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Tolley PD, Massenburg BB, Higgins J, Ettinger RE, Susarla SM. Does the Low and Short Medial Cut Affect Lingual Nerve Recovery after Sagittal Split Osteotomy? Plast Reconstr Surg 2024; 154:773e-780e. [PMID: 37678809 DOI: 10.1097/prs.0000000000011047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the recovery of lingual nerve (LN) neurosensory function in patients undergoing sagittal split osteotomy (SSO) with a low and short medial horizontal cut. METHODS This was a prospective study of patients with mandibular deformities undergoing SSO with a low and short medial horizontal cut over a 4-year period. The outcomes of interest were neurosensory recovery of the LN, as assessed objectively using functional sensory recovery (FSR) and subjectively by patient report. RESULTS The sample included 123 SSOs in 62 subjects with a mean age of 19.3 ± 3.1 years. Thirty-seven subjects (61.7%) were female. Mandibular advancements were performed in 52 SSOs (42.3%); mandibular setbacks were performed in 71 SSOs (57.7%). One subject underwent revision BSSO. FSR was achieved at 122 LNs (99.1%) within 6 weeks postoperatively, with 120 sites (97.5%) having S4 sensation at 6 weeks. Decreased LN sensation was reported at 10 (8.3%) sites at 1 week postoperatively. At 6 weeks postoperatively, 118 sites (97.5%) had reported normal sensation. By 12 weeks postoperatively, all LN sites had S4 sensation and there were no subjective complaints. Revision sagittal split osteotomy was associated with prolonged (≥6 weeks) time to S4 sensation ( P = 0.02) and subjective complaint of decreased sensation ( P = 0.02). CONCLUSIONS LN sensory recovery occurs rapidly following the low and short SSO, with 99% of sites achieving FSR and subjectively normal sensation within 6 weeks of surgery and all patients achieving FSR with S4 sensation by 12 weeks postoperatively. LN sensory recovery may be prolonged in patients undergoing revision SSO. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Philip D Tolley
- From the Craniofacial Center, Division of Oral and Maxillofacial Surgery, and Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital; and Departments of Oral and Maxillofacial Surgery and Surgery, Division of Plastic Surgery, University of Washington
| | - Benjamin B Massenburg
- From the Craniofacial Center, Division of Oral and Maxillofacial Surgery, and Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital; and Departments of Oral and Maxillofacial Surgery and Surgery, Division of Plastic Surgery, University of Washington
| | - Julia Higgins
- From the Craniofacial Center, Division of Oral and Maxillofacial Surgery, and Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital; and Departments of Oral and Maxillofacial Surgery and Surgery, Division of Plastic Surgery, University of Washington
| | - Russell E Ettinger
- From the Craniofacial Center, Division of Oral and Maxillofacial Surgery, and Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital; and Departments of Oral and Maxillofacial Surgery and Surgery, Division of Plastic Surgery, University of Washington
| | - Srinivas M Susarla
- From the Craniofacial Center, Division of Oral and Maxillofacial Surgery, and Division of Plastic and Craniofacial Surgery, Seattle Children's Hospital; and Departments of Oral and Maxillofacial Surgery and Surgery, Division of Plastic Surgery, University of Washington
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Sahu S, Hellwig D, Morrison Z, Hughes J, Sadleir RJ. Contrast-free visualization of distal trigeminal nerve segments using MR neurography. J Neuroimaging 2024. [PMID: 39175143 DOI: 10.1111/jon.13230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND AND PURPOSE The 3-dimensional cranial nerve imaging (CRANI) sequence may assist visualization of anatomical details of extraforaminal cranial nerves and aid in clinical diagnosis and preoperative planning. In this study, we investigated the feasibility of using a combined CRANI and magnetization-prepared rapid-acquisition gradient-echo (MPRAGE) imaging protocol to comprehensively identify trigeminal nerve projections. METHOD We evaluated the detection of distal regions of three branches of the ophthalmic nerve (V1), three branches of the maxillary nerve (V2), and five branches of the mandibular nerve (V3) in seven healthy adult subjects, with and without contrast injection. Nerve branches were rated on a 5-point scale by three observers. Interobserver reliability was studied using weighted kappa statistics and percentage agreement. RESULTS Among V1 and V2 branches, the frontal nerve and infraorbital nerve were most successfully identified (average rating of 3.9, agreement >80%) in precontrast MPRAGE images. In V3 branches, lingual and inferior alveolar nerves were most successfully identified (average rating of 3.9, agreement >80%) in precontrast CRANI images, with an excellent average rating. In all cases except one, interobserver reliability was rated good to excellent. The buccal nerve was the only branch with a low average interobserver rating. Gadolinium contrast did not improve nerve segment visualization in our study. This may relate to the specific anatomic regions assessed, gadolinium dose, postcontrast image timing, and lack of pathology. CONCLUSION A combined CRANI and MPRAGE protocol can be combined to visualize distal branches of V1, V2, and V3 and has potential for clinical use.
