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1.
Rev. Odontol. Araçatuba (Impr.) ; 44(1): 57-61, jan.-abr. 2023. tab
Article in Portuguese | LILACS, BBO - Dentistry | ID: biblio-1427956

ABSTRACT

Nas cirurgias odontológicas é possível que ocorra alguns acidentes ou complicações que podem interferir no dia a dia do paciente. A lesão do nervo alveolar inferior é uma complicação decorrente de cirurgias orais que podem causar um distúrbio de sensibilidade transitória ou persistente, na região do lábio inferior e na região delimitada do forame mentoniano e hemi-arco da mucosa. O diagnóstico da parestesia pode ser feito através de testes mecanoceptivos e nocioceptivos em que o profissional escolherá para qual melhor se adapte no paciente. O objetivo do presente trabalho foi abordar por meio de uma revisão de literatura as formas de diagnóstico e tratamento da parestesia do nervo alveolar inferior decorrentes de cirurgias orais. As bases de dados utilizadas para confecção desta revisão são encontradas nas bibliotecas virtuais eletrônicas: BVS (Biblioteca Virtual em Saúde), LILACS (Literatura Latino-Americana e do Caribe em Ciências da Saúde) e Pubmed. Como critério de inclusão foram selecionados artigos publicados de 2012 a 2022 em língua inglesa, portuguesa e espanhola. Após a leitura do título e resumo dos resultados da pesquisa e aplicação dos critérios de inclusão e exclusão dentre eles foram excluídos 883, pois não se enquadravam no nosso critério de inclusão. No final, foram selecionados 13 estudos por meio de base de dados, que serviram de base para esta revisão. Concluímos que as formas de tratamento para a parestesia na literatura, são um pouco escassas e conflitantes, mas relata que o uso da laserterapia e acupuntura tem sido uma forma de tratamento com um bom índice de sucesso, e para os casos que não sejam suficientes tais tratamentos, pode-se optar por uma cirurgia(AU)


In dental surgeries it is possible to have some accidents or complications that can interfere with the patient's day. Injury to the inferior alveolar nerve is a complication resulting from oral surgeries that can cause a disturbance of sensitivity that can be transient or persistent in the region of the lower lip and in the delimited region of the mental foramen and hemiarch of the mucosa. The diagnosis of paresthesia can be made through mechanoceptive and nocioceptive tests that the professional will choose, which best suits the patient. The objective of the present work is to approach, through a literature review, the forms of diagnosis and treatment aimed at inferior alveolar nerve paresthesia resulting from oral surgeries. The databases used for this review are found in the virtual electronic libraries: VHL (Virtual Health Library), LILACS (Latin American and Caribbean Literature on Health Sciences) and Pubmed. As inclusion criteria, articles published from 2012 to 2022 in English, Portuguese and Spanish were selected. After reading the title and summary of the research results and applying the inclusion and exclusion criteria, 883 were excluded, as they did not meet our inclusion criteria. In the end, 13 studies were selected from the database, which served as the basis for this review. We conclude that the forms of treatment for paresthesia in the literature are a little scarce and conflicting, but it reports that the use of laser therapy and acupuncture has been a form of treatment with a good success rate, and for cases that are not enough, such treatments, one can opt for surgery(AU)


Subject(s)
Paresthesia , Oral Surgical Procedures/adverse effects , Mandibular Nerve Injuries/diagnosis , Mandibular Nerve Injuries/therapy , Acupuncture , Laser Therapy , Trigeminal Nerve Injuries , Trigeminal Nerve Injuries/diagnosis , Trigeminal Nerve Injuries/therapy , Mandibular Nerve Injuries , Mandibular Nerve
2.
Oral Maxillofac Surg Clin North Am ; 33(2): 239-248, 2021 May.
Article in English | MEDLINE | ID: mdl-33526318

ABSTRACT

Injury to the lingual nerve is a well-recognized risk associated with certain routine dental and oral surgical procedures. The assessment and management of a patient with a traumatic lingual nerve neuropathy requires a logical and stepwise approach. The proper application and interpretation of the various neurosensory tests and maneuvers is critical to establishing an accurate diagnosis. The implementation of a surgical or nonsurgical treatment strategy is based not only on the established diagnosis, but also a multitude of variables including patient age, timing and nature of the injury, and the emotional or psychological impact.


