RESUMEN

Classical trigeminal neuralgia (CTN) is a disease characterized by severe pain in the facial area related to the trigeminal nerve. CTN occurs due to neurovascular compression of the Trigeminal nerve presenting with recurrent pain episodes. This case reports the effect of Ayurveda interventions on CTN. Thirty-nine-year-old male patient with pain on the right side of the face for two years presented to the National Institute of Ayurveda, Hospital, Jaipur, Rajasthan, India. The pain was distributed on the right side of the upper lip, cheek, and chin. Paroxysms of pain appeared at the interval of 1-2 h and were lasting of 1-2 min. The case was diagnosed with the help of magnetic resonance imaging (MRI) as right-side classical trigeminal neuralgia due to indentation of the vascular loop of the right superior cerebellar artery. The patient had a treatment history of two years with allopathic medicine, and he sought Ayurveda treatment due to recurrence and excessive pain. The patient was given Ayurvedic interventions (oral medication, Nasya, Kavalagraha, and Gandusha) for three months. The improvement were observed on the visual analogue scale (VAS) for pain, hospital anxiety and depression scale (HADS), and Short Form -36 questionnaire (SF-36) for quality of life. After three months of the treatment, the VAS scale for pain and the HADS scale for anxiety and depression showed marked improvement. Improvement in all the domains of SF-36 was observed, with a total percentage improvement from 10.7% to 83.2%. Observations of this case highlight the usefulness of Ayurveda interventions, i.e., Oral medication, Nasya, Kavalagraha, and Gandusha, in reducing the acute paroxysms of pain in Classical TN and improving the quality of life of CTN patients.

RESUMEN

The fifth cranial nerve is the common denominator for many headaches and facial pain pathologies currently known. Projecting from the trigeminal ganglion, in a bipolar manner, it connects to the brainstem and supplies various parts of the head and face with sensory innervation. In this review, we describe the neuroanatomical structures and pathways implicated in the sensation of the trigeminal system. Furthermore, we present the current understanding of several primary headaches, painful neuropathies and their pharmacological treatments. We hope that this overview can elucidate the complex field of headache pathologies, and their link to the trigeminal nerve, to a broader field of young scientists.

Asunto(s)

RESUMEN

Resumen La coartación de aorta es una cardiopatía congénita con altas tasas de morbilidad y mortalidad, que usualmente es subdiagnosticada a pesar de la disponibilidad de herramientas diagnósticas. El grado de severidad de las manifestaciones clínicas de la coartación de aorta va a depender del grado de obstrucción, así como de la presencia de defectos cardiacos y lesiones extracardíacas asociados. En la población pediátrica la modalidad terapéutica mayormente utilizada es la reparación quirúrgica; mientras que la angioplastia con balón y la colocación de una endoprótesis son menos utilizadas en esta población, ya que asocian mayor riesgo de reestenosis con la consecuente reintervención, estas técnicas son principalmente utilizadas en pacientes mayores. A pesar del éxito en la reparación de la coartación de aorta, los pacientes deben continuar un seguimiento estrecho a largo plazo, que incluye mediciones de la presión arterial de manera periódica, así como estudios por imagen de la estructura cardíaca, debido a la aparición tardía de complicaciones cardiovasculares asociadas.

Abstract Coarctation of the aorta is a congenital heart disease with high rates of morbidity and mortality, which is usually underdiagnosed despite the availability of diagnostic tests. The degree of severity of the clinical manifestations of coarctation of the aorta will depend on the level of obstruction, as well as the presence of cardiac defects and associated extracardiac lesions. In the pediatric population the most used therapeutic modality is surgical correction; while balloon angioplasty and stent placement are less used in this population, since they are associated with a greater risk of restenosis with the subsequent reintervention; these techniques are mostly used in older patients. Despite the success in the repair of coarctation of the aorta, patients should continue a close long-term follow-up, which includes periodic blood pressure measurements, as well as imaging studies that assess the cardiac structure, due to the late onset of associated cardiovascular complications.

