Paresthesia: A Review of Its Definition, Etiology and Treatments in View of the Traditional Medicine.

OBJECTIVE: To search major Islamic Traditional Medicine (ITM) textbooks for definition, etiology and medicinal plants used to manage 'khadar' or 'paresthesia', a common sensory symptom of multiple sclerosis (MS) and peripheral neuropathies. In addition, the conformity of the efficacy of ITM-suggested plants with the findings from modern pharmacological research on MS will be discussed. METHODS: Data on the medicinal plants used to treat 'khadar' were obtained from major ITM texts. A detailed search in PubMed, ScienceDirect, Scopus and Google Scholar databases was performed to confirm the effects of ITM-mentioned medicinal plants on MS in view of identified pharmacological actions. RESULTS: Moringa oleifera Lam., Aloe vera (L.) Burm.f., Euphorbia species, Citrullus colocynthis (L.) Schrad., and Costus speciosus (Koen ex. Retz) Sm. are among the most effective ITM plants for the management of 'khadar'. Recent experimental evidence confirms the effectiveness of the mentioned plants in ameliorating MS symptoms. Moreover, according to ITM, prolonged exposure to cold and consuming foodstuff with cold temperament might be involved in the etiopathogenesis of MS. CONCLUSIONS: The use of traditional knowledge can help finding neglected risk factors as well as effective and safe therapeutic approaches, phytomedicines and dietary habits for the management of paresthesia and related disorders such as MS.

Indenização por danos estéticos e morais decorrentes de fratura mandibular ocasionada por acidente de trabalho - relato de perícia odontológica trabalhista / Indemnity for aesthetic and moral damages resulting mandibular fracture for work accident - reporting dental labor expertise

Introdução: a perícia trabalhista odontológica visa verificar e quantificar as lesões no aparelho estomatognático, e suas repercussões, decorrentes de trauma produzidos durante a atividade laborativa. Nos casos onde as lesões geram danos estéticos e/ou funcionais, cabe ao expert reportar a presença dasmesmas, seu aspecto estático e dinâmico, e as consequências para o trabalhador. Objetivo: relatar um caso de perícia odontológica trabalhista em que mesmo havendo trauma facial com sequela estética de pequena monta, houve condenação do empregador para pagamento de danos morais e estéticos. Relatode Caso: um trabalhador foi soterrado durante a sua atividade laboral e, em decorrência do trauma,fraturou a mandíbula (fratura não exposta) e ficou com parestesia nesta região. Em primeira instância, foideterminada uma avaliação médica, onde o perito médico não verificou lesões e/ou sequelas que inviabilizassem o exercício da atividade do reclamante e/ou que fosse digno de reparação. Após orecurso, foi anulada a sentença inicial e determinada uma nova perícia, porém, nomeou-se um expertespecialista em Odontologia Legal que encontrou evidências da referida parestesia, bem como, que amesma era de caráter permanente e irreversível, caracterizando-se nexo causal, o que levou o magistrado a sentenciar o pagamento de danos estéticos e morais. Conclusão: conclui-se com o referidorelato de caso pericial que uma alteração estética de pequena monta na face, decorrente de fratura mandibular não exposta, associada a prejuízos funcionais e sensoriais no complexo maxilomandibular pode resultar em danos estéticos indenizáveis, cabendo ao perito judicial expor adequadamente estasalterações para que o magistrado possa julgar e fazer justiça em cada caso.

Introduction: labor dental expertise aims to verify and quantify injuries and impacts on stomatognathicsystem resulting from trauma suffered at work. In cases where injuries cause aesthetic and/or functionaldamages, the expert must report them as well as their static and dynamic aspect and the consequencesfor the worker. Objective: to report a case of labor dental expertise in which even having facial trauma withslight aesthetic sequel, there was employer condemnation for payment of moral and aesthetic damages.Case Report: a worker was buried during his labor activity, and as a result of trauma, he fractured hismandible (unexposed fracture) staying with paresthesia in this region. In the first instance, it was made amedical evaluation and the medical expert found no injuries and/or sequels that made it impossible toexercise the claimant's activity and/or it was worthy of indemnity. After the appeal, the initial sentence wasoverturned and another expertise determined, but with a new expert, a specialist in forensic dentistry, whofound evidence of permanent and irreversible paresthesia, establishing causal link and leading themagistrate to sentence the payment of aesthetic and moral damages. Conclusion: it is concluded that aslight facial aesthetic alteration resulting from unexposed mandibular fracture, associated with functionaland sensory impairments of maxilomandibular complex, can result in compensable aesthetic damages,falling to the court expert to properly expose these alterations so that the magistrate can judge and dojustice in each case.