Subject(s)
Lingual Nerve Injuries , Oral Surgical Procedures , Trigeminal Nerve Injuries , Humans , Lingual Nerve Injuries/surgery , Lingual Nerve Injuries/therapy , Trigeminal Nerve Injuries/diagnosis , Trigeminal Nerve Injuries/therapy
4.
J Neurosurg ; 134(3): 1271-1275, 2020 Apr 24.
Article in English | MEDLINE | ID: mdl-32330885

ABSTRACT

Acute injury of the trigeminal nerve or its branches can result in posttraumatic trigeminal neuropathy (PTTN). Affected patients suffer from chronic debilitating symptoms long after they have recovered from the inciting trauma. Symptoms vary but usually consist of paresthesia, allodynia, dysesthesia, hyperalgesia, or a combination of these symptoms. PTTN of the trigeminal nerve can result from a variety of traumas, including iatrogenic injury from various dental and maxillofacial procedures. Treatments include medications, pulsed radiofrequency modulation, and microsurgical repair. Although trigeminal nerve stimulation has been reported for trigeminal neuropathy, V3 implantation is often avoided because of an elevated migration risk secondary to mandibular motion, and lingual nerve implantation has not been documented. Here, the authors report on a patient who suffered from refractory PTTN despite multiple alternative treatments. He elected to undergo novel placement of a lingual nerve stimulator for neuromodulation therapy. To the best of the authors' knowledge, this is the first documented case of lingual nerve stimulator implantation for lingual neuropathy, a technique for potentially reducing the risk of electrode migration.


Subject(s)
Electric Stimulation Therapy/methods , Lingual Nerve , Trigeminal Nerve Injuries/therapy , Drug Resistance , Humans , Lingual Nerve Injuries/therapy , Male , Middle Aged , Neurosurgical Procedures/methods , Pain/etiology , Pain Management , Tongue Diseases/etiology , Tongue Diseases/therapy , Treatment Outcome , Trigeminal Nerve Diseases
5.
J Oral Maxillofac Surg ; 76(12): 2669-2675, 2018 12.
Article in English | MEDLINE | ID: mdl-30509397

ABSTRACT

PURPOSE: Iatrogenic damage to the inferior alveolar nerve (IAN) and lingual nerve (LN) may occur during routine oral and maxillofacial surgery procedures. The primary aim of this study was to determine, using a prospective, double-blind, randomized controlled clinical trial, whether the proportion of nerve-injured patients with postoperative neurosensory improvement over a 3-month period differed significantly between a control group and a low-level laser therapy (LLLT) group. PATIENTS AND METHODS: The study sample consisted of 35 patients with iatrogenic nerve injury due to third molar odontectomy, dental implant placement, or local anesthetic injection. The investigators used a randomized, double-blind laser delivery system to administer either placebo or LLLT to patients who met the inclusion criteria. The outcome variable of neurosensory improvement was defined as a minimum 1-unit increase from baseline in visual analog scale rating and was based on standard objective clinical neurosensory testing. Study variables included the affected nerve (IAN or LN) and time from injury to treatment (3 to 12 months or >12 months). Univariate statistical analysis (χ2 test) was performed to determine significance between the groups. RESULTS: Neurosensory improvement was observed in 46.7% of the LLLT patients, who showed at least a 1-unit improvement at 3 months, compared with 38.5% improvement for controls (P = .66), regardless of the specific nerve involved (IAN or LN). In addition, no observed difference was noted between the study groups based on time from injury to treatment. CONCLUSIONS: This study failed to provide sufficient evidence to conclude that a difference in neurosensory improvement exists between the LLLT and placebo groups with IAN or LN injuries. However, this study is unique in the prospective double-blind study design and comprehensive neurosensory testing protocols. There is a continued need for further clinical studies on LLLT in oral and maxillofacial surgery nerve injuries.