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Affiliation(s)
- Sulagna Sahu
- School of Biological and Health System Engineering, Arizona State University, Tempe, Arizona, USA
| | - Dane Hellwig
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Zachary Morrison
- Department of Radiology, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Jeremy Hughes
- Department of Neuroradiology, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Rosalind J Sadleir
- School of Biological and Health System Engineering, Arizona State University, Tempe, Arizona, USA
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Li S, Liao C, Yang X, Zhang W. Association of concomitant continuous pain in trigeminal neuralgia with a narrow foramen ovale. Front Neurol 2023; 14:1277654. [PMID: 38020635 PMCID: PMC10644226 DOI: 10.3389/fneur.2023.1277654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Background The pathogenesis of concomitant continuous pain remains unclear and is worthy of further study. In this clinical study, we aimed to explore the potential role of a narrow foramen ovale in the development of concomitant continuous pain. Methods A total of 108 patients with classical trigeminal neuralgia affecting the third branch of the trigeminal nerve and 46 healthy individuals were enrolled in this study. Three-dimensional reconstructed computerized tomography images of all participants were collected, and the morphometric features of the foramen ovale were examined by two investigators who were blinded to the clinical data of the patients. Results In this cohort, patients with concomitant continuous pain suffered from more sensory abnormalities (18.4% vs. 2.9%, p = 0.015) and responded more poorly to medication (74.3% vs. 91.9%, p = 0.018) than patients without concomitant continuous pain. While no significant differences regarding the mean length (5.02 mm vs. 5.36 mm, p > 0.05) and area (22.14 mm2 vs. 23.80 mm2, p > 0.05) were observed between patients with and without concomitant continuous pain, the mean width of the foramen ovale on the affected side in patients with concomitant continuous pain was significantly narrower than that in patients without concomitant continuous pain (2.01 mm vs. 2.48 mm, p = 0.003). Conclusion This neuroimaging and clinical study demonstrated that the development of concomitant continuous pain was caused by the compression of the trigeminal nerve owing to a narrow foramen ovale rather than responsible vessels in classical trigeminal neuralgia.
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Bifid Mandibular Canal: A Proportional Meta-Analysis of Computed Tomography Studies. Int J Dent 2023; 2023:9939076. [PMID: 36923560 PMCID: PMC10010879 DOI: 10.1155/2023/9939076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/20/2023] [Accepted: 02/08/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction Growing body of evidences showed different grades in prevalence of bifid mandibular canals. Because the previous reviews focused solely on patient-level occurrence, hemi-mandible-level prevalence, bilateral symmetry, length, and diameter of bifid mandibular canals were required to be estimated collectively. The research question of this meta-analysis was "What is the prevalence of bifid mandibular canal among patients seeking computed tomography examinations"? Materials and Methods In vivo, computed tomography, and cross-sectional studies were eligible. Studies, with less than 100 subjects or anatomic site restriction or controlled class of bifid mandibular canal, were excluded. Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies was used to assess methodological quality of all included studies. Random effect meta-analyses for proportion of bifid mandibular canal were done. Results 40 studies met the inclusion criteria. All studies were selected for both systematic review and meta-analyses. Totally, 17714 patients and 31973 hemi-mandibles were included. All eligible studies showed moderate risk of bias on average. Resulting from the random effect model, more than 20% of patients seeking computed tomographic examinations had bifid mandibular canals (BMCs) which penetrated into slightly more than 14% of hemi-mandibles. Of the patients having bifid mandibular canals (BMCs), nearly 23% exhibited such anatomy on both sides of their mandibles. Estimated mean length and diameter of the accessory canals of bifid mandibular canals were 12.17 mm and 1.54 mm, respectively. Conclusion The geographical locations, classifications, reliability test, and voxel size of computed tomography were all implicated in the prevalence of bifid mandibular canals along with gender and laterality, although considerable heterogeneity and bias were detected.
