Uso do laser de baixa potência para o tratamento de parestesia: uma revisão de literatura / Use of low-level laser to treat paresthesia: a literature review

Introdução: A parestesia é uma neuropatia que afeta a função sensorial. O Laser de Baixa Potência (LBP), por sua vez, apresenta propriedades analgésicas, bioestimuladoras e reparadoras. Objetivo: Realizar um levantamento na literatura científica sobre os aspectos gerais e benefícios do LBP no manejo terapêutico da parestesia, além de identificar a classificação e métodos de obtenção do diagnóstico desta condição. Materiais e Métodos: Tratou-se de uma revisão narrativa da literatura através da busca nas plataformas PubMed, SciELO, LILACS e Google Schoolar. Após o cruzamento dos descritores com os operadores booleanos e aplicação dos critérios de inclusão/exclusão, 26 estudos foram incluídos. Resultados: A parestesia pode ser classificada em neuropraxia, axonotmese e neurotmese, subdivididas em Grau I ao V. Seu diagnóstico pode ser executado através de testes subjetivos e objetivos. O LBP compreende em um dispositivo tecnológico com efeitos analgésico, anti-inflamatório e fotobiomodulador, que estimula o reparo neural. Os estudos mostram que a dosimetria nos comprimentos de onda vermelho e infravermelho, aplicação intra e extra oral, e com mais de uma sessão semanal exerce efeito modulatório positivo do reparo neural, com retorno progressivo da atividade sensitiva. Além disso, os estudos trazem uma ampla variação no número de pontos de aplicação, bem como no tempo de irradiação e quantidade de sessões, em virtude da extensão e tempo de diagnóstico da parestesia. Considerações finais: Apesar da alta complexidade da parestesia, o LBP exerce efeitos benéficos através do retorno da sensibilidade parcial ou total, além de ser um dispositivo bem tolerado pelo organismo e minimamente invasivo.

Introduction: Paresthesia is a neuropathy that affects sensory function. The Low-Level Laser (LLL), in turn, has analgesic, biostimulating and reparative properties. Purpose: Carry out a survey at the scientific literature on the general aspects and benefits of LLL in the therapeutic management of paresthesia in addition to identifying the classification and methods for obtaining a diagnosis of this condition. Materials and Methods: It was a narrative literature review through search in platforms PubMed, SciELO, LILACS and Google Schoolar. After crossing the descriptors with boolean operators and applying the inclusion/exclusion criteria, 26 articles were included in this study. Results: Paresthesia can be classified into neuropraxia, axonotmesis and neurotmesis, subdivided into Grades I to V. Its diagnostic can be carried out through subjective and objective tests. The LLL consists in a technological device with analgesic, anti-inflammatory and photobiomodulatory effects, which stimulates neural repair. Studies show that LLL in dosimetry at red and infrared wavelengths with intra and extra oral application and with more than one-week use exerts a positive modulatory effect on neural repair, with a progressive return of sensory activity. Furthermore, the studies show a wide variation in the number of application points, as well as the irradiation time and number of sessions, due to the extent and time of diagnosis of paresthesia. Final Considerations: Despite the high complexity of paresthesia, the LLL has beneficial effects through the return of partial or total sensitivity in addition being a device well tolerated by the body and minimally invasive.

[Low power laser as an adjuvant to paresthesia. report of two cases]. / Láser de baja potencia como coadyuvante a la parestesia. reporte de dos casos.

Tooth extraction or extraction is a common procedure in dental practice, although it is a common practice, it is not exempt from complications. Paraesthesia is defined as a neuropathy with altered sensations and permanent anesthesia. The case of two patients who attended the Department of Pathology at the Faculty of Dentistry with paresthesia is reported. Both were treated with low-power laser therapy, showing a significant improvement in their clinical condition. The application of low-power laser presents ideal benefits in various areas of the stomatological field. As it is a non-invasive, painless treatment and short sessions, the patient is encouraged to continue with the treatment until they are almost completely rehabilitated.

