Assessment of Panoramic Radiographic Variables as Predictors of Inferior Alveolar Nerve Injury During Third Molar Extraction

ABSTRACT Objective: To assess the role of radiological predictive markers on orthopantomogram for inferior alveolar nerve (IAN) injury related to the removal of mandibular third molar surgery and the occurrence of post-operative IAN paresthesia. Material and Methods: This prospective observational study was conducted on 60 patients (aged 17-35 years) indicated for extraction and showed one or more of the seven previously known panoramic radiographic risk signs of IAN injury. Variables such as age, sex, tooth angulation, and relationship with the inferior alveolar canal (IAC) were assessed to see their outcome on IAN injury. Data analysis is presented through tables and descriptive methods. Results: Among patients, 26 were male and 34 were female, with a mean age of 26.17 years. Out of seven radiological predictive markers, only six were found in this study, whereas one marker, viz. interruption of white line of the canal was not found. After surgical removal of the lower third molar, only two patients with radiographic signs showing the deflection of roots and darkening of roots continued with sensory deficit 5 weeks post-operatively. Conclusion: The risk of inferior alveolar nerve injury during lower third molar surgery is very low, even in patients with radiological predictive markers.

Basilar artery dolichoectasia an unusual and rare cause of secondary trigeminal neuralgia: a clinical report / Dolicoectasia da artéria basilar uma causa incomum e rara de neuralgia do trigêmeo secundária: um relato clínico

Objective: Patients with Trigeminal Neuralgia often consults a dentist for relief of their symptoms as the pain seems to be arising from teeth and allied oral structures. Basilar artery Dolichoectasia is an unusual and very rare cause of secondary Trigeminal Neuralgia as it compresses the Trigeminal nerve Root Entry Zone. Case reports: We report three cases of Trigeminal Neuralgia caused by Basilar artery Dolichoectasia compression. The corneal reflex was found absent in all three of the cases along with mild neurological deficits in one case. Multiplanar T1/T2W images through the brain disclosed an aberrant, cirsoid (S-shaped) and torturous Dolichoectasia of basilar artery offending the Trigeminal nerve Root Entry Zone. Discussion:Based on these findings we propose a protocol for general dentist for diagnosis of patients with trigeminal neuralgia and timely exclusion of secondary intracranial causes. Conclusion: General dentists and oral surgeons ought to consider this diagnosis in patients presenting with chronic facial pain especially pain mimicking neuralgia with loss of corneal reflex or other neurosensory deficit on the face along with nighttime pain episodes. Timely and accurate diagnosis and prompt referral to a concerned specialist can have an enormous impact on patient survival rate in such cases (AU)

Objetivo: Pacientes com Neuralgia do Trigêmeo frequentemente consultam um dentista para alívio de seus sintomas visto que a dor parece surgir dos dentes e estruturas orais relacionadas. A Dolicoectasia da artéria basilar é uma causa incomum e muito rara de Neuralgia do Trigêmeo secundária, pois comprime a zona de entrada da raiz do nervo trigêmeo. Relatos de casos: Relatamos três casos de Neuralgia do Trigêmeo causada por compressão por Dolicoectasia da artéria basilar. O reflexo da córnea se encontrava ausente em todos os três casos, juntamente com leves déficits neurológicos em um caso. Imagens multiplanares T1/T2W através do cérebro revelaram uma Dolicoectasia cirsóide (em forma de S) anômala e tortuosa da artéria basilar que atingiu a zona de entrada da raiz do nervo trigêmeo. Discussão: Com base nesses achados, propomos para o dentista clínico-geral um protocolo para diagnóstico de pacientes com Neuralgia do Trigêmeo e exclusão oportuna de causas intracranianas secundárias. Conclusão: Os dentistas clínicos-gerais e cirurgiões orais devem considerar este diagnóstico em pacientes que apresentam dor facial crônica, especialmente dor que mimetiza neuralgia com perda do reflexo da córnea ou outro déficit neurossensorial na face junto com episódios de dor noturna. O diagnóstico oportuno e preciso e o encaminhamento imediato a um especialista em questão podem ter um enorme impacto na taxa de sobrevida do paciente em tais casos (AU)

Prevalence of ACS and Causal Relation of Hypomagnesaemia.