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Kalia H, Viswanath O, Abd-Elsayed A. Epidemiology. TRIGEMINAL NERVE PAIN 2021:17-21. [DOI: 10.1007/978-3-030-60687-9_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Do positional changes of the inferior alveolar canal after sagittal split mandibular osteotomy affect neurosensory recovery? Int J Oral Maxillofac Surg 2020; 49:1421-1429. [PMID: 32921555 DOI: 10.1016/j.ijom.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/18/2020] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to assess the pre- and postoperative position and dimensions of the inferior alveolar canal (IAC) following sagittal split osteotomy (SSO) and identify any association with postoperative neurosensory deficit (NSD) at 1 year. This retrospective cohort study enrolled consecutive patients who had SSO performed to correct skeletal malocclusion. The pre- and postoperative cone beam computed tomography data were superimposed to visualize differences in IAC position and dimensions. Subjective and objective neurosensory tests were used to determine NSD in the inferior alveolar nerve distribution. A total of 20 subjects were included. The preoperative distance from the lateral cortex of the IAC to the inner aspect of the lateral cortex of the mandible was significantly greater in sides with NSD when compared to sides without NSD (P = 0.01). A significantly greater reduction in the postoperative distance measurement was seen in sides with NSD when compared to sides without NSD (P = 0.01). The magnitude of mandibular movement was significantly increased in sides with NSD (P = 0.02). The preoperative location of the IAC, as well as certain changes in the mediolateral and vertical positions as a result of SSO, are risk factors for postoperative NSD.
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Nayak U, Vadgaonkar R, Pai MM, Murlimanju BV. A case of inferior alveolar nerve encircling the arteria maxillaris. Anat Cell Biol 2020; 53:240-243. [PMID: 32647091 PMCID: PMC7343564 DOI: 10.5115/acb.19.194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/04/2019] [Accepted: 11/22/2019] [Indexed: 11/27/2022] Open
Abstract
Here we report a case of inferior alveolar nerve (IAN), which had variability in its formation. IAN was formed by dual roots, which were branching out from the posterior division of mandibular nerve. The observed roots were forming a loop around the pterygoid part of arteria maxillaris (MA). One of the roots was superficial to the MA and the other was deep to it. It is believed that this type of morphological variation in the formation of IAN can have clinial implications, which include compression by adjacent structures and nerve entrapment. The knowledge of this variation is important to anaesthesiologists and dentists, while administering local anaesthesia. This is also enlightening to the maxillofacial surgeons, neurologists and radiologists.
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Affiliation(s)
- Unnathi Nayak
- Third Semester MBBS Student, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajanigandha Vadgaonkar
- Department of Anatomy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Mangala M Pai
- Department of Anatomy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - B V Murlimanju
- Department of Anatomy, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Matys T, Ali T, Zaccagna F, Barone DG, Kirollos RW, Massoud TF. Ossification of the pterygoalar and pterygospinous ligaments: a computed tomography analysis of infratemporal fossa anatomical variants relevant to percutaneous trigeminal rhizotomy. J Neurosurg 2020; 132:1942-1951. [PMID: 31075780 DOI: 10.3171/2019.2.jns182709] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 02/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ossification of pterygoalar and pterygospinous ligaments traversing the superior aspect of the infratemporal fossa results in formation of osseous bars that can obstruct percutaneous needle access to the trigeminal ganglion through the foramen ovale (FO), interfere with lateral mandibular nerve block, and impede transzygomatic surgical approaches. Presence of these ligaments has been studied on dry skulls, but description of their radiological anatomy is scarce, in particular on cross-sectional imaging. The aim of this study was to describe visualization of pterygoalar and pterygospinous bars on computed tomography (CT) and to review their prevalence and clinical significance. METHODS The authors retrospectively reviewed 200 helical sinonasal CT scans by analyzing 0.75- to 1.0-mm axial images, maximum intensity projection (MIP) reconstructions, and volume rendered (VR) images, including views along the anticipated axis of the needle in percutaneous Hartel and submandibular approaches to the FO. RESULTS Ossified pterygoalar and pterygospinous ligaments were readily identifiable on CT scans. An ossified pterygoalar ligament was demonstrated in 10 patients, including 1 individual with bilateral complete ossification (0.5%), 4 patients with unilateral complete ossification (2.0%), and 5 with incomplete unilateral ossification (2.5%). Nearly all patients with pterygoalar bars were male (90%, p < 0.01). An ossified pterygospinous ligament was seen in 35 patients, including 2 individuals with bilateral complete (1.0%), 8 with unilateral complete (4%), 8 with bilateral incomplete (4.0%), 12 with bilateral incomplete (6.0%) ossification, and 5 (2.5%) with mixed ossification (complete on one side and incomplete on the contralateral side). All pterygoalar bars interfered with a hypothetical needle access to the FO using the Hartel approach but not the submandibular approach. In contrast, 54% of complete and 24% of incomplete pterygospinous bars impeded the submandibular approach to the FO, without affecting the Hartel approach. CONCLUSIONS This study provides the first detailed description of cross-sectional radiological and applied surgical anatomy of pterygoalar and pterygospinous bars. Our data are clinically useful during skull base imaging to predict potential obstacles to percutaneous cannulation of the FO and assist in the choice of approach, as these two variants differentially impede the Hartel and submandibular access routes. Our results can also be useful in planning surgical approaches to the skull base through the infratemporal fossa.