Validity and reliability of patient-centered outcome measures in oral dysesthesia.

OBJECTIVE: The objective of this study was to investigate the validity and reliability of a quality of life instrument in patients with oral dysesthesia. STUDY DESIGN: Forty-five individuals newly diagnosed with oral dysesthesia (37 women, 8 men) were enrolled in this study. Individuals were interviewed using the Visual Analogue Scale (VAS), and the Oral Health Impact Profile (OHIP-14). Construct validity and internal reliability were examined. RESULTS: Patient rating of pain experienced, using VAS, correlated with OHIP-14 scores (P < .05), demonstrating construct validity. OHIP-14 demonstrated good internal consistency with Cronbach's alpha of 0.79. The corrected item-total correlations for items 3 (painful aching) and 12 (difficulty doing usual jobs) were below the recommended minimum of 0.20. Cronbach's alpha increased to 0.81 with the exclusion of these 2 items from OHIP-14. CONCLUSIONS: The OHIP-14 questionnaire appeared to perform relatively well in the 45 patients with oral dysesthesia enrolled in this study, demonstrating validity and reliability in the assessment of the effect of oral dysesthesia on quality of life. However, the exclusion of items 3 and 12 from the questionnaire should be considered in future studies with this patient population.

Clinical and radiographic evaluation of three-implant-retained mandibular overdentures: a 3-year retrospective study.

OBJECTIVE: To evaluate three-implant-retained mandibular overdentures after 3 years in terms of success rates, maximum occlusal force (MOF), marginal bone loss around implants (MBL), patient satisfaction, and quality of life (QoL). METHOD AND MATERIALS: Twenty-three edentulous adults with maxillary complete dentures who received three-implant-retained mandibular overdentures with ball or bar attachments by the same surgeon over a 1-year period were evaluated 3 years after overdenture loading. Subjects were asked to grade their three-implant-retained mandibular overdentures on a visual analog scale and to complete the short-form Oral Health Impact Profile (OHIP-14) to evaluate satisfaction and QoL. MBL was evaluated using panoramic radiography. MOF with and without implant support was recorded using a strain gauge. Overall success was measured by absence of mobility, peri-implant radiolucency, pain and paresthesia, and progressive MBL. RESULTS: The overall success rate of implants was 100%. MBL around center implants was lower than around implants on the right and left sides (P = .001 and P =.03, respectively). MOF without implant support was lower than with implant support (P =.001). There was no association between attachment type and either MBL, MOF, satisfaction, or QoL (P > .05). CONCLUSION: The excellent outcomes for three-implant-retained mandibular overdentures indicate that, regardless of attachment type, three-implant-retained mandibular overdentures opposing complete dentures are a successful treatment option for edentulous adults.

Prospective evaluation of a new classification system for the management of mandibular subcondylar fractures.

PURPOSE: We propose a new classification of subcondylar fractures of the mandible based on ramal height shortening and degree of fracture angulation and present our treatment experience using this classification system. PATIENTS AND METHODS: Eighty patients with subcondylar fractures of the mandible were evaluated. We categorized the fractures into 3 classes: Class 1 (minimally displaced), fracture with ramal height shortening: <2 mm and/or degree of fracture displacement: <10°; Class 2 (moderately displaced), fracture with ramal height shortening: 2 to 15 mm and/or degree of fracture displacement: 10 to 35°; Class 3 (severely displaced), fracture with ramal height shortening: >15 mm and/or degree of fracture displacement: >35°. Our treatment protocol is closed treatment for Class 1 fractures; either closed or open treatment for Class 2 fractures; and open treatment for Class 3 fractures. RESULTS: Among 80 patients, 20 had Class 1 fractures (25%), 40 had Class 2 fractures (50%), and 20 had Class 3 fractures (25%). In Class 2 fractures, 22 patients were managed by closed treatment (Class 2a) and 18 by open treatment (Class 2b). No statistically significant differences were found between the 3 classes in terms of functional outcome, while, within Class 2 patients, significantly (P = .00) better functional results were observed in open (Class 2b) group compared with closed group (Class 2a). CONCLUSIONS: Our new classification based on ramal height shortening and degree of fracture displacement can better guide clinical treatment. Class 1 fractures are treated by closed method, while open reduction is recommended in Class 2 and Class 3 cases.