Subject(s)
Low-Level Light Therapy/methods , Postoperative Complications/therapy , Trigeminal Nerve Injuries/therapy , Adult , Double-Blind Method , Female , Follow-Up Studies , Humans , Male , Prospective Studies , Treatment Outcome , Trigeminal Nerve Injuries/etiology
6.
Cephalalgia ; 37(7): 670-679, 2017 Jun.
Article in English | MEDLINE | ID: mdl-28403646

ABSTRACT

Definition and taxonomy This review deals with neuropathic pain of traumatic origin affecting the trigeminal nerve, i.e. painful post-traumatic trigeminal neuropathy (PTTN). Symptomatology The clinical characteristics of PTTN vary considerably, partly due to the type and extent of injury. Symptoms involve combinations of spontaneous and evoked pain and of positive and negative somatosensory signs. These patients are at risk of going through unnecessary dental/surgical procedures in the attempt to eradicate the cause of the pain, due to the fact that most dentists only rarely encounter PTTN. Epidemiology Overall, approximately 3% of patients with trigeminal nerve injuries develop PTTN. Patients are most often female above the age of 45 years, and both physical and psychological comorbidities are common. Pathophysiology PTTN shares many pathophysiological mechanisms with other peripheral neuropathic pain conditions. Diagnostic considerations PTTN may be confused with one of the regional neuralgias or other orofacial pain conditions. For intraoral PTTN, early stages are often misdiagnosed as odontogenic pain. Pain management Management of PTTN generally follows recommendations for peripheral neuropathic pain. Expert opinion International consensus on classification and taxonomy is urgently needed in order to advance the field related to this condition.


Subject(s)
Facial Pain , Trigeminal Nerve Injuries , Trigeminal Neuralgia , Adult , Facial Pain/diagnosis , Facial Pain/etiology , Facial Pain/therapy , Female , Humans , Male , Middle Aged , Neuralgia/diagnosis , Neuralgia/etiology , Neuralgia/therapy , Trigeminal Nerve Injuries/complications , Trigeminal Nerve Injuries/diagnosis , Trigeminal Nerve Injuries/therapy , Trigeminal Neuralgia/diagnosis , Trigeminal Neuralgia/etiology , Trigeminal Neuralgia/therapy
7.
Br Dent J ; 222(6): 447-455, 2017 Mar 24.
Article in English | MEDLINE | ID: mdl-28337002

ABSTRACT

Aims Periapical lesions have been implicated in mandibular trigeminal sensory neuropathy. This study aimed to report on a case series of consecutive patients presenting with mandibular division trigeminal nerve injuries (TNI) caused by periapical lesions. Common presenting characteristics and possible strategies for management were also investigated.Materials and methods A retrospective study of 22 patients with TNI caused by periapical lesions. Data were extracted from patient records and analysed using Microsoft Excel and SPSS. Factors associated with TNI resolution were assessed using Student's t-Tests and one-way Analysis of Variance (ANOVA), where P <0.05 indicated statistical significance.Results Twenty-one patients had inferior alveolar nerve injuries (IANI) and one had a lingual nerve injury (LNI). The most commonly affected teeth were the first molars (11 patients; 50%). TNI symptoms included numbness, pain and/or paraesthesia. IANI resolved completely among five patients within a mean time of 4.7 months (range 1.5-12 months). Patients who showed complete resolution had the affected teeth extracted or primary endodontic treatment with antibiotics.Conclusions Patients with TNI caused by periapical lesions can suffer significantly from combined numbness, pain and paraesthesia. Resolution of these injuries may be maximised upon early diagnosis and treatment of the periapical lesion by tooth extraction or primary endodontic treatment.


Subject(s)
Periapical Diseases/complications , Trigeminal Nerve Injuries/etiology , Adult , Aged , Female , Humans , Male , Mandible , Middle Aged , Retrospective Studies , Tooth , Trigeminal Nerve Injuries/diagnosis , Trigeminal Nerve Injuries/therapy
8.
Oral Maxillofac Surg Clin North Am ; 28(3): 371-80, 2016 08.
Article in English | MEDLINE | ID: mdl-27475512

ABSTRACT

This article discusses neuropathic pain of traumatic origin affecting the trigeminal nerve. This syndrome has been termed painful traumatic trigeminal neuropathy by the International Headache Society and replaces atypical odontalgia, deafferentation pain, traumatic neuropathy, and phantom toothache. The discussion emphasizes the diagnosis and the early and late management of injuries to the trigeminal nerve and subsequent painful conditions.