Asunto(s)

RESUMEN

Resumen La neuralgia del trigémino (NT) es una enfermedad cuya prevalencia es alta y corresponde a un porcentaje importante de neuralgias faciales; en donde las personas más afectadas son mayores de 50 años. Su manifestación clínica suele ser de cuadros de dolor facial severo y recurrentes, unilateral; en la distribución de una o más divisiones del nervio trigémino y no se explica con otro diagnóstico. El diagnóstico se basa en el cuadro clínico y usualmente no se encuentra déficit sensorial, sin embargo, si está presente se deben hacer neuroimágenes para descartar otras causas. En primera instancia está el manejo farmacológico. La carbamazepina se ha establecido como efectivo, llegando a producir un alivio del dolor dentro de las 24 horas. Cuando la farmacoterapia falla, se opta por la cirugía que se divide generalmente en dos: técnicas que destruyen la porción sensitiva del nervio; y la descompresión microvascular (DMV), que es la que tiene mejores resultados.

Abstract Trigeminal neuralgia is a disease whose prevalence is high and corresponds to a significant percentage of facial neuralgia; where the most affected people are over 50 years old. The clinical picture is usually of episodes of severe and recurring facial pain, unilateral; in the distribution of one or more divisions of the trigeminal nerve and this is not explained with another diagnosis. Diagnosis is based on the clinic and usually no sensory deficit is found, however, if present, neuroimaging should be done to rule out other causes. In the first instance is the pharmacological management. Carbamazepine has been established as effective, leading to pain relief within 24 hours. When pharmacological therapy fails, surgery is generally divided into two: techniques that destroy the sensitive portion of the nerve and microvascular decompression, which has the best results.

Asunto(s)

RESUMEN

Trigeminal neuralgia (TN) is typically treated pharmacologically with anticonvulsants, but these can be ineffective, or can lose their effectiveness over time. In recent years, botulinum toxin type A (BoNT-A), when injected subcutaneously across multiple sites, can effectively treat TN. However, approximately 30% of TN cases are refractory to subcutaneous BoNT-A treatment. We report here the case of a 79-year-old female patient with TN presenting as severe, episodic pain in the lower left gingival area. She was on anticonvulsant therapy (carbamazepine) for about 3 years prior to BoNT-A treatment. Despite initial relief, the pain not only recurred, but also began to worsen, even as her carbamazepine dose was increased substantially. We injected 50 U of BoNT-A into the oral mucosa of the painful gingival area, but the patient's pain was unaffected. We then changed to an intramuscular injection protocol and injected the same dose of BoNT-A into the left masseter, which produced a good therapeutic effect for about 5 months; she was then administered a second treatment (intra-masseter), and at a 2-week follow-up, still reported being pain-free. This case and a survey of the literature suggest that BoNT-A injection protocols maybe closely correlated with their clinical efficacy in cases of TN, possibly due to the ability of BoNT-A to be transported retrogradely along trigeminal nerve axons. We believe that finding the optimal BoNT-A therapy injection protocol(s) will significantly reduce the number of refractory cases of TN.

Asunto(s)

RESUMEN

OBJECTIVES: The purpose of this first part of a two-part series was to review the literature concerning the indications, contraindications, advantages, disadvantages and surgical techniques of the lateralization and transposition of the inferior alveolar nerve, followed by the placement of an implant in an edentulous atrophic posterior mandible. MATERIAL AND METHODS: A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC database, academic sites and books. The articles were searched from January 1997 to July 2014 and comprised English-language articles that included adult patients between 18 and 80 years old with minimal residual bone above the mandibular canal who had undergone inferior alveolar nerve (IAN) repositioning with a minimum 6 months of follow-up. RESULTS: A total of 16 studies were included in this review. Nine were related to IAN transposition, 4 to IAN lateralization and 3 to both transposition and lateralization. Implant treatment results and complications were presented. CONCLUSIONS: Inferior alveolar nerve lateralization and transposition in combination with the installation of dental implants is sometimes the only possible procedure to help patients to obtain a fixed prosthesis, in edentulous atrophic posterior mandibles. With careful pre-operative surgical and prosthetic planning, imaging, and extremely precise surgical technique, this procedure can be successfully used for implant placement in edentulous posterior mandibular segments.

