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Beecroft EV, Edwards D, Allison JR. Other Secondary Headaches: Odontogenic Pain and Other Painful Orofacial Conditions. Neurol Clin 2024; 42:615-632. [PMID: 38575270 DOI: 10.1016/j.ncl.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
This article discusses extremely common odontogenic pain conditions, which may occasionally present to the neurology clinic mimicking headache, and other uncommon orofacial pain conditions, which may do the same. Typical presentations, investigative strategies, and management are discussed, as well as highlighting key diagnostic criteria and the importance of involving oral or dental specialists where diagnostic uncertainty exists.
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Affiliation(s)
- Emma V Beecroft
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom; Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom.
| | - David Edwards
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom; Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
| | - James R Allison
- School of Dental Sciences, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, United Kingdom; Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, United Kingdom
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Sharav Y, Heiliczer S, Benoliel R, Haviv Y. Pharmacological Topical Therapy for Intra-Oral Post Traumatic Trigeminal Neuropathic Pain: A Comprehensive Review. Pharmaceuticals (Basel) 2024; 17:264. [PMID: 38399479 PMCID: PMC10893422 DOI: 10.3390/ph17020264] [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: 02/05/2024] [Revised: 02/13/2024] [Accepted: 02/17/2024] [Indexed: 02/25/2024] Open
Abstract
Background: The efficacy of topical treatments in alleviating neuropathic pain is well-established. However, there is a paucity of research on topical interventions designed specifically for intra-oral application, where the tissue composition differs from that of exposed skin. Methods: This comprehensive review endeavors to assess the extant evidence regarding the efficacy of topical treatments in addressing neuropathic pain within the oral cavity. Utilizing combinations of search terms, we conducted a thorough search across standard electronic bibliographic databases-MEDLINE (via PubMed), Embase, Google Scholar, and Up to Date. The variables under scrutiny encompassed topical treatment, local intervention, chronic oral and orofacial pain, and neuropathic pain. All pertinent studies published in the English language between 1992 and 2022 were included in our analysis. Results: Fourteen relevant manuscripts were identified, primarily consisting of expert opinions and case reports. The comprehensive review suggests that topical treatments, especially when applied under a stent, could be effective in mitigating neuropathic pain in the oral area. However, it is crucial to conduct further studies to confirm these preliminary results. The limitations of the reviewed studies, mainly the reliance on expert opinions, small sample sizes, inconsistent study designs, and a lack of long-term follow-up data, highlight the need for more rigorous research. Conclusions: Although initial findings indicate topical treatments may be effective for oral neuropathic pain, the limitations of current studies call for more thorough research. Further comprehensive studies are essential to validate the efficacy of these treatments, standardize procedures, and determine long-term results. This will provide clearer guidance for treating chronic neuropathic pain in the oral cavity.
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Affiliation(s)
- Yair Sharav
- Department of Oral Medicine, Sedation and Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (Y.S.); (S.H.)
| | - Shimrit Heiliczer
- Department of Oral Medicine, Sedation and Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (Y.S.); (S.H.)
- Oral Medicine Unit, Oral and Maxillofacial Surgery Department, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
| | | | - Yaron Haviv
- Department of Oral Medicine, Sedation and Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel; (Y.S.); (S.H.)
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Yanko R, Badran Y, Leibovitz S, Sharav Y, Vered Y, Keshet N, Rettman A, Aframian DJ, Haviv Y. Exploring the Effect of Ethnicity on Chronic Orofacial Pain: A Comparative Study of Jewish and Arab Israeli Patients. Healthcare (Basel) 2023; 11:1984. [PMID: 37510424 PMCID: PMC10379038 DOI: 10.3390/healthcare11141984] [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: 05/20/2023] [Revised: 06/18/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
The relationship between ethnicity and chronic pain has been studied worldwide. The population of Israel includes two main ethnic groups, 75% Jews and 21% Arabs. The purpose of this study was to compare orofacial chronic pain characteristics and treatment outcomes between Jewish and Arab Israeli citizens. Two hundred patients admitted to the Orofacial Pain Clinic at Hebrew University-Hadassah School of Dental Medicine between 2017 and 2022 were selected randomly for this historical cohort study. Our cohort included 159 (79.5%) Jews and 41 (20.5%) Arabs. Twenty-six pain-related variables were compared of which only two differed significantly between the two groups, awakening due to pain and mean muscle sensitivity; both indicators were higher in the Arab group (p < 0.05). No differences were found in any of the other variables such as diagnosis, pain severity, onset, and treatment outcome. This minimal difference may be explained by the equal accessibility to medical services for all citizens, and the diversity of our staff that includes Jew as well as Arab service providers. These factors minimize or even eliminate racial bias, language, and cultural barriers, and is reflected in the minor differences in orofacial pain characteristics found between the two main ethnic groups in Israel.