Subject(s)
Chronic Pain/diagnosis , Chronic Pain/therapy , Trigeminal Nerve Injuries/diagnosis , Trigeminal Nerve Injuries/therapy , Diagnosis, Differential , Humans , Pain Management , Pain Measurement , Syndrome
9.
Br Dent J ; 220(12): 627-35, 2016 Jun 24.
Article in English | MEDLINE | ID: mdl-27338902

ABSTRACT

Introduction Sensory neuropathies of the mandibular division of the trigeminal (V3) nerve can be debilitating, causing difficulty with daily function. It has a variety of causes, including iatrogenic injury, usually caused by third molar removal, local anaesthetic administration, implant placement or endodontic treatment. Non-iatrogenic causes include infection, primary or secondary neoplasia and various medical conditions.Objective To review the aetiology, evaluation and management of V3 neuropathy in a retrospective case-series of patients referred to a specialist nerve injury clinic over an eight-year period, particularly focusing on the non-iatrogenic causes of this presentation.Methods A retrospective analysis of the case notes of 372 patients referred to the specialist nerve injury clinic between 2006 and 2014 was carried out to establish the cause of the neuropathy and subsequent management or referral. The assessment protocol of trigeminal neuropathy used in the clinic is also outlined.Results Most patients (89.5%) presented with neuropathy due to iatrogenic injury. Of the non-iatrogenic causes (10.5%), malignancy accounted for a fifth of presentations, and infection almost two-fifths, demonstrating the importance of prompt identification of a cause and management by the clinician, or referral to the appropriate specialty. Other, more rare causes are also presented, including multiple sclerosis, sickle-cell anaemia and Paget's disease, highlighting the importance to the clinician of considering differential diagnoses.Conclusions This case series demonstrates the less frequent, but nevertheless important, non-iatrogenic causes which clinicians should consider when assessing patients with trigeminal neuropathy.


Subject(s)
Anesthesia, Local , Tooth Extraction , Trigeminal Nerve Diseases , Trigeminal Nerve Injuries , Humans , Mandible , Retrospective Studies , Trigeminal Nerve Injuries/diagnosis , Trigeminal Nerve Injuries/therapy
10.
Schmerz ; 30(1): 99-117, 2016 Feb.
Article in German | MEDLINE | ID: mdl-26815785

ABSTRACT

Neuropathic pain is the result of a lesion or disease of the somatosensory system in the peripheral or central nervous system. Classical trigeminal neuralgia and posttraumatic trigeminal neuropathy are pain disorders which oral and maxillofacial surgeons and dentists are confronted with in the differential diagnostics in routine daily practice. The etiopathogenesis of classical trigeminal neuralgia is attributable to pathological blood vessel-nerve contact in the trigeminal nerve root entry zone to the brain stem. The typical pain symptoms are characterized by sudden stabbing pain attacks. The pharmaceutical prophylaxis is based on the individually titrated administration of anticonvulsant drugs. The indications for interventional treatment are dependent on the course, response to drug treatment, resilience and wishes of the patient. The neuropathic mechanism of posttraumatic trigeminal neuropathy originates from nerve damage, which leads to peripheral and central sensitization with lowering of the pain threshold and multiple somatosensory disorders. The prophylaxis consists of avoidance of excessive acute and long-lasting pain stimuli. Against the background of the biopsychosocial pain model, the treatment of posttraumatic trigeminal neuropathy necessitates a multimodal, interdisciplinary concept.


Subject(s)
Facial Pain/diagnosis , Trigeminal Nerve Injuries/diagnosis , Trigeminal Neuralgia/diagnosis , Aged , Anticonvulsants/therapeutic use , Combined Modality Therapy , Cross-Sectional Studies , Diagnosis, Differential , Facial Pain/classification , Facial Pain/etiology , Facial Pain/therapy , Female , Glossopharyngeal Nerve Diseases/classification , Glossopharyngeal Nerve Diseases/diagnosis , Glossopharyngeal Nerve Diseases/etiology , Glossopharyngeal Nerve Diseases/therapy , Humans , Interdisciplinary Communication , Intersectoral Collaboration , Male , Middle Aged , Risk Factors , Trigeminal Nerve Injuries/classification , Trigeminal Nerve Injuries/etiology , Trigeminal Nerve Injuries/therapy , Trigeminal Neuralgia/classification , Trigeminal Neuralgia/etiology , Trigeminal Neuralgia/therapy
11.
Compend Contin Educ Dent ; 36(9): 652-9; quiz 660, 2015 Oct.
Article in English | MEDLINE | ID: mdl-26448148

