con neuropatía (84.3 ± 16.3 mseg) con respecto a las manos sin neuropatía (74.8 ± 11.6 mseg), p < 0.05. Las latencias medias se hallaron más prolongadas en las manos con neuropatía de mayor gravedad (p < 0.05). En los 3 pacientes con neuropatía grado más grave no se halló el PSC. Se demostró el compromiso de las fibras finas A-delta en los pacientes con STC, con mayor compromiso a mayor severidad. El PSC puede usarse como complemento de los estudios de neuroconducción motora y sensitiva.

Carpal tunnel síndrome (CTS) is an entrapment neuropathy of the median nerve at the wrist, that leads to pain, paresthesia and painful dysesthesia. The electrophysiological diagnosis is based upon nerve conduction studies which evaluate thick nerve fibers. Our hypothesis is that there is an additional dysfunction of small fibers in CTS, which correlates with the degree of severity of the neuropathy. A retrospective study of 69 hands that belonged to 47 patients of both sexes (mean age 53.8, years, range 22-87) was performed, and, as a control group, 21 hands which corresponded to the asymptomatic side of those patients were evaluated. Motor and sensory conduction studies, as well as F-waves were performed to classify the neuropathy according to the degree of severity. Cutaneous silent period (CSP) was elicited in all hands. Mean onset latencies and durations of CSP were evaluated. Mean onset latencies were significantly prolonged in neuropathic hands (84.3 ± 16.3 msec) compared to asymptomatic hands (74.8 ± 11.6 msec) (p < 0.05). Mean latencies of the CSP were even prolonged (p < 0.05) in hands affected by a more severe neuropathy. In the 3 hands with most severe neuropathy, a CSP could not be elicited. In CTS an impairment of A-delta fibers was recorded through the CSP. The more severe the neuropathy is, the more impairment of A-delta fibers can be found. CSP may be assessed as a complement of motor and sensory nerve conduction studies in this neuropathy.

Nefopam Reduces Dysesthesia after Percutaneous Endoscopic Lumbar Discectomy

BACKGROUND: Neuropathic pain, including paresthesia/dysesthesia in the lower extremities, always develops and remains for at least one month, to variable degrees, after percutaneous endoscopic lumbar discectomy (PELD). The recently discovered dual analgesic mechanisms of action, similar to those of antidepressants and anticonvulsants, enable nefopam (NFP) to treat neuropathic pain. This study was performed to determine whether NFP might reduce the neuropathic pain component of postoperative pain. METHODS: Eighty patients, who underwent PELD due to herniated nucleus pulposus (HNP) at L4-L5, were randomly divided into two equal groups, one receiving NFP (with a mixture of morphine and ketorolac) and the other normal saline (NS) with the same mixture. The number of bolus infusions and the infused volume for 3 days were compared in both groups. The adverse reactions (ADRs) in both groups were recorded and compared. The neuropathic pain symptom inventory (NPSI) score was compared in both groups on postoperative days 1, 3, 7, 30, 60, and 90. RESULTS: The mean attempted number of bolus infusions, and effective infused bolus volume for 3 days was lower in the NFP group for 3 days. The most commonly reported ADRs were nausea, dizziness, and somnolence, in order of frequency in the NFP group. The median NPSI score, and all 5 median sub-scores in the NFP group, were significantly lower than that of the NS group until postoperative day 30. CONCLUSIONS: NFP significantly reduced the neuropathic pain component, including paresthesia/dysesthesia until 1 month after PELD. The common ADRs were nausea, dizziness, somnolence, and ataxia.

Cleaning and decompression of inferior alveolar canal to treat dysesthesia and paresthesia following endodontic treatment of a third molar.

Endodontic overfilling involving the mandibular canal may cause an injury of the inferior alveolar nerve (IAN). We report a case of disabling dysesthesia and paresthesia of a 70-year-old man after endodontic treatment of his mandibular left third molar that caused leakage of root canal filling material into the mandibular canal. After radiographic evaluation, extraction of the third molar and distal osteotomy, a surgical exploration was performed and followed by removal of the material and decompression of the IAN. The patient reported an improvement in sensation and immediate disappearance of dysesthesia already from the first postoperative day.

Baerveldt Tube Implantation After Bleb Dysesthesia: Case Report

PURPOSE: To report a case of bleb dysesthesia successfully treated after Baerveldt tube implantation. CASE SUMMARY: A 37-year-old woman presented with a history of persistent foreign body sensation and pain in the left eye. The patient was referred to our hospital and was diagnosed as having had plateau iris syndrome. Having shown no improvement with conservative management, she eventually received trabeculectomy in the left eye six months prior to her current presentation. Under the impression of bleb dysesthesia, she received artificial tears and a bandage contact lens. These, however, failed to alleviate her symptoms. She then had a compression suture of the bleb and bleb revision. These were performed sequentially but neither was effective. Finally, a Baerveldt tube implantation was performed successfully, and, three months later, bleb revision was performed using a donor sclera, which resulted in no further complaint of ocular discomfort. CONCLUSIONS: Bleb dysesthesia, although not a common postoperative complication, can occur after trabeculectomy and can be successfully treated with Baerveldt tube implantation. Patients should receive appropriate counseling and advice on bleb dysesthesia prior to undergoing trabeculectomy.