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Affiliation(s)
- Robert Yanko
- Department of Oral Medicine, Sedation & Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Yaara Badran
- In Partial Fulfillment of DMD Requirements, Hebrew University-Hadassah School of Dental Medicine, Jerusalem 91120, Israel
| | - Shirley Leibovitz
- Department of Pediatric Dentistry, Barzilai Medical Center, Ashkelon 78306, Israel
| | - Yair Sharav
- Department of Oral Medicine, Sedation & Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Yuval Vered
- Department of Community Dentistry, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Naama Keshet
- Department of Oral Medicine, Sedation & Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Andra Rettman
- Department of Oral Medicine, Sedation & Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Doron J Aframian
- Department of Oral Medicine, Sedation & Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Yaron Haviv
- Department of Oral Medicine, Sedation & Imaging, Hadassah Medical Center, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem 91120, Israel
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Is Surgical Repair With Nerve Allograft More Cost-Effective Than Non-Surgical Management for Persistent Trigeminal Neuropathy? Initial Assessment With Markov Model. J Oral Maxillofac Surg 2023:S0278-2391(23)00176-3. [PMID: 36893794 DOI: 10.1016/j.joms.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 02/07/2023] [Accepted: 02/12/2023] [Indexed: 03/08/2023]
Abstract
PURPOSE Persistent trigeminal neuropathy (PTN) is associated with high rates of depression, loss of work, and decreased quality of life (QoL). Nerve allograft repair can achieve functional sensory recovery in a predictable manner; however, it bears significant upfront costs. In patients suffering from PTN, is surgical repair with allogeneic nerve graft, when compared to non-surgical therapy, a more cost-effective treatment option? MATERIALS AND METHODS A Markov model was constructed with TreeAge Pro Healthcare 2022 (TreeAge Software, Massachusetts) to estimate the direct and indirect costs for PTN. The model ran for 40 years with 1-year-cycles on a 40-year-old model patient with persistent inferior alveolar or lingual nerve injury (S0 to S2+) at 3 months without signs of improvement, and without dysesthesia or neuropathic pain (NPP). The 2 treatment arms were surgery with nerve allograft versus non-surgical management. There were 3 disease states, functional sensory recovery (S3 to S4), hypoesthesia/anesthesia (S0 to S2+), and NPP. Direct surgical costs were calculated using the 2022 Medicare Physician Fee Schedule and verified with standard institutional billing practices. Non-surgical treatment direct costs (follow-up, specialist referral, medications, imaging) and indirect costs (QoL, loss of employment) were determined from historical data and the literature. Direct surgical costs for allograft repair were $13,291. State-specific direct costs for hypoesthesia/anesthesia were $2,127.84 per year, and $3,168.24 for NPP per year. State-specific indirect costs included decreased labor force participation, absenteeism, and decreased QoL. RESULTS Surgical treatment with nerve allograft was more effective and had a lower long-term cost. The incremental cost-effectiveness ratio was -10,751.94, indicating surgical treatment should be utilized based on efficiency and cost. With a willingness-to-pay threshold of $50,000, the net monetary benefits of surgical treatment are $1,158,339 compared to $830,654 for non-surgical treatment. With a standard threshold incremental cost-effectiveness ratio of 50,000, the sensitivity analysis shows that surgical treatment would remain the preferred choice based on efficiency even if surgical costs were doubled. CONCLUSION Despite high initial costs of surgical treatment with nerve allograft for PTN, surgical intervention with nerve allograft is a more cost-effective treatment option when compared to non-surgical therapy.
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Pathophysiology of Post-Traumatic Trigeminal Neuropathic Pain. Biomolecules 2022; 12:biom12121753. [PMID: 36551181 PMCID: PMC9775491 DOI: 10.3390/biom12121753] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/11/2022] [Accepted: 11/12/2022] [Indexed: 11/29/2022] Open
Abstract
Trigeminal nerve injury is one of the causes of chronic orofacial pain. Patients suffering from this condition have a significantly reduced quality of life. The currently available management modalities are associated with limited success. This article reviews some of the common causes and clinical features associated with post-traumatic trigeminal neuropathic pain (PTNP). A cascade of events in the peripheral and central nervous system function is involved in the pathophysiology of pain following nerve injuries. Central and peripheral processes occur in tandem and may often be co-dependent. Due to the complexity of central mechanisms, only peripheral events contributing to the pathophysiology have been reviewed in this article. Future investigations will hopefully help gain insight into trigeminal-specific events in the pathophysiology of the development and maintenance of neuropathic pain secondary to nerve injury and enable the development of new therapeutic modalities.
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Lakshmi R, Chitra A, Singh A, Pentapati KC, Gadicherla S. Neurosensory Assessment of Infraorbital Nerve Injury Following Unilateral Zygomaticomaxillary Complex Fracture – A Prospective Study. Open Dent J 2022. [DOI: 10.2174/18742106-v16-e2206140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
This study aimed to assess the difference in the recovery pattern of branches of infraorbital nerve paraesthesia after zygomaticomaxillary complex (ZMC) fracture in both surgically and non-surgically managed patients.
Materials & Methods:
A prospective, observational study involving 31 patients with unilateral ZMC fracture - 15 in the surgical group (Group A) and 16 in the non-surgical group (Group B) was evaluated. These patients were assessed at the time of injury, 3-months follow-up, and 6-months follow-up for the sensory function of the infraorbital nerve. The assessment of paraesthesia by cotton wisp test, light touch monofilament test, and the cold thermal test was subjected to intra-group and inter-group correlation by McNemar test and Fischer's exact test. Repeated Measures ANOVA with post-hoc Bonferroni test for intra-group correlation and independent sample t-test for inter-group correlation were used for two-point discrimination.
Results:
A statistically significant improvement was noted on both 3 and 6 months follow-up in the malar region in group A. Other statistically significant improvements were noted only on 6 months follow-up in the infraorbital region in group A. On the 2-point discrimination test, all the facial regions showed significant improvement in both the groups over 3 months and 6 months of follow-up.
Conclusion:
There was a significant improvement in the infraorbital nerve sensory function following ZMC fracture over 6 months; however, the surgical intervention showed no statistical significance. Further, it can also be concluded that the inferior palpebral branch of the infraorbital nerve shows maximum functional disruption resulting in a higher incidence of paraesthesia in the infraorbital and malar region.
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Dhabaria H, Kolari V, Sequeira J, Shah A. Evaluation of Infraorbital Nerve Recovery and its Effect on Quality of Life following Open Reduction and Internal Fixation of Zygomaticomaxillary Complex Fractures - An Evaluative Study. Ann Maxillofac Surg 2022; 12:128-132. [PMID: 36874781 PMCID: PMC9976864 DOI: 10.4103/ams.ams_100_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/02/2022] [Accepted: 08/16/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction The zygomaticomaxillary complex (ZMC) fractures are the second most common fractures affecting the midfacial skeleton. Neurosensory disturbances of the infraorbital nerve are one of the most common signs of ZMC fractures. The aim of the study was to evaluate the neurosensory recovery of the infraorbital nerve and its effect on the quality of life (QoL) following open reduction and internal fixation of ZMC fractures. Methods Thirteen patients clinically and radiologically diagnosed with unilateral ZMC fractures with neurosensory deficits of the infraorbital nerve were enrolled for this study. All patients were assessed presurgically for neurosensory deficits of the infraorbital nerve using the various neurosensory tests, followed by open reduction with two-point fixation under general anaesthesia. The patients were followed up at one, three and six months postoperatively to evaluate the recovery of neurosensory deficits. Results Recovery of tactile and pain sensation was relatively complete in 84.62% and 76.92% of patients respectively by the end of six months postoperatively. The spatial mechanoreception of the affected side improved significantly. 61.54% of patients led an excellent QoL six months postoperatively. Discussion The majority of the patients with ZMC fractures and neurosensory deficits of the infraorbital nerve, when treated with open reduction and internal fixation, have complete recovery of the neurosensory deficits by the end of six months postoperatively. However, some patients may continue to experience some long-term residual deficits, which can affect the patient's QoL.