Comparison of conchal cartilage graft with nasal septal cartilage graft for reconstruction of orbital floor blowout fractures.

Our aim was to compare autogenous nasal septal cartilage and conchal cartilage as grafts for reconstruction of orbital blowout fractures. Twenty-two patients with blowout fractures were randomly assigned to two groups for treatment with a graft of nasal septal cartilage or conchal cartilage. Patients were evaluated for the presence of enophthalmos, diplopia, dysfunction of the infraorbital nerve, and restriction of the ocular muscles. Patients with enophthalmos of more than 2 mm were included in the study, and were followed up postoperatively at 10 days, 1 month, and 3-6 months. The patients treated with a nasal septal cartilage graft had significantly better correction of enophthalmos than those treated with conchal cartilage (p=0.02) after 10 days (p=0.02), 1 month (p=0.004), and 3-6 months (p=0.001). There was significantly less residual enophthalmos in the nasal septal graft group after 1 month (0.91 compared with 1.72 mm, p=0.02), and after 3-6 months (1.0 compared with 2.54 mm, p=0.008). Correction of enophthalmos was considerably better in patients who were operated on within 4 weeks of injury. We think that nasal septal cartilage is a better graft than conchal cartilage for reconstruction of blowout fractures. The time to intervention (the earlier the better) is a critical point in the correction of enophthalmos.

Implicações clínicas da doença de Lyme em região facial: revisão da literatura / Clinical implications of the disease of Lyme in facial area: literature revision: literature review

Doença de Lyme (DL) é uma alteração inflamatória sistêmica resultante da ação direta e da resposta imune à espiroqueta Borrelia burgdoferi transmitida pela inoculação na corrente circulatória por carrapato do gênero Ixodes, sendo mais comumente encontrada na América do Norte, Europa e Ásia. Essa enfermidade pode levar a manifestações neurológicas periféricas e faciais, tais como paralisia de Bell, alterações oftalmológicas, desordens na articulação temporo-mandibular além de parestesia de nervos alveolares superiores e inferiores. No Brasil, o diagnóstico da DL é primeiramente baseado na apresentação clínica, com o eritema migrans cutâneo, e informações epidemiológicas do paciente. O reconhecimento das primeiras manifestações da DL por profissionais de saúde é essencial para o correto tratamento antibiótico impedindo a progressão da doença, sendo também relevante orientações preventivas para aqueles que vivem ou trabalham em áreas endêmicas.

Lyme disease (LD) is a systemic inflammatory changes resulting from direct action and the immune response to the spirochete Borrelia burgdoferi transmitted by inoculation of the flow of the genus Ixodes tick and is most commonly found in North America, Europe and Asia. This disease can lead to facial and peripheral neurological manifestations, such as Bell’s palsy, eye changes, disorders in the temporo-mandibular joint in addition to paresthesia of superior and inferior alveolar nerves. In Brazil, the diagnosis of LD is primarily based on clinical presentation, the erythema migrans skin, and epidemiological information of the patient. Recognition of the onset of the DL by health professionals is essential for the correct antibiotic treatment preventing the progression of the disease, and also relevant preventive guidelines for those living or working in endemic areas.

Segmental distraction osteogenesis of the anterior mandible for improving facial esthetics. Preliminary results.