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Affiliation(s)
- Tomasz Matys
- 1Section of Neuroradiology, Department of Radiology, University of Cambridge, Biomedical Campus, Cambridge
- Departments of2Radiology and
| | | | - Fulvio Zaccagna
- 1Section of Neuroradiology, Department of Radiology, University of Cambridge, Biomedical Campus, Cambridge
| | - Damiano G Barone
- 3Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ramez W Kirollos
- 3Neurosurgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- 4Department of Neurosurgery, National Neuroscience Institute, Singapore; and
| | - Tarik F Massoud
- 5Division of Neuroimaging and Neurointervention, Department of Radiology, Stanford University School of Medicine, Stanford, California
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Varadan M, Chopra A, Sanghavi A, Sivaraman K, Gupta K. Etiology and clinical recommendations to manage the complications following lingual frenectomy: A critical review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2019; 120:549-553. [DOI: 10.1016/j.jormas.2019.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 05/07/2019] [Accepted: 06/18/2019] [Indexed: 11/25/2022]
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Ultrasound-Guided Intervention for Treatment of Trigeminal Neuralgia: An Updated Review of Anatomy and Techniques. Pain Res Manag 2018; 2018:5480728. [PMID: 29808105 PMCID: PMC5902000 DOI: 10.1155/2018/5480728] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 03/15/2018] [Indexed: 12/13/2022]
Abstract
Orofacial myofascial pain is prevalent and most often results from entrapment of branches of the trigeminal nerves. It is challenging to inject branches of the trigeminal nerve, a large portion of which are shielded by the facial bones. Bony landmarks of the cranium serve as important guides for palpation-guided injections and can be delineated using ultrasound. Ultrasound also provides real-time images of the adjacent muscles and accompanying arteries and can be used to guide the needle to the target region. Most importantly, ultrasound guidance significantly reduces the risk of collateral injury to vital neurovascular structures. In this review, we aimed to summarize the regional anatomy and ultrasound-guided injection techniques for the trigeminal nerve and its branches, including the supraorbital, infraorbital, mental, auriculotemporal, maxillary, and mandibular nerves.
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11
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Santos M, Carreira LM. Insight of Dogs' Inner Mandible Anatomy using Mathematical Models. Anat Histol Embryol 2016; 45:479-484. [PMID: 26833625 DOI: 10.1111/ahe.12226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 01/04/2016] [Indexed: 11/30/2022]
Abstract
This study was performed in a sample of 20 dogs (n = 20) and aimed to: (1) characterize the mandible height (Mh), mandibular canal height (MCh) and distance between the inter-dental alveolar margin and the mandibular canal (dIAM-MC) dimensions, and (2) to develop mathematical models that express the insight's mandible anatomy of those important mandible structural elements allowing the prediction of their dimensions using physical parameters such as patient body weight (Wg) and the canine tooth width at the free gingival margin level-(wCGM). Lateral-view X-rays of both sides of the skull were taken for all the individuals. Three mathematical prediction models were developed to calculate Mh, MCh and dIAM-MC. Achieved proportions of the mandible considered parameters regarding its height were of 36.45% for MCh, 50.90% for dMAI-MC and 12.65% for vMC. Statistically significant differences were registered between the Wg and wCGM (P = 0.00), Mh (P = 0.00), MCh (P = 0.00) and dIAM-MC (P = 0.00). Only the Wg presented a strong correlation with the wCGM (R = 0.58), Mh (R = 0.70), dIAM-MC (R = 0.60) and MCh (R = 0.68). These models will allow a clinician to estimate the size of the mandible structures by only using data obtained during the physiological examination, with a sufficiently high prediction capacity and a very low standard error. The study points out the relationships of physiological parameters such as Wg and wCGM with mandible anatomical structural elements considered as important in oral surgery. The results of this study give the surgeon a new additional tool providing more information on the mandible anatomical structures and its relationships. This reduces the risk of iatrogenic lesions during the oral surgical procedures and improves patient safety.
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Affiliation(s)
- M Santos
- Canham Veterinary Clinic, Almancil, Portugal
| | - L M Carreira
- Faculty of Veterinary Medicine, University of Lisbon (FMV/ULisboa), Av. da Universidade Técnica de Lisboa, 1300, Lisboa, Portugal. .,Centre for Interdisciplinary Research Animal Health (CIISA) - FMV/ULisboa, Lisboa, Portugal. .,Anjos of Assis Veterinary Medicine Centre (CMVAA), Rua Dª Francisca da Azambuja, N°9 - 9A, 2830-077, Barreiro, Portugal.