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Affiliation(s)
- Husain Dhabaria
- Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Yenepoya (Deemed to be University), Mangalore, India
| | - Vinayakrishna Kolari
- Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Yenepoya (Deemed to be University), Mangalore, India
| | - Joyce Sequeira
- Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Yenepoya (Deemed to be University), Mangalore, India
| | - Abhishek Shah
- Department of Oral and Maxillofacial Surgery, KLE VK Institute of Dental Sciences, KLE Deemed University, Karnataka, India
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Dubron K, Verbist M, Shaheen E, Dormaar TJ, Jacobs R, Politis C. Incidence, Aetiology, and Associated Fracture Patterns of Infraorbital Nerve Injuries Following Zygomaticomaxillary Complex Fractures: A Retrospective Analysis of 272 Patients. Craniomaxillofac Trauma Reconstr 2022; 15:139-146. [PMID: 35633769 PMCID: PMC9133524 DOI: 10.1177/19433875211022569] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE Zygomaticomaxillary complex (ZMC) fractures are common facial injuries with heterogeneity regarding aetiologies, fracture types, infraorbital nerve (ION) involvement, and treatment methods. The aim of this study was to identify associations between aetiologies, fracture types, and neurological complications. Additionally, treatment methods and recovery time were investigated. METHODS Medical files of 272 patients with unilateral and bilateral ZMC fractures were reviewed, whose cases were managed from January 2014 to January 2019 at the Department of Oral and Maxillofacial Surgery, University hospitals Leuven, Belgium. History of ION sensory dysfunction and facial nerve motoric dysfunction were noted during follow-up. RESULTS ION hypoaesthesia incidence was 37.3%, with the main causes being fall accidents, road traffic accidents, and interpersonal violence. Significant predictors of ION hypoaesthesia were Zingg type B fractures (P = 0.003), fracture line course through the infraorbital canal (P < .001), orbital floor fracture (P < 0.001), and ZMC dislocation or mobility (P = 0.001). CONCLUSION Of all ZMC fractures, 37.3% exhibited ION hypoaesthesia. Only ZMC Zingg type B fractures (74.0%) were significantly more associated with ION hypoaesthesia. ION hypoesthesia was more likely (OR = 2.707) when the fracture line course ran through the infraorbital canal, and was less dependent on the degree of displacement. Neuropathic pain symptoms developed after ZMC fractures in 2.2% patients, posing a treatment challenge. Neuropathic pain symptoms were slightly more common among women, and were associated only with type B or C fractures. No other parameters were found to predict the outcome of this post-traumatic neuropathic pain condition.
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Affiliation(s)
- Kathia Dubron
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Maarten Verbist
- Department of Oral Health Sciences, KU Leuven and Dentistry, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Titiaan Jacob Dormaar
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
- Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Constantinus Politis
- Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
- OMFS IMPATH Research Group, Department of Imaging & Pathology, University Hospitals Leuven, Leuven, Belgium
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Abdelazeem MH, Erdogan Ö, Osman MF, Awad TA. Implications of an Anatomical Variation of the Infraorbital Nerve in Orbital Floor Reconstruction. J Craniofac Surg 2022; 33:e572-e573. [PMID: 35119409 DOI: 10.1097/scs.0000000000008488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Fractures involving the orbital floor such as blow-out fractures may cause damage to the infraorbital nerve (ION). The integrity and course of the nerve should be evaluated preoperatively in order to prevent from such nerve injuries. The anatomy of the ION can show variations in significant number of patients, which should be taken into account in treatment planning. In this report, the authors present a patient with an isolated fracture of the orbital floor, who had abnormal anatomy of his both IONs. Our treatment approach for this patient is presented along with relevant literature findings.
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Affiliation(s)
- Mohamed Hazem Abdelazeem
- Department of General Surgery, Plastic Surgery Division, Cairo University, Cairo, Egypt Department of Oral and Maxillofacial Surgery, Istanbul Okan University, Istanbul, Turkey Department of Radiology Department of General Surgery, Cairo University, Cairo, Egypt
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Jay GW, Barkin RL. Trigeminal neuralgia and persistent idiopathic facial pain (atypical facial pain). Dis Mon 2022; 68:101302. [PMID: 35027171 DOI: 10.1016/j.disamonth.2021.101302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Gary W Jay
- Department of Neurology, Division: Headache/Pain, University of North Carolina, Chapel Hill, USA.
| | - Robert L Barkin
- Departmentts of Anesthesilogy, Family Medicine, Pharrmacology, Rush University Medical College, Chicago Illinois, USA
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Handa S, Keith DA, Abou-Ezzi J, Rosèn A. Neuropathic orofacial pain: Characterization of different patient groups using the ICOP first edition, in a tertiary level Orofacial Pain Clinic. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:653-661. [PMID: 34518134 DOI: 10.1016/j.oooo.2021.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/09/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To characterize patients with chronic neuropathic orofacial pain in accordance with the International Classification of Orofacial Pain (ICOP first edition) criteria. STUDY DESIGN A retrospective chart review of 108 patients was conducted. The most common categories observed were trigeminal neuralgia (TN) (25.9%), burning mouth syndrome (BMS) (11.1%), persistent idiopathic facial pain (PIFP) (26.9%), and posttraumatic trigeminal neuropathic pain (PTTNP) (26.9%); 9.3% of patients could not be categorized. RESULTS TN and BMS was more prevalent in the sixth decade, and PIFP and PTTN were more prevalent in the fifth decade. All categories showed female predilection. The pain in TN was predominantly episodic, described as "sharp shooting" and like an "electric shock," unilateral and affecting the V2 division, and with trigger zones in 50% of patients. Pain in BMS was predominantly constant and described as "burning," with the tongue being the most common site. Pain in PIFP and PTTNP was as follows: varied from constant to episodic; described as "burning," "sharp shooting," "throbbing," or "dull aching"; intraoral or extraoral; and mostly involving the V2 or V3 division. CONCLUSION This study is the first to characterize patients with neuropathic orofacial pain using the new ICOP criteria. PIFP and PTTNP were most commonly misdiagnosed categories. Using diagnostic criteria will increase the understanding of this patient group.