AIM: To report preliminary results of treatment with gradual repositioning of the anterior mandibular segment using distraction osteogenesis in patients with anterior tooth crowding and/or an unfavorable anteroposterior relationship between the anterior dentoalveolar area and the skeletal base. METHODS: The following outcome measures were considered: ability of the technique to achieve the desired skeletal jaw position, resolution of the crowding, periodontal condition (recessions and probing pocket depths), temporomandibular joint symptoms, tooth sensitivity, permanent nerve injury, additional complications, and patient satisfaction. Four patients were treated. RESULTS: All outcome measures indicated that the therapy goal was achieved and the results maintained to date. Periodontal conditions were slightly improved. Two patients were very satisfied; 2 were only partially satisfied with the therapy. In 1 patient the root of the mandibular right first premolar was damaged during the vertical osteotomy procedure and the mandibular right central incisor did not respond to the postoperative sensitivity test. Another patient reported tension at the temporomandibular joint when chewing hard food. CONCLUSION: The preliminary results are encouraging. However, larger trials are needed to acquire sufficient knowledge of the efficacy, predictability, and ideal indications for the mandibular osteodistraction technique.

Orofacial pain conditions and impact on quality of life in community-dwelling elderly people in Hong Kong.

AIMS: To determine orofacial pain (OFP) characteristics, associated disability, and effect on quality of life in elderly community-dwelling Chinese people. METHODS: A cross-sectional survey involving elderly people registered with the Family Medicine Unit of the University of Hong Kong served as the sampling frame. Elderly people with recent OFP symptoms and a comparison control group without OFP participated. Standard questions were asked about OFP conditions in the previous month and the Oral Health Impact Profile (OHIP-14), General Health Questionnaire (GHQ-12), and pain-related disability questions were administered prior to a standard clinical examination. RESULTS: Ninety-five people with OFP and 100 people without OFP participated. The median number of pain symptoms per subject was 2.0. Toothache was the most common symptom (58.9%); shooting pain across the face and muscle tenderness were the least common (6.3%). More than half of the pain participants described moderate to severe OFP. The prevalences of patients with neurological/vascular (NV), musculoligamentous/soft tissue (MST), or dentoalveolar (DA) OFP were 35.8%, 33.7%, and 30.5%, respectively. Chronic OFP was common (80%). The mean OHIP-14 summary score was significantly higher in OFP subjects than controls (P < .001) and significantly higher in the MST and DA subgroups than in the NV subgroup (P < .001). GHQ scores of > or = 4, indicating greater psychological distress, were more common in OFP subjects than controls (P < .01). Twenty percent of OFP subjects indicated that their conditions interfered with daily life activities, and in 9.9% it affected ability to work. CONCLUSION: OFP had a substantial detrimental impact on daily life activities, psychological distress level, and quality of life in Chinese elders. MST and DA conditions had the greatest adverse impact on quality of life.

Characterization of different paresthesias following orthognathic surgery of the mandible.

PURPOSE: Paresthesia is a well known consequence of peripheral nerve injury. However, the neural mechanisms of the 2 recognized types, spontaneous and elicited, are currently unknown. This study aimed to investigate these 2 paresthesias and the possible mechanisms accompanying orthognathic surgery. PATIENTS AND METHODS: Mechanical-touch thresholds and current perception threshold were measured before and 7 days after surgery in 60 chin sites (mental nerve area) of 30 patients who underwent orthognathic surgery. Similar testing was conducted on healthy volunteers (controls). All sites were classified by the presence or absence of each paresthesia: spontaneous paresthesia or no spontaneous paresthesia, and elicited paresthesia or no elicited paresthesia. Presence or absence analyses were followed-up for 6 weeks after surgery. RESULTS: Gender differences and maxillary surgery did not change the incidence of paresthesia during postoperative week 1 (chi-square test, P > .05). A significantly higher mechanical-touch threshold was observed with spontaneous paresthesia compared with no spontaneous paresthesia (Mann-Whitney U-test; P < .05), but not between no elicited paresthesia and elicited paresthesia (Mann-Whitney U-test; P > .05). A significant increase in postsurgery current perception thresholds values compared with presurgery values was observed at 2,000 Hz in spontaneous paresthesia, and at 2,000 and 5 Hz in elicited paresthesia (paired t test, P < .05). The incidence of spontaneous paresthesia decreased more rapidly than elicited, while the latter tended to increase again during the 6-week postsurgical test period. CONCLUSION: The results suggested that both spontaneous and elicited paresthesias are associated with damage and dysfunction in myelinated primary afferent fibers, but additional neural mechanisms are implicated during elicited paresthesia.