Vulvodinia: un diagnóstico olvidado frente al dolor vulvar / Vulvodynia: unknown etiology of vulvar pain

La vulvodinia es una patología compleja y de difícil tratamiento. Se define como un dolor crónico de la vulva, que puede ser generalizado o localizado. La primera vez que se escribe sobre esta fue en 1889, por Skene. Sin embargo, es sólo hasta 1976, que los miembros de la International Society for Study of Vulvovaginal Diseases, reconocieron el dolor vulvar como una entidad patológica. Se estima una prevalencia de un 15 por ciento, con unas 14 millones de mujeres que lo padecen en EEUU. Generalmente consultan múltiples veces y a diferentes médicos, antes de llegar a un diagnóstico. No existen pruebas específicas, por lo que la clínica y el examen físico son las principales herramientas. Se deben excluir todas aquellas patologías que explican este dolor crónico vulvar. Su etiología es multifactorial, involucrando cambios a nivel de nociceptores, alteraciones de la inervación y la presencia de factores inflamatorios. Sin embargo, no podemos dejar de lado los aspectos psicosexuales, que pueden modular o desencadenar el dolor vulvar, al encontrar un sustrato alterado a nivel de estos tejidos. Basándose en estos aspectos, hoy existen diferentes tratamientos, que son efectivos si los utilizamos asociados y en forma gradual, ya que se potencian entre ellos.

Vulvodynia is a complex pathology and difficult to treat. In 1889 Skene was the first who write about this. However, only until 1976 the members of the International Society for Study of Vulvovaginal Diseases, recognized the vulvar pain as a disease entity. Prevalence estimated at 15 percent with an estimated 14 million women who suffer in the USA. A high number of gynaecologists do not know this diagnosis. For this reason women consult multiple times and to different doctors to reach a diagnosis. There are no specific tests for diagnosis. Finding in the clinical and physical examination are the main tools for this diagnosis. The different pathologies that could explain the presence of a chronic vulvar pain must be excluded. Undoubtedly its aetiology is multifactorial, involving changes in the number of nociceptors and alterations in the innervations, and the presence of inflammatory factors that may be the starting point of this pathology, as it seeks to explain the neuropathic theory. However we can not ignore the psychosomatic theory in explaining the psychosexual disorders as a trigger vulvar pain, in these altered tissues. Based on these aspects there are now treatments that are more or less effective when are gradually associated for better results.

Three Case Reports of Dysesthesia Successfully Treated with Ougikeishi-gomotsu-to / 日本東洋医学雑誌

We report three cases of dysesthesia that showed improvement after treatment with Ougikeishi-gomotsu-to. Case 1 was a 70-year-old woman diagnosed with post-herpetic neuralgia in 1998 (left trigeminal nerve level). She visited our department with left facial dysesthesia and pain on ****, 2002. We initiated the treatment by Ougikeishi-gomotsu-to. She judged the dysesthesia to have disappeared by about 50% after 4 weeks, and by about 10-20% after 6 weeks. We used Rokumi-gan with Ougikeishi-gomotsu-to on ********. She felt a little dysesthesia and pain on *****.<br>Case 2 was a 55-year-old woman diagnosed with carpal tunnel syndrome in March 2002. She had felt dysesthesia in both hands since 1999. She visited our department for the first time in April 2002. We initiated the treatment by Ougikeishi-gomotsu-to. After 1 week, she felt dysesthesia in only the fingertips. Now, we are using Boui-ougi-to, acupuncture and moxibustion in combination with Ougikeishi-gomotsu-to. She feels only a little dysesthesia.<br>Case 3 was a 72-year-old woman diagnosed with post-herpetic neuralgia on ********, 2002 (Th 12 and L 1 level). She was treated at the anesthesiology department on *****. But her pain and dysesthesia hardly improved. She visited our department on ****. We initiated the treatment by Ougikeishi-gomotsu-to. She judged her dysesthesia and pain to have disappeared by about 40% after 23 days, and by about 20% after 6 weeks.