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Affiliation(s)
- Shruti Handa
- Instructor, Department of Surgery, Division of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA.
| | - David A Keith
- Professor, Department of Surgery, Division of Oral and Maxillofacial Surgery, Massachusetts General Hospital and Harvard School of Dental Medicine, Boston, MA, USA
| | - Jeanelle Abou-Ezzi
- Student, Department of Human Ecology, Cornell University, New York, NY, USA
| | - Annika Rosèn
- Professor, Department of Clinical Dentistry, University of Bergen, Bergen, Norway; Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
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The effect of delayed photobiomodulation on neurosensory disturbance recovery after zygomatic trauma: A parallel controlled clinical trial. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY B-BIOLOGY 2021; 217:112153. [PMID: 33640829 DOI: 10.1016/j.jphotobiol.2021.112153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/14/2020] [Accepted: 02/05/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Zygomatic fractures are usually accompanied with neural complications, which are routinely treated by surgery or medication. However, photobiomodulation has been proven as a non-invasive method with better results in nerve's regeneration and repair. Therefore, in this study, we aimed to investigate the healing effect of photobiomodulation on neurosensory defect after facial trauma. PATIENTS AND METHODS In this parallel controlled clinical trial, 35 control cases and 36 patients with zygomaticomaxillary complex (ZMC) fractures as well as the sustained infraorbital nerve paresthesia were included. Afterward, Laser irradiation was applied using a GaAlAs diode laser (810 nm, 27 J/cm2, 200 mW) on 12 points on malar area of paresthesia during 12 sessions within six weeks. Neurosensory evaluations were performed in four sessions as follows: at baseline, the end of treatment, one month, and three months after the last session of irradiation, which were achieved through three tests including visual analogue scales (VAS) for general sensitivity, two-point discrimination, and pain discrimination. Repeated measure ANOVA, independent t-test, and Chi-square test were used for comparing time trends, each time point, and gender, respectively. P-values less than 0.05 were considered to be statistically significant. RESULTS The patients and controls were matched in both terms of age and gender. Baseline results showed non-significant differences between the two groups based on the VAS, pain, and two-point discrimination. Moreover, for VAS scale, some significant differences were observed between the groups by passing "one month and three months from therapy". Pain and two-point discriminations showed a significant difference between the intervention and control groups in "one month after therapy" and "at the end of the therapy, one month after therapy, and three months after therapy", respectively. CONCLUSION Photobiomodulation could be considered as an effective treatment option for post-traumatic neurosensory disturbance of facial area in terms of VAS, pain and two-point discrimination, even if not performed early after trauma.
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Abstract
After traumatic brain injury (TBI), a host of symptoms of varying severity and associated functional impairment may occur. One of the most commonly encountered and challenging to treat are the post-traumatic cephalalgias. Post-traumatic cephalalgia (PTC) or headache is often conceptualized as a single entity as currently classified using the ICHD-3. Yet, the terminology applicable to the major primary, non-traumatic, headache disorders such as migraine, tension headache, and cervicogenic headache are often used to specify the specific type of headache the patients experiences seemingly disparate from the unitary definition of post-traumatic headache adopted by ICHD-3. More complex post-traumatic presentations attributable to brain injury as well as other headache conditions are important to consider as well as other causes such as medication overuse headache and medication induced headache. Treatment of any post-traumatic cephalalgia must be optimized by understanding that there may be more than one headache pain generator, that comorbid traumatic problems may contribute to the pain presentation and that pre-existing conditions could impact both symptom complaint, clinical presentation and recovery. Any treatment for PTC must harmonize with ongoing medical and psychosocial aspects of recovery.
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Affiliation(s)
- Brigid Dwyer
- Department of Neurology, Boston University, Boston, Massachusetts, USA
| | - Nathan Zasler
- Concussion Care Centre of Virginia Ltd. and Tree of Life Services, Inc., Richmond, Virginia, USA.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA.,Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA
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Choudhury R, Rastogi S, Kumar D, Indra SP, Joshi A, Jawalkar S. Does initial reduction at infra-orbital rim first improve malar height and vertical dystopia in ZMC fractures? Oral Maxillofac Surg 2020; 25:215-222. [PMID: 32910362 DOI: 10.1007/s10006-020-00905-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To estimate the clinical and functional results of patients who underwent distinctive types of open reduction and internal fixation of ZMC fractures, with particular emphasis on malar height and vertical dystopia. MATERIALS AND METHODS A randomized clinical trial was conducted from August 2016 to October 2019 in which 40 adult patients with ZMC fractures of maxillofacial region were included. Patients were randomly allocated to group A (n = 20; frontozygomatic (F-Z) first 3-point reduction and fixation) or group B (n = 20; group B infra-orbital first 3-point reduction and fixation). All patients were evaluated objectively for malar height and vertical dystopia pre- and post-operatively at 3 months. The data were scrutinized by applying mean and standard deviation and unpaired t test. RESULTS Mean values of the malar height and vertical dystopia were statistically significant (P < .05) for group B compared with group A at all intervals. Data analyzed for other secondary variables showed a statistically non-significant difference between the groups (P > 0.05). CONCLUSION The results showed improvement in the malar height and vertical dystopia for infra-orbital first three-point fixation (group B) compared with F-Z first approach for initial reduction and fixation (group A). Furthermore, group B was better in terms of malar width and antero-posterior projection of the zygomaticomaxillary complex.
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Affiliation(s)
- Rupshikha Choudhury
- Department of Oral and Maxillofacial Surgery, Regional Dental College, Guwahati, Assam, India
| | - Sanjay Rastogi
- Department of Oral and Maxillofacial Surgery, Regional Dental College, Guwahati, Assam, India.
| | - Dharmendra Kumar
- Department of Oral and Maxillofacial Surgery, CKS Theja Dental College, Tirupati, India
| | - Shanthi Prasad Indra
- Department of Orthodontics, Sharavathi Dental College and Hospital, Shimoga, India
| | - Ankur Joshi
- Government Doon Medical College, Dehradun, Uttarakhand, India
| | - Shreya Jawalkar
- Department of Oral and Maxillofacial Surgery, CKS Theja Dental College, Tirupati, India
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Degala S, Radhakrishna S, Dharmarajan S. Zygomaticomaxillary fracture fixation: a prospective comparative evaluation of two-point versus three-point fixation. Oral Maxillofac Surg 2020; 25:41-48. [PMID: 32712793 DOI: 10.1007/s10006-020-00881-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Zygomatic bone has a higher risk of sustaining injuries in the maxillofacial skeleton. On fracturing, zygomatic bone separates from the four neighbouring bones at its articulations. Treatment for zygomaticomaxillary fractures has evolved a long way since 3000 BC. With the advent of miniplates for midface fracture, controversies still exist regarding the stability of zygoma following 1, 2, and 3 points for fixation. The study aims to compare and determine the most effective technique for the reduction of zygomaticomaxillary fractures and the ability to retain the fractured zygoma in a stable position. Hence, a study was conducted in our institute to compare 2 and 3-point fixation of zygomaticomaxillary fractures taking into account the clinical and radiographic parameters. METHODS Twenty-four patients were divided into 2 equal groups A and B, receiving 2- and 3-point fixation respectively. Fracture displacement and stability were assessed using coronal and axial CT scan tracings at preoperatively, immediate, and 5-week postoperatively. RESULTS Group B showed a significant reduction in postoperative mean displacement at sphenozygomatic and infraorbital region when compared with group A. Patients in group A had an increase incidence in vertical dystopia and enophthalmos. There was no postoperative displacement at any site in both the groups. CONCLUSION The fractured segment was held in place by both the fixation methods but 3-point fixation gave better stability in maintaining the fractured segment in desired reduced position.
