Résumé
The patient was a 77-year-old man with chief complaints of left lower jaw pain and discomfort. He had pain centering on the left lower jaw and was diagnosed with trigeminal neuralgia involving the third branch of the trigeminal nerve by a local physician. The pain subsided temporarily by administering carbamazepine, but recurred in the same region. He was subsequently referred to our ambulatory pain clinic. Sudden bouts of pain occurring dozens of times a day were noted, with depression, anorexia, lack of motivation, dry mouth, cold extremities, and dry skin. A crimson colored and slightly enlarged tongue with teeth marks on the border, crimson color on the tip, and white moss, were noted in the tongue examination. Pulse examination revealed a sunken pulse and abdominal examination noted epigastric discomfort and weakness (2/5) of the lower abdominal region. Mandibular nerve block temporarily resolved the pain, but there were repeated cycles of exacerbations, between which the feeling of discomfort persisted. Yokukansan extract (7.5 g divided into 3 doses per day) was administered, 35 months after the first clinic visit to address the discomfort that persisted after resolution of pain. Discomfort resolved. Currently, the patient still does not require mandibular nerve block or analgesics. Here we report this case in which Yokukansan was effective against discomfort in trigeminal neuralgia.
Résumé
BACKGROUND: Conventional anesthetic nerve block injections into the mandibular foramen risk causing nerve damage. This study aimed to compare the efficacy and safety of the anterior technique (AT) of inferior alveolar nerve block using felypressin-propitocaine with a conventional nerve block technique (CT) using epinephrine and lidocaine for anesthesia via the mandibular foramen. METHODS: Forty healthy university students with no recent dental work were recruited as subjects and assigned to two groups: right side CT or right side AT. Anesthesia was evaluated in terms of success rate, duration of action, and injection pain. These parameters were assessed at the first incisor, premolar, and molar, 60 min after injection. Chi-square and unpaired t-tests were used for statistical comparisons, with a P value of < 0.05 designating significance. RESULTS: The two nerve block techniques generated comparable success rates for the right mandible, with rates of 65% (CT) and 60% (AT) at both the first molar and premolar, and rates of 60% (CT) and 50% (AT) at the lateral incisor. The duration of anesthesia using the CT was 233 ± 37 min, which was approximately 40 min shorter than using the AT. This difference was statistically significant (P < 0.05). Injection pain using the AT was rated as milder compared with the CT. This difference was also statistically significant (P < 0.05). CONCLUSIONS: The AT is no less successful than the CT for inducing anesthesia, and has the added benefits of a significantly longer duration of action and significantly less pain.