RESUMEN

OBJECTIVES: This article, the second in a two-part series, continues the discussion of inferior alveolar nerve lateralization/transposition for dental implant placement. The aim of this article is to review the scientific literature and clinical reports in order to analyse the neurosensory complications, risks and disadvantages of lateralization/transposition of the inferior alveolar nerve followed by implant placement in an edentulous atrophic posterior mandible. MATERIAL AND METHODS: A comprehensive review of the current literature was conducted according to the PRISMA guidelines by accessing the NCBI PubMed and PMC databases, as well as academic sites and books. The articles were searched from January 1997 to July 2014. Articles in English language, which included adult patients between 18 - 80 years of age who had minimal residual bone above the mandibular canal and had undergone inferior alveolar nerve (IAN) repositioning, with minimum 6 months of follow-up, were included. RESULTS: A total of 21 studies were included in this review. Ten were related to IAN transposition, 7 to IAN lateralization and 4 to both transposition and lateralization. The IAN neurosensory disturbance function was present in most patients (99.47% [376/378]) for 1 to 6 months. In total, 0.53% (2/378) of procedures the disturbances were permanent. CONCLUSIONS: Inferior alveolar nerve repositioning is related to initial transient change in sensation in the majority of cases. The most popular causes of nerve damage are spatula-caused traction in the mucoperiosteal flap, pressure due to severe inflammation or retention of fluid around the nerve and subsequent development of transient ischemia, and mandibular body fracture.

RESUMEN

OBJECTIVES: The purpose of this article is to systematically review diagnostic procedures and risk factors associated with inferior alveolar nerve injury following implant placement, to identify the time interval between inferior alveolar nerve injury and its diagnosis after surgical dental implant placement and compare between outcomes of early and delayed diagnosis and treatment given based on case series recorded throughout a period of 10 years. MATERIAL AND METHODS: We performed literature investigation through MEDLINE (PubMed) electronic database and manual search through dental journals to find articles concerning inferior alveolar nerve injury following implant placement. The search was restricted to English language articles published during the last 10 years, from December 2004 to March 2014. RESULTS: In total, we found 33 articles related to the topic, of which 27 were excluded due to incompatibility with established inclusion criteria. Six articles were eventually chosen to be suitable. The studies presented diagnostic methods of inferior alveolar nerve sensory deficit, and we carried out an assessment of the proportion of patients diagnosed within different time intervals from the time the injury occurred. CONCLUSIONS: Various diagnostic methods have been developed throughout the years for dealing with 1 quite frequent complication in the implantology field - inferior alveolar nerve injury. Concurrently, the importance of early diagnosis and treatment was proved repeatedly. According to the results of the data analysis, a relatively high percentage of the practitioners successfully accomplished this target and achieved good treatment outcomes.

RESUMEN

OBJECTIVES: The purpose of this study was to systematically review the comprehensive overview of literature data about injury to the inferior alveolar nerve after lower third molar extraction to discover the prevalence of injury, the risk factors, recovery rates, and alternative methods of treatment. MATERIAL AND METHODS: Literature was selected through a search of PubMed electronic databases. Articles from January 2009 to June 2014 were searched. English language articles with a minimum of 6 months patient follow-up and injury analysis by patient's reporting, radiographic, and neurosensory testing were selected. RESULTS: In total, 84 literature sources were reviewed, and 14 of the most relevant articles that are suitable to the criteria were selected. Articles were analyzed on men and women. The influence of lower third molar extraction (especially impacted) on the inferior alveolar nerve was clearly seen. CONCLUSIONS: The incidence of injury to the inferior alveolar nerve after lower third molar extraction was about 0.35 - 8.4%. The injury of the inferior alveolar nerve can be predicted by various radiological signs. There are few risk factors that may increase the risk of injury to the nerve such as patients over the age of 24 years old, with horizontal impactions, and extraction by trainee surgeons. Recovery is preferable and permanent injury is very rare.