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Affiliation(s)
- Saikrishna Degala
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysore, Karnataka, 570015, India
| | - Sathish Radhakrishna
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysore, Karnataka, 570015, India.
| | - Shweta Dharmarajan
- Department of Oral and Maxillofacial Surgery, JSS Dental College and Hospital, Mysore, Karnataka, 570015, India
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Tabrizi R, Neamati M, Rajabloo S, Latifi F. Does the Lag Time Between Injury and Treatment Affect Recovery of Infraorbital Nerve Disturbances in Zygomaticomaxillary Complex Fractures? Craniomaxillofac Trauma Reconstr 2020; 13:105-108. [PMID: 32642040 DOI: 10.1177/1943387520902896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design A cross-sectional study. Objective Neurosensory disturbances (NSDs) of the infraorbital nerve (ION) are common following orbito-zygomaticomaxillary complex (ZMC) fractures. This study aimed to evaluate the effect of lag time between injury and treatment on recovery of NSDs of the ION following open reduction internal fixation. Methods Subjects who had ZMC fracture and paresthesia were studied. The lag time between injury and treatment was considered as the predictive factor. The level of NSDs according to the brush test and two-point discrimination (TPD) test and self-reported NSD were the outcomes of this study. Self-reported NSD was quantified using a visual analog scale. Results Forty patients were studied. The lag time between injury and treatment had a significant correlation with the result of the TPD test and the self-reported level of NSD. In 73.6% of patients who had NSD following ZMC fracture, every 1-day delay in treatment increased the incidence of self-reported paresthesia by 0.44. Conclusions It seems, a delay in treatment of ZMC fractures increased the risk of NSD.
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Affiliation(s)
- Reza Tabrizi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Neamati
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Rajabloo
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Latifi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Korczeniewska OA, Khan J, Eliav E, Benoliel R. Molecular mechanisms of painful traumatic trigeminal neuropathy-Evidence from animal research and clinical correlates. J Oral Pathol Med 2020; 49:580-589. [PMID: 32557871 DOI: 10.1111/jop.13078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/02/2023]
Abstract
Painful traumatic trigeminal neuropathy (PTTN) may occur following major craniofacial or oral trauma, or may be subsequent to relatively minor dental interventions. Following injury, pain may originate from a peripheral nerve, a ganglion, or from the central nervous system. In this review, we focus on molecular mechanisms of pain resulting from injury to the peripheral branch of the trigeminal nerve. This syndrome has been termed painful traumatic trigeminal neuropathy (PTTN) by the International Headache Society and replaces previous terms including atypical odontalgia, deafferentation pain, traumatic neuropathy and phantom toothache. We emphasize the scientific evidence supporting the events purported to lead to PTTN by reviewing the pathophysiology of PTTN based on relevant animal models. Additionally, we briefly overview clinical correlates and pathophysiological manifestations of PTTN.
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Affiliation(s)
- Olga A Korczeniewska
- Center for Orofacial Pain and Temporomandibular Disorders, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Junad Khan
- Eastman Institute of Oral Health, University of Rochester Medical Center, Rochester, New Jersey, USA
| | - Eli Eliav
- Eastman Institute of Oral Health, University of Rochester Medical Center, Rochester, New Jersey, USA
| | - Rafael Benoliel
- Center for Orofacial Pain and Temporomandibular Disorders, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
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18
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Korczeniewska OA, Katzmann Rider G, Gajra S, Narra V, Ramavajla V, Chang YJ, Tao Y, Soteropoulos P, Husain S, Khan J, Eliav E, Benoliel R. Differential gene expression changes in the dorsal root versus trigeminal ganglia following peripheral nerve injury in rats. Eur J Pain 2020; 24:967-982. [PMID: 32100907 DOI: 10.1002/ejp.1546] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/02/2020] [Accepted: 02/12/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND The dorsal root (DRG) and trigeminal (TG) ganglia contain cell bodies of sensory neurons of spinal and trigeminal systems, respectively. They are homologs of each other; however, differences in how the two systems respond to injury exist. Trigeminal nerve injuries rarely result in chronic neuropathic pain (NP). To date, no genes involved in the differential response to nerve injury between the two systems have been identified. We examined transcriptional changes involved in the development of trigeminal and spinal NP. METHODS Trigeminal and spinal mononueropathies were induced by chronic constriction injury to the infraorbital or sciatic nerve. Expression levels of 84 genes in the TG and DRG at 4, 8 and 21 days post-injury were measured using real-time PCR. RESULTS We found time-dependent and ganglion-specific transcriptional regulation that may contribute to the development of corresponding neuropathies. Among genes significantly regulated in both ganglia Cnr2, Grm5, Htr1a, Il10, Oprd1, Pdyn, Prok2 and Tacr1 were up-regulated in the TG but down-regulated in the DRG at 4 days post-injury; at 21 days post-injury, Adora1, Cd200, Comt, Maob, Mapk3, P2rx4, Ptger1, Tnf and Slc6a2 were significantly up-regulated in the TG but down-regulated in the DRG. CONCLUSIONS Our findings suggest that spinal and trigeminal neuropathies due to trauma are differentially regulated. Subtle but important differences between the two ganglia may affect NP development. SIGNIFICANCE We present distinct transcriptional alterations in the TG and DRG that may contribute to differences observed in the corresponding mononeuropathies. Since the trigeminal system seems more resistant to developing NP following trauma our findings lay ground for future research to detect genes and pathways that may act in a protective or facilitatory manner. These may be novel and important therapeutic targets.