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Al-Amery SM, Nambiar P, Naidu M, Ngeow WC. Variation in Lingual Nerve Course: A Human Cadaveric Study. PLoS One 2016; 11:e0162773. [PMID: 27662622 PMCID: PMC5035068 DOI: 10.1371/journal.pone.0162773] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/29/2016] [Indexed: 11/18/2022] Open
Abstract
The lingual nerve is a terminal branch of the mandibular nerve. It is varied in its course and in its relationship to the mandibular alveolar crest, submandibular duct and also the related muscles in the floor of the mouth. This study aims to understand the course of the lingual nerve from the molar area until its insertion into the tongue muscle. This cadaveric research involved the study of 14 hemi-mandibles and consisted of two parts: (i) obtaining morphometrical measurements of the lingual nerve to three landmarks on the alveolar ridge, and (b) understanding non-metrical or morphological appearance of its terminal branches inserting in the ventral surface of the tongue. The mean distance between the fourteen lingual nerves and the alveolar ridge was 12.36 mm, and they were located 12.03 mm from the lower border of the mandible. These distances were varied when near the first molar (M1), second molar (M2) and third molar (M3). The lingual nerve coursed on the floor of the mouth for approximately 25.43 mm before it deviated toward the tongue anywhere between the mesial of M1 and distal of M2. Thirteen lingual nerves were found to loop around the submandibular duct for an average distance of 6.92 mm (95% CI: 5.24 to 8.60 mm). Their looping occurred anywhere between the M2 and M3. In 76.9% of the cases the loop started around the M3 region and the majority (69.2%) of these looping ended at between the first and second molars and at the lingual developmental groove of the second molar. It gave out as many as 4 branches at its terminal end at the ventral surface of the tongue, with the presence of 2 branches being the most common pattern. An awareness of the variations of the lingual nerve is important to prevent any untoward complications or nerve injury and it is hoped that these findings will be useful for planning of surgical procedures related to the alveolar crest, submandibular gland/ duct and surrounding areas.
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Affiliation(s)
- Samah M Al-Amery
- Dept. of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Phrabhakaran Nambiar
- Dept. of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Murali Naidu
- Dept. of Anatomy, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - Wei Cheong Ngeow
- Dept. of Oro-Maxillofacial Surgical and Medical Sciences, Faculty of Dentistry, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Androulakis XM, Krebs KA, Ashkenazi A. Hemicrania continua may respond to repetitive sphenopalatine ganglion block: A case report. Headache 2016; 56:573-9. [PMID: 26926875 DOI: 10.1111/head.12783] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Hemicrania continua (HC) is a chronic headache disorder characterized by a continuous, strictly unilateral head pain accompanied by cranial autonomic symptoms, which completely responds to indomethacin; however, few alternative treatment options exist for the patients with this disorder who cannot tolerate indomethacin. Sphenopalatine ganglion (SPG) block has been used for the treatment of various headaches, with the strongest evidence for efficacy in cluster headache. CASE REPORT A 52-year-old woman with a 7-year history of HC was evaluated in our clinic for management of her headaches after she had stopped using indomethacin due to a bleeding gastrointestinal ulcer. After failing multiple pharmacologic therapies, she was treated with repetitive SPG blocks using bupivacaine (0.6 mL at 0.5%) twice a week for 6 weeks and followed by maintenance therapy. This treatment protocol resulted in significant improvement in her headaches, mood, and functional capacity. CONCLUSION SPG block using a local anesthetic may be an effective treatment for patients with HC, specifically for those who cannot tolerate indomethacin, or when this drug is contraindicated.
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Affiliation(s)
- X Michelle Androulakis
- School of Medicine, Department of Neurology, University of South Carolina, Columbia, SC, USA
| | - Kaitlin A Krebs
- School of Medicine, Department of Neurology, University of South Carolina, Columbia, SC, USA
| | - Avi Ashkenazi
- Department of Medicine (Neurology), Doylestown Hospital, Doylestown, PA, USA
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Unusual Occurrence of Tongue Sensorial Disorder after Conservative Surgical Treatment of Lymphoepithelial Cyst. Case Rep Dent 2015; 2015:352463. [PMID: 26078888 PMCID: PMC4442266 DOI: 10.1155/2015/352463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/02/2015] [Accepted: 04/23/2015] [Indexed: 11/18/2022] Open
Abstract
Lymphoepithelial cyst is a rare lesion of the oral cavity, with the mouth floor being the most common site of occurrence. The therapeutic approach of choice is the surgical treatment, which has rare cases of postoperative complications. The aim of this study is to report the case of a 53-year-old patient who came to Dental Service in the Federal University of Ceará complaining of a small nodular lesion (0.5 cm) located in the ventral tongue. Excisional biopsy was performed and the surgical specimen was submitted for anatomopathological analysis, which found that there was an oral lymphoepithelial cyst. The patient returned after seven days for suture removal and reported loss of sensitivity around the ventral tongue. We prescribed Citoneurin for ten days; however, there was not any significant improvement of the sensitivity. Low frequency laser therapy sessions were applied. The only postoperative symptom was dysesthesia, where there is only a sensitivity decrease. Currently, the patient has a postoperative period of 1 year without recurrence of the lesion. Although previous reports have no described tongue sensorineural disorders associated with this lesion, the occurrence of this event may be related to an unexpected anatomical variation of the lingual nerve.