Treatment of lingual nerve paresthesia through photobiomodulation therapy: a case report employing an approach integrating extraoral and intraoral modalities

Aims: Oral nerve injuries are the primary cause of paresthesia in the head and neck regions. To report the managing of a combined protocol involving extraoral and intraoral photobiomodulation (PBM) therapy for lingual nerve paresthesia. Case report: A 38-year-old female patient underwent 25 PBM sessions using laser with dual wavelength infrared (810nm + 980 nm). The extraoral application included 6 seconds and 6J per point. per point, 1W, 4.91 cm², 1.2 J/cm. The intraoral protocol with 0.3W of power, a spot size of 0.38 cm², 15.78 J/cm² of energy density, 6J of energy per point, for 20 seconds. Results: Assessment of neurosensitivity on the dorsum of the tongue was a 75% improvement. On the lateral tongue improved to 50%. In the floor of the mouth, PBM demonstrated a 25% improvement. Conclusion: PBM is an important treatment option in the case of lingual nerve paresthesia. The use of PBM should be considered as a feasible, non-invasive treatment approach.

Evaluation of early ocular discomfort after glaucoma surgery: trabeculectomy versus Ahmed glaucoma valve implantation

ABSTRACT Purpose: This study aims to compare the initial ocular discomfort symptoms resulting from trabeculectomy and Ahmed glaucoma valve implantation surgeries. Methods: A prospective comparative study was conducted. The evaluation of ocular discomfort employed a questionnaire designed to identify the frequency and severity of distinct symptoms: ocular pain, general discomfort, tearing, foreign body sensation, and burning. This questionnaire was administered prior to surgery as a baseline, and subsequently at 7, 30, and 90 days post-surgery. Simultaneously, the Ocular Surface Disease Index (OSDI) was applied at these same time intervals. Results: The study encompassed a total of 17 patients (9 undergoing trabeculectomy and 8 undergoing Ahmed glaucoma valve implantation). The Ahmed glaucoma valve implantation group exhibited higher tearing levels at baseline (p=0.038). However, no statistically significant differences in symptoms were observed between the two surgeries at 7 and 30 days post-surgery. At the 90-day mark following surgery, patients who had undergone trabeculectomy reported a significantly higher foreign body sensation (p=0.004). Although OSDI scores did not differ between groups at baseline, the trabeculectomy group showed significantly higher OSDI scores than the Ahmed glaucoma valve implantation group at 7, 30, and 90 days after surgery (p<0.05). Conclusion: Post-surgery, patients who had undergone trabeculectomy experienced increased foreign body sensation. Trabeculectomy appears to cause greater early postoperative ocular discomfort compared to the Ahmed glaucoma valve implantation group.

Laserterapia de baixa intensidade aplicado a parestesia do nervo alveolar inferior / Low laser therapy applied to inferior alveolar nerve paresthesia

A parestesia do nervo alveolar inferior é uma alteração neurossensorial, que provoca distúrbios de sensibilidade em determinadas áreas da face, essa situação pode ocorrer em diversos procedimentos cirúrgicos odontológicos. Na qual pode-se citar diversas técnicas de tratamento para tal complicação. Sob esse viés, a aplicação do laser de baixa intensidade na região afetada, vem obtendo resultados amplamente satisfatórios, apresentando uma melhora eficaz em sua recuperação sensorial ao decorrer do seu tratamento, além de ser uma via terapêutica de protocolo e método simples, baixo custo e não invasivo. Visto isso, este trabalho teve por objetivo compreender a eficácia da terapia com laser de baixa potência para o tratamento da parestesia orofacial do nervo alveolar inferior em complicações pós-operatórias em procedimentos cirúrgicos na odontologia. O estudo aqui presente baseia-se numa revisão de literatura narrativa e qualitativa, dentre as quais as bases de dados utilizadas foram: Google Scholar, PubMed e Portal BVS. A busca resultou no total de 456 artigos, dentre os quais após filtragem em leitura dos títulos, dos resumos e suas metodologias, foram selecionados 21 artigos para leitura íntegra e produção desta literatura. Portanto, por mais que haja divergência quanto ao protocolo da laserterapia para as diferentes classificações da parestesia do NAI, a literatura aponta evidências quanto a sua melhora sensorial, alguns autores mencionam através da Escala visual analógica que os lasers possuíram resultados significativos ao decorrer do tratamento(AU)