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Affiliation(s)
- Olga A Korczeniewska
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Giannina Katzmann Rider
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Sheetal Gajra
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Vivek Narra
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Vaishnavi Ramavajla
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Yun-Juan Chang
- Office of Advance Research Computing, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Yuanxiang Tao
- Center for Pain Medicine Research, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Patricia Soteropoulos
- The Genomics Center, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Seema Husain
- The Genomics Center, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Junad Khan
- Eastman Institute of Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Eli Eliav
- Eastman Institute of Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Rafael Benoliel
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
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Chronic orofacial pain. J Neural Transm (Vienna) 2020; 127:575-588. [DOI: 10.1007/s00702-020-02157-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/03/2020] [Indexed: 02/06/2023]
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Khan J, Zusman T, Wang Q, Eliav E. Acute and Chronic Pain in Orofacial Trauma Patients. J Endod 2019; 45:S28-S38. [DOI: 10.1016/j.joen.2019.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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21
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Khan J, Zusman T, Wang Q, Eliav E. Acute and chronic pain in orofacial trauma patients. Dent Traumatol 2019; 35:348-357. [PMID: 31125489 DOI: 10.1111/edt.12493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 01/07/2023]
Abstract
Trauma or injury to the dentition and supporting tissues is associated with pain and discomfort, as expected, that may present immediately, shortly afterwards, or within a few days. Pain is an essential response to injury because it allows the organism to develop avoidance behavior to potential threats and helps the organism to avoid usage of the injured organ during the healing process. Not only does external trauma induce pain, but also essential invasive dental procedures such as extractions, dental implant insertions, root canal treatments, and oral surgeries are accompanied by similar post-surgical (post-traumatic) pain. The pain intensity after trauma varies and does not always correlate with the extent of injury. Trauma to the orofacial region or the teeth may also indirectly affect and induce pain in other orofacial structures such as the masticatory muscles, the temporomandibular joint, and even the cervical spine. In most cases, the pain will resolve as soon as healing of the affected tissue occurs or after dental and routine palliative treatment. In a limited number of cases, the pain persists beyond healing and evolves into a chronic pain state. Chronic pain in the orofacial region presents diagnostic and management challenges. Misdiagnosis or delayed diagnosis of the oral chronic pain condition may lead to unnecessary dental treatment. This article will discuss diagnosis and treatment for acute and chronic pain as well as potential mechanisms involved in the undesirable transition from acute to chronic pain.
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Affiliation(s)
- Junad Khan
- Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Tal Zusman
- Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Qian Wang
- Orofacial Pain and TMJ Disorders, Eastman Institute for Oral Health, Rochester, NY, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, Rochester, NY, USA
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Kim KS, Lee WS, Cho H, Shim SM, Kwak S, Ji SY, Jeon S, Kim YM. Introduction of pulsed radiofrequency cautery in infraorbital nerve block method for postoperative pain management of trauma-induced zygomaticomaxillary complex fracture reduction. J Pain Res 2019; 12:1871-1876. [PMID: 31354336 PMCID: PMC6576132 DOI: 10.2147/jpr.s197139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 03/26/2019] [Indexed: 11/30/2022] Open
Abstract
Although various cases of neuralgia and its treatments have been reported, not enough evidence is present to recommend a single type of treatment as the most effective. The patient we have dealt with experienced significant interferences in his daily life due to chronic allodynia, but the symptom could not be resolved via previously reported treatments. We report a case of which a patient who presented infraorbital neuralgia after trauma was successfully treated by a novel treatment strategy. The patient was treated by applying infraorbital nerve block and pulsed radiofrequency cautery side by side. Through this report, we evaluate proper prevention and treatment strategies for patients who develop infraorbital neuralgia through similar etiologies. ![]()
Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/mp8ho9r06Dc
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Affiliation(s)
- Kwan-Sub Kim
- Department of Anesthesiology and Pain Medicine, Dongkang Medical Center, Ulsan, South Korea
| | - Wu-Seop Lee
- Department of Plastic Surgery, Dongkang Medical Center, Ulsan, South Korea
| | - Haejun Cho
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sung-Min Shim
- Department of Anesthesiology and Pain Medicine, Gangneung Asan Medical Center, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Soohyun Kwak
- Department of Rehabilitation Medicine, Semin Hospital, Ulsan, South Korea
| | - So-Young Ji
- Department of Plastic Surgery, Dongkang Medical Center, Ulsan, South Korea
| | - SangYoon Jeon
- Department of Anesthesiology and Pain Medicine, Dongkang Medical Center, Ulsan, South Korea
| | - Yong-Min Kim
- Department of Chemical and Biomolecular Engineering, Hong Kong University of Science and Technology, Hong Kong, Hong Kong
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24
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A Rare Complication of Infraorbital Nerve Hyperesthesia in Surgically Repaired Orbital Fracture Patients. J Craniofac Surg 2018; 28:e233-e234. [PMID: 28468199 DOI: 10.1097/scs.0000000000003439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Injury to the peripheral sensory branches of the trigeminal nerve can follow a wide variety of craniofacial injuries. Many patients with facial fractures complain about the symptom of numbness to the distribution of injured nerve, which is indicative of hypoesthesia. Hyperesthesia involving the infraorbital nerve is rare in comparison to hypoesthesia secondary to facial trauma. The authors report on 2 patients with infraorbital nerve hyperesthesia in surgically repaired orbital fracture patients. Surgical decompression of the infraorbital nerve led to rapid resolution of hyperesthesia. To the best of our knowledge, these were rare cases of patients who presented with persistent hyperesthesia. Clinician should perform early surgical decompression of the infraorbital nerve in patient with persistent hyperesthesia of the infraorbital nerve.
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25
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Korczeniewska OA, Husain S, Khan J, Eliav E, Soteropoulos P, Benoliel R. Differential gene expression in trigeminal ganglia of male and female rats following chronic constriction of the infraorbital nerve. Eur J Pain 2018; 22:875-888. [PMID: 29350446 DOI: 10.1002/ejp.1174] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND The mechanisms underlying sex-based differences in pain and analgesia are poorly understood. In this study, we investigated gene expression changes in trigeminal ganglia (TG) of male and female rats exposed to infraorbital nerve chronic constriction injury (IoN-CCI). METHODS Somatosensory assessments were performed prior to IoN-CCI and at selected time points postsurgery. Selected gene expression changes were examined with real-time quantitative polymerase chain reaction (RT-PCR) in ipsilateral TG at 21 days postsurgery. RESULTS Rats exposed to IoN-CCI developed significant mechanical allodynia and hyperalgesia on days 19 and 21 postsurgery. During this period, females developed significantly more allodynia but not hyperalgesia compared to males. At 21 days postsurgery, expression levels of 44 of the 84 investigated pain-related genes in ipsilateral TG were significantly regulated relative to naïve rats in either sex. Csf1 and Cx3cr1 were up-regulated in both sexes, but the magnitude of regulation was significantly higher in females (p = 0.02 and p = 0.001, respectively). Htr1a and Scn9a were down-regulated in both sexes, but the down-regulation was significantly more pronounced in males (p = 0.04 and p = 0.02, respectively). Additionally, Cck, Il1a, Pla2g1b and Tnf genes were significantly regulated in females but not in males, and Chrna4 gene was significantly down-regulated in males but not in females. CONCLUSIONS Our findings suggest sex-dependent gene regulation in response to nerve injury, which may contribute to sex dimorphism of trigeminal neuropathic pain. Further studies are needed to establish gene expression changes over time and correlate these with hormonal and other physiological parameters in male and female. SIGNIFICANCE We present novel sex-specific transcriptional regulation in trigeminal ganglia that may contribute to male-/female-based differences in trigeminal neuropathic pain. These findings are expected to open new research horizons, particularly in male versus female targeted therapeutic regimens.