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Thiruvenkatarajan V, Van Wijk RM, Rajbhoj A. Cranial nerve injuries with supraglottic airway devices: a systematic review of published case reports and series. Anaesthesia 2014; 70:344-59. [DOI: 10.1111/anae.12917] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2014] [Indexed: 12/12/2022]
Affiliation(s)
- V. Thiruvenkatarajan
- Department of Anaesthesia; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Discipline of Acute Care Medicine; The University of Adelaide; Adelaide South Australia Australia
| | - R. M. Van Wijk
- Department of Anaesthesia; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Discipline of Acute Care Medicine; The University of Adelaide; Adelaide South Australia Australia
| | - A. Rajbhoj
- Department of Anaesthesia; The Queen Elizabeth Hospital; Woodville South Australia Australia
- Discipline of Acute Care Medicine; The University of Adelaide; Adelaide South Australia Australia
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Guimarães DM, Pontes FSC, Da Mata Rezende DDS, Pontes HAR. Anatomical variation of mandibular canal simulating a recurrence of odontogenic tumor. Ann Maxillofac Surg 2014; 4:107-9. [PMID: 24987611 PMCID: PMC4073451 DOI: 10.4103/2231-0746.133088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Mandibular nerve has an important role in the field of oral maxillofacial surgery. Furthermore, several anatomical variations can be found and are clinically relevant mainly in procedures involving the posterior mandible. The unknown of these anatomical variations of the inferior alveolar nerve have been implicated with complications in the performance of surgical procedures and anesthesia in dental and maxillofacial practice. The present paper reports a rare anatomical variation of inferior alveolar nerve mimicking a recurrence of keratocystic odontogenic tumor.
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Affiliation(s)
- Douglas Magno Guimarães
- Department of Surgery and Oral Pathology, "João de Barros Barreto" University Hospital, Belém, Pará, Brazil
| | - Flávia Sirotheau Correa Pontes
- Department of Surgery and Oral Pathology, "João de Barros Barreto" University Hospital, Belém, Pará, Brazil ; Federal University of Pará, Belém, Pará, Brazil
| | | | - Helder Antonio Rebelo Pontes
- Department of Surgery and Oral Pathology, "João de Barros Barreto" University Hospital, Belém, Pará, Brazil ; Federal University of Pará, Belém, Pará, Brazil
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Thiruvenkatarajan V, Van Wijk RM, Elhalawani I, Barnes AM. Lingual nerve neuropraxia following use of the Laryngeal Mask Airway Supreme. J Clin Anesth 2014; 26:65-8. [DOI: 10.1016/j.jclinane.2013.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 10/24/2013] [Accepted: 10/29/2013] [Indexed: 12/19/2022]
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Tan VL, Andrawos A, Ghabriel MN, Townsend GC. Applied anatomy of the lingual nerve: relevance to dental anaesthesia. Arch Oral Biol 2013; 59:324-35. [PMID: 24581856 DOI: 10.1016/j.archoralbio.2013.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 12/05/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES (1) to classify the external morphology of the lingual nerve and investigate any relationship between its external and internal morphology, (2) to explore the fascicular structure, nerve tissue density and capillary density of the lingual nerve, and (3) to provide an anatomical explanation as to why adverse clinical outcomes more commonly affect the lingual nerve following local dental anaesthesia. Where possible, comparisons were made between the lingual and inferior alveolar nerves. MATERIALS AND METHODS The lingual and inferior alveolar nerves were examined in 23 hemi-sectioned heads macroscopically and microscopically 2mm above the lingula. The lingual nerve was also examined in the regions of the third and second molars. Specimens underwent histological processing and staining with Haematoxylin & Eosin, Masson's Trichrome, anti-GLUT-1 and anti-CD 34. RESULTS The lingual nerve became flatter as it traversed through the pterygomandibular space. There was an increase in the connective tissue and a decrease in nerve tissue density along the lingual nerve (p<0.001). At 2mm above the lingula, the lingual nerve was uni-fascicular in 39% of cases, whilst the inferior alveolar nerve consistently had more fascicles (p<0.001). The lingual nerve fascicles had thicker perineurium but the endoneurial vascular density was not significantly different in the two nerves. CONCLUSIONS The greater susceptibility of lingual nerve dysfunction during inferior alveolar nerve blocks may be due to its uni-fascicular structure and the thicker perineurium, leading to increased endoneurial pressure and involvement of all axons if oedema or haemorrhage occurs due to trauma.