Inferior alveolar nerve paresthesia is a sensorineural alteration, which causes sensitivity disorders in certain areas of the face, this situation can occur in several dental surgical procedures. In which one can cite several treatment techniques for such a complication. The application of low-intensity laser in the affected region has obtained largely satisfactory results, showing an effective improvement in its sensory recovery during the course of its treatment, in addition to being a therapeutic route with a simple protocol and method, low cost and noninvasive. Given this, this study aimed to understand the effectiveness of low-power laser therapy for the treatment of orofacial paresthesia of the inferior alveolar nerve in postoperative complications in surgical procedures in dentistry. The present study is based on a review of narrative and qualitative literature, among which the databases used were: Google Scholar, PubMed and Portal VHL. The search resulted in a total of 454 articles, among which after filtering by reading the titles, reading the abstract and their methodologies, 19 articles were selected for full reading and production of this literature. Therefore, as much as there is divergence regarding the laser therapy protocol for the different classifications of IAN paresthesia, the literature points to evidence regarding its sensory improvement, some authors mention through the visual analogue Escava that the lasers had significant results during the treatment(AU)

Endoscopic Release of the Ulnar Nerve at the Elbow: Technique Description and Case Series.

Objective The endoscopic release of the ulnar nerve reproduces a simple ( in situ ) procedure with smaller incisions, less soft tissue damage, and higher preservation of nerve vascularization. Endoscopy allows the clear visualization of the entire path of the nerve and surrounding noble structures. Moreover, it reveals any signs of compression and allows a safe release of 10 cm distally or proximally to the medial epicondyle. Methods A retrospective survey revealed that 15 subjects (1 with a bilateral injury) underwent an ulnar nerve compression release at the elbow using the endoscopic technique with Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA) equipment from January 2016 to January 2020. Results Symptoms of ulnar nerve compression improved in all patients; on average, they resumed their work activities in 26.5 days. There was no recurrence or need for another procedure. In addition, there were no severe procedure-related complications, such as infection and nerve or vascular injury. One patient had transient paresthesia of the sensory branches to the forearm, with complete functional recovery in 8 weeks. Conclusion Our study shows that the endoscopic release of the ulnar nerve at the elbow with the Agee equipment is a safe, reliable technique with good outcomes.

Somatosensory Auras in Epilepsy: A Narrative Review of the Literature.

An aura is a subjective experience felt in the initial phase of a seizure. Studying auras is relevant as they can be warning signs for people with epilepsy. The incidence of aura tends to be underestimated due to misdiagnosis or underrecognition by patients unless it progresses to motor features. Also, auras are associated with seizure remission after epilepsy surgery and are an important prognostic factor, guiding the resection site and improving surgical outcomes. Somatosensory auras (SSAs) are characterized by abnormal sensations on one or more body parts that may spread to other parts following a somatotopic pattern. The occurrence of SSAs among individuals with epilepsy can range from 1.42% to 80%. The upper extremities are more commonly affected in SSAs, followed by the lower extremities and the face. The most common type of somatosensory aura is paresthetic, followed by painful and thermal auras. In the primary somatosensory auras, sensations occur more commonly contralaterally, while the secondary somatosensory auras can be ipsilateral or bilateral. Despite the high localizing features of somatosensory areas, cortical stimulation studies have shown overlapping sensations originating in the insula and the supplementary sensorimotor area.

The Relationship between Paresthesia and the Presence of Cardiac Dysautonomia in Patients with Post-COVID-19 Syndrome: A Preliminary Observational Study.

INTRODUCTION: Post-Coronavirus disease 2019 (Post-COVID-19) syndrome has neurological symptoms related to the dysfunction of the autonomous nerve system. However, a pathogenic relationship between post-COVID-19 syndrome and dysautonomia still remains to be demonstrated. Establishing a pathogenic relationship between paresthesia and the presence of cardiac dysautonomia in patients with post-COVID-19 syndrome is the objective of this study. PARTICIPANTS AND METHODS: This observational study was carried out in the neurophysiology service wing of the Juan Bruno Zayas Hospital, Santiago de Cuba, in Cuba. The patients were recruited through a post-COVID-19 clinic at the same hospital. A variability study of cardiac frequency and a test of autonomic cardiovascular reflexes was carried out, which is composed of deep breathing, orthostatism, and the Valsalva maneuver. RESULTS: The variability parameters of the cardiac frequency, the expiration-inspiration ratio between deep breaths, and the Valsalva Index showed no statistically significant differences between healthy participants and those with post-COVID-19 syndrome. During the Valsalva maneuver, there was a greater cardiac frequency response in participants with post-COVID-19 syndrome than in healthy subjects. The difference in supine and standing blood pressure was significantly minor in patients with post-COVID-19 syndrome. The logarithm of high frequency (log HF) increased significantly in patients with paresthesia when compared to patients without paresthesia. CONCLUSIONS: In the autonomic function tests, no signs of dysautonomia were found in patients with post-COVID-19 syndrome. The presence of paresthesias is associated with differences in cardiac vagal activity, which may suggest that damage to peripheral sensory nerve fibers could be associated with an affectation to autonomic fibres.