Anatomic distribution of sensory symptoms in the hand and their relation to neck pain, psychosocial variables, and occupational activities.

To explore whether different distributions of numbness and tingling in the hand can be usefully distinguished in epidemiologic studies of disorders such as carpal tunnel syndrome, the authors used a postal questionnaire, an interview, and a physical examination to collect information about risk factors, symptoms, and signs from a general population sample of 2,142 adults in Southampton, England, during 1998-2000. The authors distinguished six distributions of numbness and tingling and compared their associations with other clinical findings and with known risk factors for upper limb disorders. Distinctive relations were found for symptoms that involved most of the palmar surface of the first three digits but not the dorsum of the hand or the little finger. Such symptoms were more often associated with positive Phalen's and Tinel's tests and, unlike other categories of sensory disturbance, were not related to neck pain or restriction of neck movement. They also differed in showing no association with lower vitality or poorer mental health but an association with repeated wrist and finger movements at work. These findings suggest that, in the classification of numbness and tingling of the hand, it may be useful to distinguish symptoms that involve most of the sensory distribution of the median nerve but not other parts of the hand.

Arm restlessness in patients with restless legs syndrome.

Restless legs syndrome (RLS) is a neurologic disorder characterized principally by leg paresthesia and motor restlessness. Several clinical reports indicated that many patients with RLS also have arm paresthesia and restlessness. In the present study, the incidence of arm restlessness was assessed by questionnaire in 230 patients diagnosed with idiopathic RLS. Arm restlessness was reported by 48.7% of the patients. Patients with and without arm restlessness were compared with regard to clinical and polysomnographic parameters. No between-group differences were found for age at onset of RLS, duration of illness, gender, presence of a family history of RLS, sleep latency, total sleep time, sleep efficiency, and periodic leg movements index during sleep. However, arm restlessness was more frequent in patients with severe RLS. Interestingly, the polysomnographic data failed to differentiate the patients with arm restlessness from those without arm restlessness, except for sleep efficiency, which tended to be lower in patients with arm restlessness. In conclusion, the results of the present study are in agreement with clinical observations that a large proportion of patients with RLS have arm restlessness.

At which stage of sensory recovery can a tingling sign be expected? a review and proposal for standardization and grading.

The phenomenon of paresthesia elicited by percussion of regenerating axons is usually associated with Tinel and Hoffmann, who both described it separately in 1915, although the same phenomenon had been described previously, in 1909, by Trotter and Davies. This sign is used widely, but its standardization is almost completely lacking, its grading is seldom used, and its reliability or validity is scarcely mentioned in the literature. The authors present a method of standardization and grading of the tingling response by means of a vibrostimulator, which permits precise localization of the trigger point and uniform stimulation. The tingling response may then be classified according to its location and to the magnitude threshold at which the response is triggered. In the distal part of the nerve, after neurotmesis repair, the tingling sign is graded T++ (tingling after a weak stimulus) and T+ (tingling only after a strong stimulus). At the site of the injury, the initial tingling sign is graded T0. The sign is graded T00 if, independent of recovery, a slight positivity persists at the initial site of injury. Grading of sensory recovery is poorly standardized, since different authors use different variations and modifications of existing classifications. The authors of this paper present a cross-matching of these classifications and propose to use Dellon's modification of Zachary's classification in eight stages, from S0 to S4. A discussion of the probability of eliciting a tingling sign during axonal regeneration concludes that the clinician can expect to trigger a T+ + sign when sensory recovery evolves from stage S0 to stage S1 and should no longer expect to trigger one when sensory recovery improves from stage S2+ to stage S3.

[Classification of post-cordotomy dysesthesia].

Postcordotomy dysesthesia was classified from the clinical features of dysesthesia following percutaneous cervical cordotomy (PCC) in 66 patients. Dysesthesia occurred in 10 (15.2%) of 66 patients and was classified into three types. In the first type, dysesthesia occurred at the region where pain had been before PCC, and pain sensitivity had been lost due to PCC. This type of dysesthesia occurred in 6 patients. In this type, the peripheral nerve damage caused by tumor invasion was presumably the cause of dysesthesia. In the second type, dysesthesia occurred all over the region where pain sensitivity had been lost due to PCC. This type of dysesthesia occurred in 2 patients. The destruction of second order neurons of the nociceptive pathway by PCC was presumably the cause of this type of dysesthesia. In the third type, dysesthesia occurred at the region where pain had been before PCC and pain sensitivity had partially recovered. This type of dysesthesia occurred in 3 patients. The reduction of the effect of PCC was presumably the cause of this type of dysesthesia.