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Affiliation(s)
- Vui Leng Tan
- School of Dentistry, The University of Adelaide, Adelaide, SA, Australia
| | - Alice Andrawos
- Discipline of Anatomy and Pathology, The University of Adelaide, Adelaide, SA, Australia
| | - Mounir N Ghabriel
- Discipline of Anatomy and Pathology, The University of Adelaide, Adelaide, SA, Australia
| | - Grant C Townsend
- School of Dentistry, The University of Adelaide, Adelaide, SA, Australia.
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Elfring T, Boliek CA, Winget M, Paulsen C, Seikaly H, Rieger JM. The relationship between lingual and hypoglossal nerve function and quality of life in head and neck cancer. J Oral Rehabil 2013; 41:133-40. [PMID: 24289234 DOI: 10.1111/joor.12116] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2013] [Indexed: 11/27/2022]
Abstract
Sensorimotor impairment of the tongue has the potential to affect speech and swallowing. The purpose of this study was to critically examine the effects of nerve preservation and reinnervation after reconstruction of the base of tongue on patient-perceived outcomes of quality of life (QoL) related to speech and swallowing through completion of the EORTC QLQ-H&N35 standardised questionnaire. Thirty participants with a diagnosis of base of tongue cancer underwent primary resection and reconstruction with a radial forearm free flap, which may or may not have included nerve repair to the lingual nerve, hypoglossal nerve or both. Eight QoL domains sensitive to changes in motor and sensory nerve function were included in the analysis. Transected lingual and hypoglossal nerves were associated with difficulty in swallowing, social eating, dry mouth and social contact. There were fewer problems reported when these nerves were either repaired or left intact. There were no significant differences between patient nerve status and QoL outcomes for speech, sticky saliva and use of feeding tubes. This study was the first to examine the impact of sensory or motor nerve transection and reconstruction on health-related QoL outcomes.
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Affiliation(s)
- T Elfring
- Special Education, Santa Barbara County Education Office, Santa Maria, CA, USA
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Lingual nerve deficit following mandibular third molar removal: review of the literature and medicolegal considerations. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 113:e10-8. [PMID: 22669152 DOI: 10.1016/j.tripleo.2011.06.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 06/05/2011] [Accepted: 06/28/2011] [Indexed: 12/15/2022]
Abstract
The removal of mandibular third molars is probably the most frequently performed procedure in oral and maxillofacial surgery, and it is the most common surgical procedure associated with lingual nerve deficit. Lingual sensory impairment remains a clinical problem in oral and maxillofacial surgery and has serious medical and legal implications. In fact, damage to the lingual nerve is a common cause of litigation in dentistry. The purpose of this article was to review the literature about lingual nerve deficit following mandibular third molar removal and discuss the associated medicolegal aspects.
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21
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Ellenstein A, Yusuf N, Hallett M. Middle ear myoclonus: two informative cases and a systematic discussion of myogenic tinnitus. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2013; 3. [PMID: 23610741 PMCID: PMC3629860 DOI: 10.7916/d8rx9bs1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 03/08/2013] [Indexed: 12/01/2022]
Abstract
Background The term middle ear myoclonus (MEM) has been invoked to explain symptoms of tinnitus presumably caused by the dysfunctional movement of either of the two muscles that insert in the middle ear: tensor tympani and stapedius. MEM has been characterized through heterogeneous case reports in the otolaryngology literature, where clinical presentation is variable, phenomenology is scarcely described, the pathogenic muscle is usually not specified, natural history is unknown, and the presumptive definitive treatment, tensor tympani or stapedius tendon lysis, is inconsistently effective. It is not surprising that no unique acoustogenic mechanism or pathophysiologic process has been identified to explain MEM, one of several descriptive diagnoses associated with the complicated disorders of myogenic tinnitus. Methods Here, we explore MEM from the neurologist’s perspective. Following the detailed descriptions of two informative cases from our clinic, we systematically evaluate the different mechanisms and movement disorder phenomena that could lead to a diagnosis of MEM. Results From a functional neuroanatomic perspective, we explain how tensor tympani MEM is best explained as a form of peritubal myogenic tinnitus, similar to the related disorder of essential palatal tremor. From a pathogenic perspective, we discuss how MEM symptomatology may reflect different mechanical and neurologic processes. We emphasize the diagnostic imperative to recognize when myogenic tinnitus is consistent with a psychogenic origin. Discussion Both individual patient care and further elucidation of MEM will rely on more detailed clinical characterization as well as multidisciplinary input from neurology, otolaryngology, and dentistry.