ABSTRACT

Proper patient selection and treatment planning with respect to dental implant placement can preclude nerve injuries. Nevertheless, procedures associated with implant insertion can inadvertently result in damage to branches of the trigeminal nerve. Nerve damage may be transient or permanent; this finding will depend on the cause and extent of the injury. Nerve wounding may result in anesthesia, paresthesia, or dysesthesia. The type of therapy to ameliorate the condition will be dictated by clinical and radiographic assessments. Treatment may include monitoring altered sensations to see if they subside, pharmacotherapy, implant removal, reverse-torquing an implant to decompress a nerve, combinations of the previous therapies, and/or referral to a microsurgeon for nerve repair. Patients manifesting altered sensations due to various injuries require different therapies. Transection of a nerve dictates immediate referral to a microsurgeon for evaluation. If a nerve is compressed by an implant or adjacent bone, the implant should be reverse-torqued away from the nerve or removed. When an implant is not close to a nerve, but the patient is symptomatic, the patient can be monitored and treated pharmacologically as long as symptoms improve or the implant can be removed. There are diverse opinions in the literature concerning how long an injured patient should be monitored before being referred to a microsurgeon.


Subject(s)
Dental Implantation/adverse effects , Trigeminal Nerve Injuries/etiology , Disease Management , Humans , Incidence , Trigeminal Nerve Injuries/diagnosis , Trigeminal Nerve Injuries/epidemiology , Trigeminal Nerve Injuries/therapy
13.
Dent Clin North Am ; 59(2): 357-73, 2015 Apr.
Article in English | MEDLINE | ID: mdl-25835799

ABSTRACT

Injuries to branches of the trigeminal nerves are a known complication during dental implant placement. These injuries tend to be more severe than those experienced during other dentoalveolar procedures. This article reviews the types of nerve injuries and areas and situations of which clinicians should be cognizant when placing dental implants. Strategies to avoid injuries, and a management algorithm for suspected nerve injuries, are also discussed.


Subject(s)
Dental Implants/adverse effects , Trigeminal Nerve Injuries/etiology , Dental Arch/innervation , Dental Implantation, Endosseous/adverse effects , Dental Implantation, Endosseous/methods , Humans , Mandible/innervation , Maxilla/innervation , Nerve Compression Syndromes/classification , Nerve Compression Syndromes/etiology , Trigeminal Nerve Injuries/classification , Trigeminal Nerve Injuries/therapy
14.
J Am Dent Assoc ; 145(8): 859-61, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25082936

ABSTRACT

BACKGROUND: Nerve injury is a known and accepted risk of many oral surgical and dental procedures. Such injuries may occur despite the practitioner's providing the best of care. Taking proactive measures during evaluation and surgery may reduce the incidence of nerve injury. RESULTS: Injuries to the peripheral branches of the trigeminal nerve can cause unfavorable effects on orofacial sensation and related functions such as eating, drinking, washing, speaking, shaving and kissing. CONCLUSIONS: When nerve injuries secondary to dental or oral surgery procedures fail to resolve promptly and the resulting dysesthesia is unacceptable to the patient, timely treatment gives the patient the best chance of a favorable outcome. Treatment may involve surgical exploration and repair of the injured nerve. PRACTICAL IMPLICATIONS: Recognition of and prompt referral for nerve injuries give the patient the best chance of achieving improvement or recovery of sensory function in the distribution of the injured nerve.


Subject(s)
Lingual Nerve Injuries/etiology , Neurology , Oral Surgical Procedures/adverse effects , Referral and Consultation , Humans , Lingual Nerve Injuries/therapy , Trigeminal Nerve Injuries/etiology , Trigeminal Nerve Injuries/therapy , Workforce
15.
J Ir Dent Assoc ; 60(5): 241-50, 2014.
Article in English | MEDLINE | ID: mdl-25638921

ABSTRACT

Inferior alveolar nerve injuries are a recognised complication of mandibular third molar extractions. This paper describes the different types of nerve injuries that may occur. A differential of possible causes is provided and an approach to the immediate and follow-up management is outlined. The prognosis of such injuries is reviewed so that patients can be informed of the possible postoperative outcome. The algorithm shows the timeline for monitoring/referring and the included tables outline the advantages and disadvantages of surgery versus watchful waiting.