Diagnostic Contradictions in Carpal Tunnel Syndrome.

Objective Given the divergence of opinions on the need for complementary tests such as ultrasonography (US) and electroneuromyography (ENMG) for the diagnosis of carpal tunnel syndrome (CTS), we aimed to elucidate which of them presents greater accuracy for the confirmation of the presence or not of this condition. Methods A total of 175 patients from a hand surgery outpatient clinic were clinically evaluated, and the results of clinical trials (Tinel, Phalen and Durkan), US (normal or altered), and ENMG (normal, mild, moderate and severe) were noted, crossed, and submitted to a statistical analysis to verify the agreement between them. Results with the sample had a mean age of 53 years, with a prevalence of female patients (159 cases). Of the patients with positive clinical test, 43.7% had normal US and 41.7% had no alterations on the ENMG. Negative results were found on the Tinel in 46.9%, on the Phalen in 47.4%, and on the Durkan in 39.7%. In the crossing between the results of the ENMG and those of the other diagnostic methods, there was little statistical agreement between them. Conclusion There was no agreement between the results of the clinical examinations, the US and the ENMG in the diagnosis of CTS, and there is no clinical or complementary examination for CTS that accurately determines the therapeutic approach. Level of Evidence IV, Case Series.

Endoscopic Release of the Ulnar Nerve at the Elbow: Technique Description and Case Series / Liberação endoscópica do nervo ulnar no cotovelo: Descrição da técnica e série de casos

Abstract Objective The endoscopic release of the ulnar nerve reproduces a simple (in situ) procedure with smaller incisions, less soft tissue damage, and higher preservation of nerve vascularization. Endoscopy allows the clear visualization of the entire path of the nerve and surrounding noble structures. Moreover, it reveals any signs of compression and allows a safe release of 10cm distally or proximally to the medial epicondyle. Methods A retrospective survey revealed that 15 subjects (1 with a bilateral injury) underwent an ulnar nerve compression release at the elbow using the endoscopic technique with Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA) equipment from January 2016 to January 2020. Results Symptoms of ulnar nerve compression improved in all patients; on average, they resumed their work activities in 26.5 days. There was no recurrence or need for another procedure. In addition, there were no severe procedure-related complications, such as infection and nerve or vascular injury. One patient had transient paresthesia of the sensory branches to the forearm, with complete functional recovery in 8 weeks. Conclusion Our study shows that the endoscopic release of the ulnar nerve at the elbow with the Agee equipment is a safe, reliable technique with good outcomes.

Resumo Objetivo A liberação endoscópica do nervo ulnar permite reproduzir uma liberação simples (in situ), mas através de incisões menores e com menor lesão de partes moles e uma maior preservação da vascularização do nervo. A visualização clara através da endoscopia permite observar todo o trajeto do nervo e das estruturas nobres circundantes, mostrando os sinais de compressão, possibilitando realizar a liberação de forma segura em um trajeto de 10 cm nos sentidos distal e proximal ao epicôndilo medial. Método Foram encontrados, de forma retrospectiva, no período entre janeiro de 2016 e janeiro de 2020, 15 pacientes (sendo 1 com lesão bilateral) submetidos a liberação da compressão do nervo ulnar no cotovelo pela técnica endoscópica com equipamento de Agee (Micro-Aire Sugical Instruments, Charlottesville, VA, EUA). Resultados Todos os pacientes tiveram melhora dos sintomas de compressão do nervo ulnar e o período de retorno ao trabalho foi de em média 26,5 dias. Não houve recidivas e não houve a necessidade de outro procedimento. Também não houve complicações graves decorrentes do procedimento, como infecção, lesão nervosa ou vascular. Em um paciente, houve parestesia transitória dos ramos sensitivos para o antebraço, com retorno completo da função em 8 semanas. Conclusão Os resultados mostram que a liberação endoscópica do nervo ulnar no cotovelo comoequipamentodeAgeeéuma técnica segura, confiável e com bons resultados.

