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)

Comparison of efficacy of lignocaine anesthesia of vocal cords by [spray as you go] through a bronchoscope with lignocaine injection through the cricothyroid membrane

To assess and compare the efficacy of lignocaine anesthesia of vocal cords by [spray as you go] through a bronchoscope with lignocaine injection through the cricothyroid membrane. Quasi experimental study. This study was done in Combined Military Hospital Peshawar form May 2009 to June 2010. Thirty patients in each group were given local anesthesia to the vocal cords. With lignocaine either via intratracheal instillation through the cricothyroid membrane or through a fibreoptic bronchoscope [spray as you go]. A cough score was calculated by recording the number of coughs as the bronchoscope was advanced through the cords into the trachea. A twenty point unpleasantness score was marked by the patient 2 hours after the procedure. Cough score and unpleasantness score was compared among the two groups using SPSS version 19. Median unpleasantness score was 6 [Inter quartile range [IQR] 4-8] whereas median cough score was 2[IQR 0-3]. The difference was statistically significant among the two groups for both cough and unpleasant scores [p < 0.001 and p < 0.001 respectively]. Intratracheal injection of lignocaine is more comfortable for the patient. It induces much less cough and irritability to the patient than the [spray as you go] technique

Evaluation of tooth brushing technique and oral hygiene knowledge at Afid, Rawalpindi

The aim of the present study was to evaluate tooth-brushing technique and oral hygiene knowledge in Rawalpindi population. This study was a single centre, descriptive study which was carried out at the Department of Operative Dentistry, AFID, Rawalpindi from January 2010 to January 2011. 500 individuals fulfilling the inclusion criteria were included in the study. They were asked about their tooth brushing technique and oral hygiene knowledge using a questionnaire. The data obtained were analyzed using Statistical Package for Social Sciences [SPSS] version 15. Out of 500 adult participants, 140 [28%] were females and 360 [72%] males. 425 [85%] brushed their teeth regularly, 87% twice a day, 10% once a day and only 3% thrice a day. The study subjects demonstrated the brushing technique in front of the researcher. The result showed that only 4% knew proper technique. Only 7% used the brush for 2 minutes, 67% for one minute and 36% for less than one minute. 45% used fluoride tooth pastes and 24% which did not contain fluoride. 31% did not know about fluoride. The overall awareness about oral hygiene knowledge was not satisfactory

Oral aspects and complications in type 2 diabetes mellitus - a study

Type 2 diabetes mellitus comprises an array of dysfunctions resulting in several soft tissue abnormalities in the oral cavity. These include gingivitis periodontitis, salivary dysfunction, taste dysfunction, oral fungal and bacterial infections, geographic tongue, benign migratory glossitis, fissured tongue, traumatic ulcer, lichen planus, angular cheilitis, delayed mucosal healing, dental root caries, tooth loss, mucosal neurosensory disorders, and oral mucosal lesions. This article aims to determine the frequency of different oral manifestations and complications in patients of Type 2 Diabetes Mellitus. This will not only increase the awareness of oral manifestations and complications of diabetes mellitus but also help in expediting the research on the subject. It was a descriptive study and was carried out at the Operative Dentistry Department of Armed Forces Institute of Dentistry from January 2010 to January 2011. 200 patients fulfilling the inclusion criteria [diagnosed cases of type 2 diabetes mellitus of >35 years of age] were included in the study. 70 [35%] were female and 130 [65%] were male patients. The frequency of different oral manifestations and complications seen in these patients in descending order were; gingivitis [45%], periodontitis [36%], dental root caries [22%], taste dysfunction [7%], neurosensory dysesthesias [5%], xerostomia [4%] and oral candidiasis [2%]. It was concluded that diabetic patients are more prone to get oral complications so health education, timely diagnosis and effective treatment should be carried out to prevent these complications

Wheat pill: clinical characterisitcs and outcome

To determine the clinical characteristics and outcome in patients presenting with wheat pill poisoning. Retrospective study. Department of medicine, Combined Military Hospital, Kharian from 1st July 2009 to 30 December 2010. Fifty two patients with wheat pill ingestion were included in the study. All patients' history, symptoms, signs and management data was collected on a pre-designed data collection form. Mean age was 25.10 +/- 5.35 years with 51.9% females. Time interval between ingestion of pills and presentation to hospital was 2.5 +/- 1.27 hours. Numbers of pills consumed were 2.73 +/- 20. Most common symptom seen in patients was vomiting seen in 88.5% of the patients. Other common symptoms were irritability in 63.5% and confusion in 55.8% patients. Most common clinical sign hypoxia in 75% patients. Overall mortality was 86.5 percent. Wheat pills are highly toxic with rapid and high mortality rate. These patients develop refractory hypotension and metabolic acidosis which progresses to death. More research is required to develop antidote and to minimize toxicity. Strict legislations are required to control sale of aluminium phosphide over the counter

Mucormycosis: a devastating fungal infection in diabetics

Mucormycosis is a highly invasive, devastating and usually fatal fungal infection of the sinuses, brain, or lungs that occurs primarily in people with immune disorders. Despite advances in diagnosis and treatment, a high mortality still exists. We present a middle aged diabetic male with this serious fungal infection involving nose, paranasal area and adjacent periorbital regions with a high risk of progressing further towards the dura mater. He was promptly diagnosed and managed with serial surgical debridements with systemic antifungals and was later fitted with a nasal prosthesis

Lingual thyroid as a cause of snoring and sleep apnea

Lingual thyroid is a rare developmental abnormality. We describe a case of lingual thyroid in a 28 years old female who presented with symptoms of heroic snoring and obstructive sleep apnea. She was treated with surgery and was advised a life long thyroid hormone replacement therapy