Subject(s)
Mandibular Nerve/physiopathology , Somatosensory Disorders/etiology , Tooth Extraction/adverse effects , Trigeminal Nerve Injuries/etiology , Humans , Nerve Block/adverse effects , Prognosis , Sensory Thresholds/physiology , Somatosensory Disorders/therapy , Trigeminal Nerve Injuries/therapy
16.
Somatosens Mot Res ; 30(4): 175-84, 2013 Dec.
Article in English | MEDLINE | ID: mdl-23721649

ABSTRACT

Neuronal excitability in the trigeminal sensory nuclei (TSN) changes after nerve transection. We examined the effects of chronic transection of the trigeminal nerve on the c-Fos-immunoreactivity in the TSN induced 2 h after 10 min of electrical stimulation of the trigeminal ganglion (TG) at C-fiber activating condition (1.0 mA, 5 ms, 5 Hz) in urethane-anesthetized rats. In the non-transected control rats, stimulation of the TG induced c-Fos-immunoreactive cells (c-Fos-IR cells) mostly in superficial layers (VcI/II) of the nucleus caudalis (Vc) in its full extent along the dorsomedial-ventrolateral axis, but modestly in the rostral TSN above the obex, the principal, oral, and interpolar nuclei. Three days, 1, 2, or 3 weeks after transection of the inferior alveolar (IAN), infraorbital, or masseteric nerves, the stimulation of the TG induced c-Fos-IR cells in the central terminal fields of the transected nerve in the rostral TSN and magnocellular zone of the Vc. However, the number of c-Fos-IR cells in the VcI/II decreased inside the central terminal fields of the transected nerve and increased outside the fields. These results indicate that transection of the trigeminal nerve increases the excitability of TSN neurons that receive inputs from injured mechanoreceptors and uninjured nociceptors, but decreases it from injured nociceptors. The altered c-Fos responses may imply mechanisms of neuropathic pain seen after nerve injury.


Subject(s)
Brain Stem/metabolism , Electric Stimulation/methods , Gene Expression Regulation/physiology , Proto-Oncogene Proteins c-fos/metabolism , Trigeminal Ganglion/physiology , Trigeminal Nerve Injuries/pathology , Afferent Pathways/physiology , Analysis of Variance , Animals , Biophysics , Disease Models, Animal , Male , Rats , Rats, Sprague-Dawley , Time Factors , Trigeminal Nerve Injuries/therapy
17.
Clin Oral Implants Res ; 24(2): 183-90, 2013 Feb.
Article in English | MEDLINE | ID: mdl-22092662

ABSTRACT

OBJECTIVES: Inferior alveolar nerve (IAN) is the most commonly injured nerve (64.4%) during implant treatment. At present, no standardized protocol exists for clinicians to manage IAN injury related with implant surgery. Therefore, the purposes of the present article were to analyze the reasons for nerve injury and to propose guidelines in managing IAN injury. MATERIAL AND METHODS: Patients with IAN sensory disturbances after implant treatment were recruited for the study. Sixteen patients, eight men and eight women, with a mean age of 52.2 ± 8.1 years participated in this study. Patient examination, treatment, and IAN sensory function recovery monitoring were performed following six-step IAN injury during dental implant surgery (IANIDIS) protocol. The control group was composed of 25 healthy volunteers who never had IAN sensory disturbances or any trauma in the maxillofacial region. RESULTS: The IAN sensory disturbances were scored as following: 5 (31.25%) had hyperalgesia and 11 (68.75%) expressed hypoalgesia. The mean asymmetry index (AI) was calculated for each patient and varied from 0.6 to 3.2. Overall, 31.3% of nerve injury patients were classified as mild, 31.3% as moderate, and remaining 37.5% as severe injury. All patients were successfully treated with proposed IANIDIS protocol. CONCLUSION: The most frequent (50%) risk factor for IAN injury was intraoperative bleeding during bone preparation. The most common (56.3%) etiological risk factor of nerve injury was dental implant. A six-step protocol aimed at managing patients with IAN injury, during dental implant surgery, was a useful tool that could provide successful treatment outcome.