Photobiomodulation using 940-nm laser as an adjuvant therapy on orthognathic surgery: A randomized clinical trial.

This study aimed to evaluate the effectiveness of photobiomodulation (PBM) therapy using 940-nm laser in patients undergoing orthognathic surgery. Twenty individuals were randomly distributed into laser (n = 10) and control (n = 10) groups. The PBM was conducted immediately after surgery, after 24 h, 48 h, and weekly for up to 4 weeks. All participants were evaluated for pain, edema, trismus and paresthesia. Data were compared by Fisher's and Mann-Whitney or chi-square tests (5%). The pain decreased from 24 h to 4 weeks, with the laser group reaching any pain after 3 weeks (p < 0.001). A significant difference was noticed for trismus on days 14 and 30 (p = 0.002; p = 0.019), without difference in paresthesia (p = 0.198). Edema was lower on the laser group compared to control, without a significant difference for most measurements. Data indicate that 940-nm PBM therapy decreased the occurrence of postoperative pain and significantly improved trismus.

Parestesia do nervo alveolar inferior decorrente de procedimentos cirúrgicos e suas formas de tratamentos / Paresthesi of the lower alveolar nerve resulting from surgical procedures and its forms of treatment

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)

Diagnostic Contradictions in Carpal Tunnel Syndrome / Contradições diagnósticas na síndrome do túnel do carpo

Abstract Objective Given the divergence of opinions on the need for complementary tests such as ultrasonography (US) and electroneuromyography (ENMG) for the diagnosis of carpal tunnel syndrome (CTS), we aimed to elucidate which of them presents greater accuracy for the confirmation of the presence or not of this condition. Methods A total of 175 patients from a hand surgery outpatient clinic were clinically evaluated, and the results of clinical trials (Tinel, Phalen and Durkan), US (normal or altered), and ENMG (normal, mild, moderate and severe) were noted, crossed, and submitted to a statistical analysis to verify the agreement between them. Results with the sample had a mean age of 53 years, with a prevalence of female patients (159 cases). Of the patients with positive clinical test, 43.7% had normal US and 41.7% had no alterations on the ENMG. Negative results were found on the Tinel in 46.9%, on the Phalen in 47.4%, and on the Durkan in 39.7%. In the crossing between the results of the ENMG and those of the other diagnostic methods, there was little statistical agreement between them. Conclusion There was no agreement between the results of the clinical examinations, the US and the ENMG in the diagnosis of CTS, and there is no clinical or complementary examination for CTS that accurately determines the therapeutic approach. Level of Evidence IV, Case Series.

Resumo Objetivo Diante da divergência sobre a necessidade de exames complementares, como ultrassonografia (US) e eletroneuromiografia (ENMG) para o diagnóstico da síndrome do túnel do carpo (STC), objetivamos elucidar qual deles apresenta maior precisão na confirmação da presença ou não desta afecção. Métodos Um total de 175 pacientes de um ambulatório de cirurgia da mão foram avaliados clinicamente, e os resultados dos testes clínicos (Tinel, Phalen e Durkan), da US (normal ou alterada) e da ENMG (normal, leve, moderada e grave) foram anotados, cruzados, e submetidos a análise estatística para verificar a concordância entre eles. Resultados A idade média da amostra era de 53 anos, sendo prevalente o sexo feminino (159 casos). Dos pacientes com teste clínico positivo, 43,7% apresentavam US normal, e 41,7%, ENMG sem alterações. Foram encontrados resultados negativos no Tinel em 46,9% no Phalen em 47,4%, e no Durkan em 39,7%. No cruzamento entre a ENMG e os demais métodos diagnósticos, houve pouca concordância estatística. Conclusão Não houve concordância entre os resultados dos exames clínicos, da US e da ENMG no diagnóstico da STC, e não há exame clínico ou complementar para STC que determine a conduta terapêutica com precisão. Nível de Evidência IV, Série de Casos.