PAINFUL DYSESTHESIA FOLLOWED AFTER IMPLANT PLACEMENT IN POSTERIOR MANDIBLE AND THEIR PROGNOSIS

PURPOSE: This study is to examine the painful dysesthesia of lip & gingiva followed after implant surgeries and to evaluate the prognosis of microsurgical epineurotomy & tubulization with e-PTFE tubes. METHOD: Three patients who had been suffered from painful anesthesia and dysesthesia following dental implant surgeries were examined periodically and followed for over 1 year after epineurotomy and e-PTFE tubulization. Neurosensory dysfunctions were examined by Static Light Touch Threshold, Moving Direction Discrimination. Two Point Discrimination, Pin-Prick Nociception. Visual Analog Scales and Tinel sign. The subjective symptoms were confirmed by SSEP and DITI prior to surgical exploration. RESULT: Two patients complained of continuous tearing and lancinating pain disclosed complete avulsion of IAN and degenerative changes with neuroma. One patient complained of mild painful dysesthesia revealed partial adhesion & fibrous epineural changes. Two patients whose IAN were explored after over 1 year resulted in only mild improvement in sensory recovery and moderate reduction of pain score. While the patient to whom decompression & epineural repair were given in 3 months after nerve injuries resulted in satisfactory improvement in sensory function and pain reduction. CONCLUSION: Painful dysesthesias occurred after implant placement were resulted from neurotmesis and disclosed degenerative neuropathy. Therefore, the micro-surgical explorations and repairs (epineurotomy, decompression neurolysis, and neurorrhaphy) can be recommended for known injuries as early as possible. For the delayed painful dysesthesia lasted over year, however, epineurotomy & tubulization could be an option to improve the painful discomfort but not satisfactory.

Paresthesia and Motor Weakness of Left Shoulder after Interscalene Nerve Block: A case report / 대한마취과학회지

Nerve injury can arise as a complication of peripheral nerve block. Three factors are of special etiologic interest: nerve lesion due to the needle injury or intraneural injection; toxic effects of drugs injected overall when epinephrine is used; ischemic trauma. The symptoms of such nerve lesions are dysesthesia, motor weakness or paralysis. We report a case of severe neurologic symptoms of left shoulder after interscalene nerve block in a 23-year-old ASA I male patient. Interscalene block utilizing nerve stimulator and elicitation of paresthesia was performed smoothly for incision and drainage of 2nd finger mass. Total 30 cc of 2% lidocaine with epinephrine was used. After the procedure, the patient developed a severe dysesthesia and motor weakness of left shoulder which gradually improved over the next 6 months through the extensive rehabilitation program. The block should be handled with care: rough paresthesia seeking techniques and intraneural injections should be avoided; short bevel needles and plain solutions should be used to avoid complications.

Paresthesia and Motor Weakness of Left Shoulder after Interscalene Nerve Block: A case report / 대한마취과학회지

Nerve injury can arise as a complication of peripheral nerve block. Three factors are of special etiologic interest: nerve lesion due to the needle injury or intraneural injection; toxic effects of drugs injected overall when epinephrine is used; ischemic trauma. The symptoms of such nerve lesions are dysesthesia, motor weakness or paralysis. We report a case of severe neurologic symptoms of left shoulder after interscalene nerve block in a 23-year-old ASA I male patient. Interscalene block utilizing nerve stimulator and elicitation of paresthesia was performed smoothly for incision and drainage of 2nd finger mass. Total 30 cc of 2% lidocaine with epinephrine was used. After the procedure, the patient developed a severe dysesthesia and motor weakness of left shoulder which gradually improved over the next 6 months through the extensive rehabilitation program. The block should be handled with care: rough paresthesia seeking techniques and intraneural injections should be avoided; short bevel needles and plain solutions should be used to avoid complications.

A Case of Dysesthesia and Bronchial Asthma Treated with Ku-oketu-zai Effectively / 日本東洋医学雑誌

28 years-old male patient has felt dysesthesia as swelling of forehead, numbness of cheeks and pain of eyes. Dysesthesia has developed gradually.<br>“Fuku-myaku” means the pulse difficult to be palpable. This characteristic pulse and Oketsu symptoms suggested the indications of Tokaku-joki-to and Tokaku-joki-to-go-Daio-botampi-to. As we had found “Fuku-myaku” and oketsu syndrome in this patient, we treated with these kampo medicine according to “Sho” diagnosed by Kampo. The dysesthesia in the patient has been gradually disappeared. At the same time, attacks of asthma which had appeared after discontinuation of Saiboku-to administration have been also disappeared. It is easy to make a mistake that “Fuku-myaku” is for pulse of hypo-functioning condition. But we understand that “Fuku-myaku” is not always for pulse of hypo-functioning condition, but for hyper-functioning condition.

A Case of Meralgia Paresthetica / 대한피부과학회지

Meralgia paresthetica is a syndrome consisting of numbness, pain, tingling, burning and/or a variety of other paresthesias on the distribution of the lateral femoral cutaneous nerve (LFCN) of the thigh. We report a case of meralgia paresthetica in a 41-year-old woman who complained of the symptoms of pain, burning sensation, and dysesthesia which occurred whilst standing up without any other constitutional symptoms. The authors suspect that frequent. and persistent squatting may play a role in the development of the present symptoms.