Subject(s)
Dental Implantation, Endosseous/adverse effects , Dental Implants/adverse effects , Mandibular Nerve , Trigeminal Nerve Injuries/etiology , Trigeminal Nerve Injuries/therapy , Adult , Female , Humans , Iatrogenic Disease , Injury Severity Score , Male , Middle Aged , Pain Measurement , Recovery of Function , Risk Factors
18.
J Neurotrauma ; 30(6): 480-6, 2013 Mar 15.
Article in English | MEDLINE | ID: mdl-23190308

ABSTRACT

Nerve-related complications have been frequently reported in dental procedures, and a very frequent type of occurrence involves the inferior alveolar nerve (IAN). The nerve injury in humans often results in persistent pain accompanied by allodynia and hyperalgesia. In this investigation, we used an experimental IAN injury in rats, which was induced by a Crile hemostatic clamp, to evaluate the effects of laser therapy on nerve repair. We also studied the nociceptive behavior (von Frey hair test) before and after the injury and the behavioral effects of treatment with laser therapy (emitting a wavelength of 904 nm, output power of 70 Wpk, a spot area of ∼0.1 cm², frequency of 9500 Hz, pulse time 60 ns and an energy density of 6 J/cm²). As neurotrophins are essential for the process of nerve regeneration, we used immunoblotting techniques to preliminarily examine the effects of laser therapy on the expression of nerve growth factor (NGF) and brain-derived neurotrophic factor (BDNF). The injured animals treated with laser exhibited an improved nociceptive behavior. In irradiated animals, there was an enhanced expression of NGF (53%) and a decreased BDNF expression (40%) after laser therapy. These results indicate that BDNF plays a locally crucial role in pain-related behavior development after IAN injury, increasing after lesions (in parallel to the installation of pain behavior) and decreasing with laser therapy (in parallel to the improvement of pain behavior). On the other hand, NGF probably contributes to the repair of nerve tissue, in addition to improving the pain-related behavior.


Subject(s)
Brain-Derived Neurotrophic Factor/biosynthesis , Low-Level Light Therapy/methods , Mandibular Nerve/metabolism , Nerve Growth Factor/biosynthesis , Pain/metabolism , Trigeminal Nerve Injuries/metabolism , Animals , Male , Nerve Growth Factors/biosynthesis , Pain Management/methods , Rats , Rats, Wistar , Trigeminal Nerve Injuries/therapy
19.
Int J Oral Maxillofac Surg ; 41(5): 629-37, 2012 May.
Article in English | MEDLINE | ID: mdl-22326447

ABSTRACT

This study describes the management of 216 patients with post-traumatic iatrogenic lingual nerve injuries (LNIs; n=93) and inferior alveolar nerve injuries (IANI; n=123). At initial consultation, 6% IANI and 2% LNI patients had undergone significant resolution requiring no further reviews. Reassurance and counselling was adequate management for 51% IANI and 55% LNI patients. Systemic or topical medication was offered as pain relief to 5% of patients. Additional cognitive behaviour therapy (CBT) was offered to 8% of patients. Topical 5% lidocaine patches reduced pain and allodynia in 7% of IANI patients, most often used without any other form of management. A small percentage of IANI patients (4%) received a combination of therapies involving CBT, surgery, medication and 5% lidocaine patches. Exploratory surgery improved symptoms and reduced neuropathic area in 18 LNI and 15 IANI patients resulting in improved quality of life. In conclusion, the authors suggest a more diverse and perhaps holistic strategy for management of patients with iatrogenic trigeminal nerve injuries and recommend pragmatic assessment criteria for measurement of treatment success in these patients.


Subject(s)
Iatrogenic Disease , Trigeminal Nerve Injuries/therapy , Adult , Aged , Aged, 80 and over , Analgesics/therapeutic use , Anastomosis, Surgical/methods , Anesthetics, Local/administration & dosage , Cognitive Behavioral Therapy , Cohort Studies , Combined Modality Therapy , Counseling , Decompression, Surgical/methods , Humans , Lidocaine/administration & dosage , Lingual Nerve Injuries/therapy , Mandibular Nerve/pathology , Middle Aged , Pain Management/methods , Pain Measurement , Quality of Life , Remission, Spontaneous , Somatosensory Disorders/classification , Somatosensory Disorders/diagnosis , Trigeminal Nerve Injuries/diagnosis , Trigeminal Neuralgia/diagnosis , Trigeminal Neuralgia/therapy , Young Adult
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