RESUMO
Idiopathic trigeminal neuralgia (ITN) is a chronic neuropathic pain that affects the masticatory system. The objective of this study was to identify orofacial pain and temporomandibular characteristics, including temporomandibular disorder (TMD), in a sample of 105 ITN patients treated with compression of the trigeminal ganglion. The evaluations occurred before, 7, 30 (1 month), 120 (3 months) and 210 days (7 months) after surgery. The Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), the Clinical Questionnaire (EDOF-HC) and Helkimo Indexes were used. Findings before neurosurgery were used as control for parameters. McNemar test and variance analysis for repetitive measurements were used for statistical analysis; 45.3% of the edentulous patients presented severe dental occlusion index; numbness was an important masticatory complaint in 42.6%; mastication became bilateral, but its discomfort continued during all period; headache and body pain reduced after surgery; TMD, present in 43.8% before surgery, increased but normalized after 7 months; jaw mobility compromise was still present, but daily activities improved after 7 months. We concluded that: (i) ITN relief reduced headache, body pain, depression and unspecific symptoms; and (ii) TMD before surgery and at 7 months suggests that this may be a contributory factor to patients' pain complaints.
Assuntos
Cateterismo/efeitos adversos , Dor/etiologia , Transtornos da Articulação Temporomandibular/etiologia , Gânglio Trigeminal/cirurgia , Neuralgia do Trigêmeo/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Transtorno Depressivo/etiologia , Dor Facial/etiologia , Feminino , Cefaleia/etiologia , Humanos , Estudos Longitudinais , Masculino , Mastigação , Pessoa de Meia-Idade , Neuralgia do Trigêmeo/complicaçõesRESUMO
Idiopathic trigeminal neuralgia (ITN) is a well-known disease often treated with neurosurgical procedures, which may produce sensorial abnormalities, such as numbness, dysesthesia and taste complaints. We studied 12 patients that underwent this technique, in order to verify pain, gustative and olfactory thresholds abnormalities, with a follow-up of 120 days. We compared the patients with a matched control group of 12 patients. Our results found a significant difference in the olfactory threshold at the immediate post-operative period (p=0.048). We concluded that injured trigeminal fibers are probably associated with the increase in the olfactory threshold after the surgery, supporting the sensorial interaction theory.
Assuntos
Cateterismo/métodos , Bloqueio Nervoso/métodos , Complicações Pós-Operatórias/diagnóstico , Limiar Sensorial/fisiologia , Olfato/fisiologia , Gânglio Trigeminal , Neuralgia do Trigêmeo/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Nervo da Corda do Tímpano/fisiopatologia , Feminino , Humanos , Masculino , Nervo Maxilar/fisiopatologia , Pessoa de Meia-Idade , Limiar da Dor/fisiologia , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Pressão , Papilas Gustativas/fisiopatologia , Limiar Gustativo/fisiologia , Gânglio Trigeminal/fisiopatologia , Neuralgia do Trigêmeo/diagnóstico , Neuralgia do Trigêmeo/fisiopatologiaRESUMO
To evaluate the relationship between autonomic neuropathy (AN) and nephropathy we measured 24-h blood pressure (BP) and overnight urinary albumin excretion (UAE) in 38 patients with insulin dependent diabetes mellitus (IDDM). Autonomic function was evaluated by the heart rate response to deep breathing. Valsalva maneuver, heart rate at rest and BP variation with posture. Sympathetic cutaneous reflex was also tested in both inferior and superior limbs. Patients with mean day diastolic BP (DDBP) < or = 90 mmHg without AN (N = 15) compared to 12 normal controls had similar BP values, but compared to those with DDBP < or = 90 mmHg and AN (N = 12) they had lower night diastolic BP (NDBP) (66 +/- 4.8 vs 72 +/- 8.8 mmHg: p < 0.05) and UAE (9.8 +/- 2.3 vs 107.2 +/- 3.5 micrograms/min; p < 0.001). No difference in DDBP was observed between these two diabetic groups (80 +/- 3.9 vs 83 +/- 6.1 mmHg). Of the 11 patients with DDBP > 90 mmHg, only three were free of AN and only two of the eight with AN where free of diabetic nephropathy. The percentage day/night changes in systolic BP were lower in patients with AN (13 vs 7.9%; p < 0.05) and were inversely related to autonomic score, used as an index of the degree of autonomic dysfunction (r = -0.48; p < 0.01) and to UAE (r = -0.39; p < 0.05). Furthermore, UAE correlated with autonomic score (r = 0.69; p < 0.0001) and with NDBP (r = 0.44; p < 0.01). Our results show that AN in IDDM patients is associated with a reduced nocturnal fall in BP and suggest a pathogenic role of autonomic dysfunction in the development of diabetic nephropathy, possibly favoring both BP elevation during the night and increases in intraglomerular pressure.