Cheiro-oral syndrome: identification of the lesion sites and a proposal for its clinical classification.

Five cases suffering from unilateral paresthesia over the corner of the mouth and the hand on the same side were examination for cheiro-oral syndrome. Of these, three cases were typical and the other were variant cases associate with transient hemi-signs. Lesion sites were identified by computed tomographic (CT) scan, magnetic resonance imaging (MRI) or both. Of the five patients, lesions were due to thalamic infarction in three cases, pontine hemorrhage in one case, and tumor compression on the right frontoparietal lobe in the last case. The pathophysiology of all cases were classified according to location of the lesion on the thalamus, the pons, and the parietal lobe, which are the usual anatomical sites responsible for this syndrome. Based on the three typical cases and thirteen cases cited from the English literature, a clinical classification has been established. The classification is based on age at the time of onset, gender, lesion site, etiology, risk factors, and certain clinical features. These sixteen cases fell into three distinct groups: a) those in which the thalamic lesions were related to infarction, b) those in which tumors, or in rare cases infarction, were found in the parietal lobe, and c) those in which hemorrhage occurred in the pons. Using this classification, the cheiro-oral syndrome can be more systematically defined.

Vulvodynia. A multifactorial clinical problem.

Symptomatic vulvar burning (vulvodynia) in the absence of abnormal physical findings was long thought to be an unusual psychosomatic gynecologic problem. Within the past decade, however, a number of investigators began to study patients with this frustrating problem. Initial physician insistence on a major role for psychological factors has gradually given way to sophisticated searches for evidence of persistent infectious agents, especially human papillomavirus and Candida. Gynecologists searching for causes and surgical relief of vulvodynia have even reevaluated elements of vulvar anatomy. The purpose of this article is to introduce dermatologists to current perspectives on vulvodynia in the context of the clinical experience of the author, who has been actively involved in the multidisciplinary investigation of this problem since its recognition in the early 1980s. To date, the following five sign-symptom complexes have been identified by the author and recognized by other vulvodynia investigators: (1) vulvar dermatoses, (2) cyclic vulvitis, (3) vulvar papillomatosis, (4) vulvar vestibulitis, and (5) essential vulvodynia. A given patient's complaint may be primarily associated with one of these factors, but it is not unusual to see others develop simultaneously or sequentially. Remission or exacerbation of symptoms may occur when treatment for one condition affects the onset of another. It is evident that vulvodynia is a complex diagnosis and that recognition of multiple factors is important to appropriate patient evaluation and management.

Progressive paresthesias after cessation of therapy with very high-dose cisplatin.

Control of cisplatin-induced nephrotoxicity and nausea/vomiting has enabled the development of very high-dose cisplatin regimens (monthly total dose, 200 mg/m2). Neurotoxicity is now recognized to be the dose-limiting toxicity of these regimens. However, during a pilot study involving 5 mg/m2 vinblastine and 100 mg/m2 cisplatin given every 28 days on days 1 and 8 for the treatment of advanced non-small-cell lung cancer, we noted a high incidence of progressive peripheral neuropathy, which continued for several months after the discontinuation of cisplatin chemotherapy. Of the six patients treated, four received at least three cycles of therapy (median total cisplatin dose, 685 mg/m2; range, 500-725 mg/m2). All four patients developed a progressive peripheral neuropathy, with a worsening of toxicity by 1-3 grades over the 2-3 months after cisplatin discontinuation. One patient progressed from grade I (mild paresthesia) to grade IV (inability to ambulate) over a period of 3 months after the discontinuation of therapy. Stricter rules for early dose de-escalation and discontinuation may be required for very high-dose cisplatin regimens. Delayed progressive neuropathy should be recognized as a possible late complication of this form of therapy.