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Affiliation(s)
- O A Korczeniewska
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - S Husain
- The Genomics Center, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - J Khan
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - E Eliav
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - P Soteropoulos
- The Genomics Center, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - R Benoliel
- Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, NJ, USA
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Devine M, Hirani M, Durham J, Nixdorf DR, Renton T. Identifying criteria for diagnosis of post-traumatic pain and altered sensation of the maxillary and mandibular branches of the trigeminal nerve: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:526-540. [PMID: 29426749 DOI: 10.1016/j.oooo.2017.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/20/2017] [Accepted: 12/29/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of the study was to systematically identify criteria used to diagnose patients with trigeminal nerve injury. STUDY DESIGN A systematic review of the literature registered in the PROSPERO database. Inclusion criteria were patients diagnosed with nerve injury of the sensory divisions of the maxillary or mandibular branches of the trigeminal nerve, with reported tests and criteria used for diagnosis and persistent pain or unpleasant sensation associated with nerve injury. RESULTS In total, 28 articles were included. Diagnostic tests included clinical neurosensory tests (89%), thermal quantitative sensory testing (QST; 25%), electromyography (7%), and patient interview (14%). Neuropathic pain was assessed by using the visual analogue scale (39%); patient use of neuropathic medication (7%); questionnaires, including McGill and PainDETECT (21%). Functional impact was assessed in 14% and psychological impact in 7% of articles. Methodology in performing clinical neurosensory tests, application of diagnostic terms and diagnostic grading of nerve injury was found to be inconsistent among the included articles, making direct comparison of results difficult. CONCLUSIONS Recommendations for assessment and diagnosis of trigeminal nerve injury have been made based on the best available evidence from the review. There is an urgent requirement for a consensus in diagnostic criteria, criteria for assessment, and outcome reporting among stakeholder organizations to improve knowledge in this field.
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Affiliation(s)
- Maria Devine
- Department of Oral Surgery, King's College London Dental Institute, London, UK.
| | - Murtaza Hirani
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - Justin Durham
- Centre for Oral Health Research and School of Dental Sciences, Newcastle University. Newcastle-Upon-Tyne Hospitals' NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Donald R Nixdorf
- Department of Diagnostic and Biological Sciences, School of Dentistry, Department of Neurology, Medical School, University of Minnesota and HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | - Tara Renton
- Department of Oral Surgery, King's College London Dental Institute, London, UK
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Abstract
Background Persistent idiopathic facial pain (PIFP) is a chronic disorder recurring daily for more than two hours per day over more than three months, in the absence of clinical neurological deficit. PIFP is the current terminology for Atypical Facial Pain and is characterized by daily or near daily pain that is initially confined but may subsequently spread. Pain cannot be attributed to any pathological process, although traumatic neuropathic mechanisms are suspected. When present intraorally, PIFP has been termed ‘Atypical Odontalgia’, and this entity is discussed in a separate article in this special issue. PIFP is often a difficult but important differential diagnosis among chronic facial pain syndromes. Aim To summarize current knowledge on diagnostic criteria, differential diagnosis, pathophysiology and management of PIFP. Methods We present a narrative review reporting current literature and personal experience. Additionally, we discuss and differentiate the common differential diagnoses associated with PIFP including traumatic trigeminal neuropathies, regional myofascial pain, atypical neurovascular pains and atypical trigeminal neuropathic pains. Results and conclusion The underlying pathophysiology in PIFP is still enigmatic, however neuropathic mechanisms may be relevant. PIFP needs interdisciplinary collaboration to rule out and manage secondary causes, psychiatric comorbidities and other facial pain syndromes, particularly trigeminal neuralgia. Burden of disease and psychiatric comorbidity screening is recommended at an early stage of disease, and should be addressed in the management plan. Future research is needed to establish clear diagnostic criteria and treatment strategies based on clinical findings and individual pathophysiology.
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Affiliation(s)
| | - Charly Gaul
- Migraine and Headache Clinic Königstein, Königstein im Taunus, Germany
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Abstract
Definition and taxonomy This review deals with neuropathic pain of traumatic origin affecting the trigeminal nerve, i.e. painful post-traumatic trigeminal neuropathy (PTTN). Symptomatology The clinical characteristics of PTTN vary considerably, partly due to the type and extent of injury. Symptoms involve combinations of spontaneous and evoked pain and of positive and negative somatosensory signs. These patients are at risk of going through unnecessary dental/surgical procedures in the attempt to eradicate the cause of the pain, due to the fact that most dentists only rarely encounter PTTN. Epidemiology Overall, approximately 3% of patients with trigeminal nerve injuries develop PTTN. Patients are most often female above the age of 45 years, and both physical and psychological comorbidities are common. Pathophysiology PTTN shares many pathophysiological mechanisms with other peripheral neuropathic pain conditions. Diagnostic considerations PTTN may be confused with one of the regional neuralgias or other orofacial pain conditions. For intraoral PTTN, early stages are often misdiagnosed as odontogenic pain. Pain management Management of PTTN generally follows recommendations for peripheral neuropathic pain. Expert opinion International consensus on classification and taxonomy is urgently needed in order to advance the field related to this condition.