Laser acupuncture in the treatment of neuropathies in dentistry: a systematic review.

Laser acupuncture can be used to treat neurosensory alterations and motor disorders caused by dental treatments. This study aimed to review the existing literature on the effects of laser acupuncture on neuropathies in the context of dentistry and to search for treatment modalities in which this technique is used. This systematic review was conducted in accordance with the Cochrane Collaboration guidelines and the PICOS strategy. Randomized clinical trials that evaluated laser acupuncture as a primary intervention for facial neuropathy were included. We searched the database for relevant studies and manually searched the gray literature until April 2022, and finally included four studies. The study was considered eligible if it included patients with paresthesia, facial paralysis, or neuralgia, neuropathies within dentistry, and referred to the application of laser acupuncture as a treatment method. The risk of bias was assessed using the RoB 2 tool. It was observed that the recommended wavelengths ranged from 790 nm to 810 nm, with a frequency of at least two applications per week, and to a greater or lesser degree, all evaluated studies obtained an improvement in sensory or motor recovery of the facial nerves. The use of laser acupuncture presented itself as a viable alternative in dentistry for the treatment of paresthesia and facial paralysis due to its therapeutic potential in neuropathic treatment (CRD42022344339).

Effects of light-emitting diode (LED) therapy on sensory changes in the inferior alveolar nerve after surgical treatment of mandibular fractures: a randomized controlled trial.

PURPOSE: A randomized controlled trial was performed to evaluate the effects of light-emitting diode (LED) therapy on sensory changes in the inferior alveolar nerve after surgical treatment of mandibular fractures. METHODS: Patients admitted with surgically treated mandibular fractures between January 2018 and December 2019 were evaluated. Personal data, fracture location, fracture type, and dislocation degree were obtained. The cases were randomly allocated into two groups: LED therapy (LEDT) (57 points of 660 nm and 74 points of 850 nm, 6.4 mV/cm2, and 7.64 J) with the use of a prototype device and control (CTRL). For 6 months, tactile and thermal tests were used in the mental region. Data were analyzed using the Mann─Whitney U test and likelihood ratio test (p ≤ 0.050). RESULTS: The study included 42 patients, 25 of whom had bilateral fractures and 17 had unilateral fractures, totaling 67 fractures. The mean values of the tactile and thermal sensitivity tests were lower in the LEDT group in all evaluation periods. There was a significant difference between the groups in the parasymphysis location, displacement < 5 mm, and intraoral access. Sensory changes were observed in 68.7% of all fractures upon admission, with 91.2% in the LEDT group and 78.8% in the CTRL group demonstrating complete remission during the final period of the study. CONCLUSION: LED photobiomodulation accelerated the process of sensory change remission. There was an influence of the fracture location, degree of displacement, and surgical access, with a better response in the LEDT group.

Síndrome de POEMS: a propósito de un caso / POEMS syndrome: A case report

RESUMEN El síndrome POEMS es una enfermedad de patogenia desconocida. El acrónimo deriva de las principales manifestaciones clínicas de este cuadro: polineuropatía, organomegalia, endocrinopatía, gammapatía monoclonal y trastornos de la piel. Estudios recientes sugieren la asociación de mutaciones genéticas con inmunoglobulina λ. En este reporte presentamos el caso de un paciente de 56 años, con un cuadro clínico de diez meses de evolución. Al inicio, se presentó un edema en los miembros inferiores e hipertricosis, y luego aparecieron los síntomas gastrointestinales, linfadenopatía inguinal y parestesia de miembros inferiores. Enfatizamos la importancia de este caso clínico debido a que, en nuestro país, los informes de pacientes con el síndrome POEMS son escasos, y en el departamento de La Libertad no existe ningún reporte. Además, el tiempo para diagnosticar esta enfermedad es prolongado.