Magnesium is an important intracellular cation [1], actually the second most abundant cation after Potassium, which has gained an essential role in normal human homeostasis. Low serum magnesium has been detected commonly in around 12% hospitalized patients and even more commonly in Intensive Care Patients as high as 60 to 65%. The link of low serum magnesium with acute coronary syndrome is being discussed widely and its actual role is being scrutinized [2,3]. Recently, Hypomagnesaemia has also been found to play an important role in the pathogenesis of a variety of clinical disorders including Hypertension, Diabetes Mellitus, Atherosclerosis and Acute Coronary Syndromes [4-8]. Acute coronary syndrome (ACS) has been defined as a group of conditions due to decreased blood flow in the coronary arteries. Acute coronary syndrome includes a vast spectrum like: ST elevation myocardial infarction (STEMI / 30%), non ST elevation myocardial infarction (NSTEMI / 25%), or unstable angina (U.A. / 38%).These are described according to ECGs and Cardiac Biomarkers of myocardial necrosis (troponin T, troponin I, and CK MB), in patients presenting with acute cardiac chest pain (Medscape). Aim: To look for any association between Hypomagnesaemia and Acute Coronary Syndrome. Materials and Methods: It’s a retrospective study involving 1198 patients who presented to the Accident and Emergency department (A & E), Trauma Center, Rashid Hospital, Dubai, with Acute Coronary Syndrome (ACS) between April 2010 and May 2013. We reviewed the records of all patients including their clinical history and presentation. The Magnesium levels of all the patients in the ACS pathway were checked along with, Cardiac biomarkers - Troponin, CPK and CK MB and Lipid profiles were also analyzed. A Chi-Square test was performed at 5% level of significance to test the null hypothesis of no association between cardiac markers, lipid profile and magnesium level. Inclusion Criteria: All new patients presenting to A & E Department at Rashid Hospital with an acute coronary syndrome (both NSTEMI & STEMI). All new patients presenting with non-specific chest pain who test positive for cardiac markers. All the age groups presenting to A & E Department at Rashid Hospital from 11/04/2010- 30/05/2013 were included. Both the genders were included. Exclusion Criteria: Patients diagnosed initially with acute coronary syndrome that eventually had negative cardiac markers. Results: Out of 1198, 1087(91%) patients were male. 49% were between 50 and 75 years of age group whereas 46% were between 25 years and 50 years of age. 77% patients were Asians and 17% belonged to Arabic peninsula. The Magnesium level was normal in 1097(92%), low in 63(5.3%). Troponin was negative in 431(36%) and positive in 767(64%) patients with low, medium and high levels in 338(28.2%), 426(35.5%) and 03(0.3%) respectively. These results indicate that there is no statistically significant association between Magnesium levels and Troponin groups (positive and negative) (chi-square with two degree of freedom = 3.30, p = 0.192). Conclusion: Our study proves that there is no significant association between Hypomagnesaemia and Acute Coronary Syndrome.

Emergency Room High Index of Suspicion in Apparently Innocent Wounds Can Encounter Missed Tendon Injuries.

Introduction: Limb injuries by sharp objects commonly result in tendon or neurovascular damage. The aim of this study is (1) to determine the incidence of significant neurological, musculotendinous or vascular injury; (2) to explore the cause of such wounds; (3) to determine the incidence of missed injuries; and (4) to assess the prognosis of neurological, vascular and musculotendinous injuries. Methods: Fifty eight adult patients were evaluated in the Emergency Department of our institution for incised wounds sustained to upper and lower extremities. Major trauma with obvious musculotendinous, vascular and neurological injuries was excluded. An injury was characterized as being missed if a patient had received inappropriate treatment or had returned due to persistent symptoms despite being examined, treated and discharged. Only wounds of less than 24 hours duration were included. Non-accidental injuries were excluded. Results: Fifty one (89%) patients sustained upper extremity wounds while only seven (11%) sustained injuries to the lower limb. Neurovascular and tendon injuries occurred exclusively in the upper limb. Twenty one (36%) patients sustained tendon, nerve and/or vascular injuries (41.2%). Glass injury was found to be the most common cause (41.3%) followed by Knife injuries (15.5%). Fifteen patients were offered an admission to hospital by the Trauma service for definitive treatment. Four of these patients signed DAMA (Discharge against Medical Advice). Six patients did not warrant admission and were discharged from the Emergency Department following appropriate treatment. Thirty seven patients were treated by Emergency Physicians and subsequently discharged. A missed tendon injury was reported in one patient (1.7%). Conclusion: A thorough clinical examination and accurate injury documentation in the Emergency Department is fundamental in recognizing tendon injuries.