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Affiliation(s)
- Aviva Ellenstein
- Department of Neurology, George Washington University, Washington, DC, United States of America
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Katagiri A, Shinoda M, Honda K, Toyofuku A, Sessle BJ, Iwata K. Satellite glial cell P2Y12 receptor in the trigeminal ganglion is involved in lingual neuropathic pain mechanisms in rats. Mol Pain 2012; 8:23. [PMID: 22458630 PMCID: PMC3386019 DOI: 10.1186/1744-8069-8-23] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 03/30/2012] [Indexed: 01/01/2023] Open
Abstract
Background It has been reported that the P2Y12 receptor (P2Y12R) is involved in satellite glial cells (SGCs) activation, indicating that P2Y12R expressed in SGCs may play functional roles in orofacial neuropathic pain mechanisms. However, the involvement of P2Y12R in orofacial neuropathic pain mechanisms is still unknown. We therefore studied the reflex to noxious mechanical or heat stimulation of the tongue, P2Y12R and glial fibrillary acidic protein (GFAP) immunohistochemistries in the trigeminal ganglion (TG) in a rat model of unilateral lingual nerve crush (LNC) to evaluate role of P2Y12R in SGC in lingual neuropathic pain. Results The head-withdrawal reflex thresholds to mechanical and heat stimulation of the lateral tongue were significantly decreased in LNC-rats compared to sham-rats. These nocifensive effects were apparent on day 1 after LNC and lasted for 17 days. On days 3, 9, 15 and 21 after LNC, the mean relative number of TG neurons encircled with GFAP-immunoreactive (IR) cells significantly increased in the ophthalmic, maxillary and mandibular branch regions of TG. On day 3 after LNC, P2Y12R expression occurred in GFAP-IR cells but not neuronal nuclei (NeuN)-IR cells (i.e. neurons) in TG. After 3 days of successive administration of the P2Y12R antagonist MRS2395 into TG in LNC-rats, the mean relative number of TG neurons encircled with GFAP-IR cells was significantly decreased coincident with a significant reversal of the lowered head-withdrawal reflex thresholds to mechanical and heat stimulation of the tongue compared to vehicle-injected rats. Furthermore, after 3 days of successive administration of the P2YR agonist 2-MeSADP into the TG in naïve rats, the mean relative number of TG neurons encircled with GFAP-IR cells was significantly increased and head-withdrawal reflex thresholds to mechanical and heat stimulation of the tongue were significantly decreased in a dose-dependent manner compared to vehicle-injected rats. Conclusions The present findings provide the first evidence that the activation of P2Y12R in SGCs of TG following lingual nerve injury is involved in the enhancement of TG neuron activity and nocifensive reflex behavior, resulting in neuropathic pain in the tongue.
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Affiliation(s)
- Ayano Katagiri
- Department of Physiology, Nihon University School of Dentistry, Tokyo, Japan
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Buch HA, Agnihotri RG. A recurrent variant branch of the inferior alveolar nerve: is it unique? Clin Anat 2012; 25:437-43. [PMID: 22302685 DOI: 10.1002/ca.22040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 12/20/2011] [Accepted: 01/10/2012] [Indexed: 11/06/2022]
Abstract
The only named branch of the inferior alveolar nerve (IAN) before it enters the mandibular foramen is the mylohyoid nerve. However, several variations have been reported in the literature. In this study, a recurrent variant branch of the IAN arising just below the origin of the mylohyoid nerve was investigated in adult Indian cadavers allotted for dissection to the first year dental students of Government Dental College, Ahmedabad (India). The dissection was performed by the lateral approach to the infratemporal fossa. The nerve was found in 12 of 35 sides (34.3%) and 8 of 18 cadavers (44.4%). Thus, in our study it was not a rare variation of the IAN, where in most cases it innervated the lateral pterygoid muscle. In some cases, it terminated in the lateral pterygoid muscle. In others, it penetrated the muscle to join the anterior or posterior division of the mandibular nerve or its branches; thus, the variant nerve in such cases might be regarded as an additional root of the IAN. Because the concerned primordia of the nerves and muscles migrate extensively during development and growth, alternative routes of migration may bring about variants like the one under study. The variant appeared to be unique in some of its features. It may be a source of neuropathic and referred pain. Failure of the conventional inferior alveolar nerve block anesthesia and the peripheral neurectomy used for the treatment of trigeminal neuralgia may be partly due to the presence of this variation.
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Affiliation(s)
- Hasmukh A Buch
- Department of Human Anatomy, Faculty of Dental Science, Dharmsinh Desai University, Nadiad-Gujarat, India.
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