ABSTRACT POEMS syndrome is a disease of unknown pathogenesis. The acronym stands for the disease's main clinical manifestations: polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin disorders. Recent studies suggest the association of genetic mutations with immunoglobulin λ. We report the case of a 56-year-old male patient with a 10-month clinical picture, whose initial signs and symptoms were lower limb edema and hypertrichosis, followed by gastrointestinal symptoms, inguinal lymphadenopathy and lower limb paresthesia. We emphasize the importance of this clinical case, given the limited reports of POEMS syndrome at the national level and no reported cases in the department of La Libertad, and the long time it takes to diagnose such disease.

Effectiveness of Laser Therapy and Laser Acupuncture on Treating Paraesthesia After Extraction of Lower Third Molars.

Objective: This randomized clinical trial evaluated the sensitive return of the lower alveolar nerve (LAN) using two photobiomodulation therapy (PBMT) techniques, after the extraction of lower third molars or implant surgery. Materials and methods: Sixty participants with sensory impairment of LAN were randomly divided into three groups (n = 20): group C-systemic medication (control-ETNA®, 01 capsule, 8/8 h, 30 days); group laser therapy (LT) (808 nm, 100 mW, 40 sec/point, 4 J/point, intra/extraoral, irradiation following nerve path); group laser acupuncture (LA) (same parameters as the LT group, applied at six acupuncture points on the affected side (ST 4 [Dicang], M-HN-18 [Jiachengjiang], CV 24 [Chengjiang], ST 5 [Daying], ST 6 [Jiache], and point A1 [YNSA]). The following evaluations were performed, at predetermined times: general perception of paresthesia, thermal perception, vibratory mechanical perception, two-point discrimination, pain perception, and tactile perception. Data were analyzed by two-way analysis of variance (ANOVA), followed by the Tukey, except for the two-point discrimination, which was analyzed using the chi-square test. Results: In general and thermal perception, both PBMTs had better results than control; regarding cold perception, only the LT group was statistically superior to control. LA presented inferior results of neural regeneration for tests of perception of pain and tactile at the lip, and of tactile perception at the chin. In the other tests, there was no statistical difference among the groups. Conclusions: LT and the conventional drug treatment had the same effectiveness and both were superior to LA for the treatment of paresthesia of the LAN after oral surgeries.

Onset of Trigger Finger after Carpal Tunnel Syndrome Surgery: Assessment of Open and Endoscopic Techniques.

Objective The present study aimed to determine the frequency of trigger finger (TF) onset after surgery for carpal tunnel syndrome (CTS) using an open (OT) or an endoscopic technique (ET). As a secondary endpoint, the present study also compared paresthesia remission and residual pain rates in patients submitted to both techniques. Methods Trigger finger onset and remission rates of paresthesia and pain at the median nerve territory was verified prospectively in a series of adult patients submitted to an OT procedure ( n = 34). These findings were compared with a retrospective cohort submitted to ET ( n = 33) by the same surgical team. Patients were evaluated with a structured questionnaire in a return visit at least 6 months after surgery. Results Sixty-seven patients were evaluated. There was no difference regarding trigger finger onset (OT, 26.5% versus ET, 27.3%; p = 0.94) and pain (OT, 76.5% versus ET, 84.8%; p = 0.38). Patients submitted to OT had fewer paresthesia complaints compared with those operated using ET (OT, 5.9% versus ET, 24.2%; p = 0.03). Conclusions In our series, the surgical technique did not influence trigger finger onset and residual pain rates. Patients submitted to OT had less complaints of residual postoperative paresthesia.

Electrodiagnostic Testing Characteristics of Diabetic People with Carpal Tunnel Syndrome.

Objective The present study aimed to correlate electroneuromyography (ENMG) findings in diabetic and nondiabetic subjects with carpal tunnel syndrome (CTS). Methods In total, 154 patients were evaluated in a hand surgery outpatient clinic. All ENMG tests were bilaterally performed by a single neurologist. Qualitative variables were described for all patients with CTS according to their diabetic status, and the chi-squared test was used to reveal any association. A joint model was adjusted to determine the influence of diabetes on ENMG severity in CTS patients. Results The sample consisted of 117 women and 37 men, with an average age of 56.9 years old. Electroneuromyography demonstrated bilateral CTS in 82.5% of the patients. Diabetes was identified in 21.4% of the cases. Severe ENMG was prevalent. Conclusion There was no association between diabetes and ENMG severity in patients with CTS. Level of evidence IV, case series.