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Affiliation(s)
- Lene Baad-Hansen
- 1 Section of Orofacial Pain and Jaw Function, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark.,2 Scandinavian Center for Orofacial Neurosciences (SCON), Denmark/Sweden
| | - Rafael Benoliel
- 3 Rutgers School of Dental Medicine, Rutgers State University of New Jersey, Newark, NJ, USA
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Jianan S, Bing X. [Zygomaticomaxillary complex fractures with infraorbital nerve damage]. HUA XI KOU QIANG YI XUE ZA ZHI = HUAXI KOUQIANG YIXUE ZAZHI = WEST CHINA JOURNAL OF STOMATOLOGY 2017; 34:531-533. [PMID: 28326716 DOI: 10.7518/hxkq.2016.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Zygomaticomaxillary complex (ZMC) fracture is a common type of maxillofacial fracture. In addition to facial depression and diplopia, paresthesia of the lower eyelid, malar regions, nose skin, upper lip skin, and mucous membranes occurs because of infraorbital nerve injury. This article reviewed the anatomy, diagnosis, assessment, treatment, and prognosis of ZMC fracture-related infraorbital nerve injury.
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Affiliation(s)
- Su Jianan
- Dept. of Oral and Craniomaxillofacial Science, The Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
| | - Xu Bing
- Dept. of Oral and Craniomaxillofacial Science, The Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University; Shanghai Key Laboratory of Stomatology, Shanghai 200011, China
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Neovius E, Fransson M, Persson C, Clarliden S, Farnebo F, Lundgren TK. Long-term sensory disturbances after orbitozygomatic fractures. J Plast Reconstr Aesthet Surg 2016; 70:120-126. [PMID: 27769603 DOI: 10.1016/j.bjps.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 07/08/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Orbitozygomatic fractures often lead to infraorbital nerve (ION) injury, and affected sensibility is a common long-term complaint within this patient group. We present a long-term follow-up study where the validated von Frey filament system was used for testing ION sensibility. Furthermore, we examined the incidence of persistent nerve injury and whether more complex fractures led to more pronounced ION sensibility disturbances. METHODS Patients treated for facial fractures involving the orbitozygomatic complex were included and the follow-up time was 3 years or more. Depending on the location and severity of the fractures, the patients were divided into 4 groups. The patients answered a questionnaire before ION sensibility testing with von Frey filaments. RESULTS Eighty-one patients were examined: 65 males (80%) and 16 females (20%). Examinations were conducted between 3.0 and 7.6 years (mean 4.9 years) after injury. Sixteen patients (20%) had affected and 6 patients (7.4%) had severely affected ION sensibility according to von Frey testing. No statistically significant differences were found in terms of questionnaire score between the groups. There was also no statistically significant correlation between questionnaire results and log von Frey values. Although the effect of groups could not be statistically verified using the log von Frey values, a larger proportion of patients with complex fractures had higher log von Frey values than the other groups. CONCLUSIONS Patients with complex fractures report more permanent sensory disturbance of the ION after surgery than those with isolated orbitozygomatic fractures, although this could not be verified statistically with von Frey filament testing at several locations. Hence, a validated method for testing facial sensibility such as von Frey filaments, although sensitive, is inadequate to determine all aspects of sensory malfunction after orbitozygomatic fractures. This suggests that the patient's experience of long-term sensation after trauma may not be correlated with objective measures.
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Affiliation(s)
- Erik Neovius
- Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden.
| | - Maria Fransson
- Department of General Surgery, Sundsvall-Härnösand County Hospital, Sundsvall, Sweden
| | - Cecilia Persson
- Division of Applied Materials Science, Department of Engineering Sciences, Uppsala University, Sweden
| | - Sophie Clarliden
- Department of Oral- & Maxillofacial Surgery, Örebro University Hospital, Sweden
| | - Filip Farnebo
- Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - T Kalle Lundgren
- Stockholm Craniofacial Center, Department of Reconstructive Plastic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
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Primary Infraorbital Foramen Decompression for the Zygomaticomaxillary Complex Fracture: Is It Essential? J Craniofac Surg 2016; 27:61-3. [PMID: 26716549 DOI: 10.1097/scs.0000000000002255] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The frequency of zygomaticomaxillary fracture is second only to nasal bone fracture. Up to 30% to 80% of zygomaticomaxillary fracture patients complain of sensory disturbance results from infraorbital nerve injury. The objective of this study was to detect what factors are related to infraorbital nerve recovery and specifically to investigate decompression of infraorbital foramen improves sensory recovery. PATIENTS AND METHODS A total of 257 patients were assessed with unilateral zygomaticomaxillary complex fracture, treated with open reduction and internal fixation with orbital floor reconstruction. Of these, 166 patients followed up over 6 months were included in this study. The data collected included age, sex, pre, and postoperative sensory score measured by visual analogue scale (range: 0-10). Sensory score was measured at the infraorbital nerve innervation. The impact of decompression operation on the change of sensory score was compared. Statistical analysis was performed using SPSS 18.0 software (SPSS Inc, Chicago, IL). RESULTS In patients with preoperative hypoesthesia, difference between postoperative and preoperative sensory score was 3.2 (decompression group), 4.4 (nondecompression group), respectively, but not significant (P > 0.05). In patients without preoperative hypoesthesia, difference between postoperative and preoperative sensory score was -0.2 (decompression group), -0.3 (nondecompression group), respectively, and did not show significant association (P > 0.05). DISCUSSION Based on this result, in patients with preoperative hypoesthesia, infraorbital decompression operation is not useful for sensory recovery. This result indicates infraorbital sensory disturbance occurs from not only pinched nerve injury at the infraorbital foramen but also traction nerve injury at the other part of the nerve.
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Benoliel R, Teich S, Eliav E. Painful Traumatic Trigeminal Neuropathy. Oral Maxillofac Surg Clin North Am 2016; 28:371-80. [DOI: 10.1016/j.coms.2016.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Continuous neuropathic pain secondary to endoscopic procedures: report of two cases and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:e55-9. [PMID: 27422430 DOI: 10.1016/j.oooo.2016.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 04/14/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
Neuropathic pain encompasses a spectrum of conditions that can arise from a lesion or dysfunction of the central or the peripheral nervous system, and it may develop at variable intervals after nerve injury or inflammation. Nerve injuries arising from surgical procedures commonly occur secondary to the surgical trauma, and in rare instances they are a complication of intubation during general anesthesia or endoscopic procedures. A series of 2 cases of bilateral glossopharyngeal neuropathic pain subsequent to endoscopic procedures is presented with a review of the literature concerning the mechanisms of development of neuropathic pain after these procedures. The purpose of these case reports is to make dentists aware of the occurrence, the mechanisms of nerve injuries, and the treatment of neuropathic pain after endoscopic procedures. In the first case, the patient had relief of pain with a combination therapy of clonazepam 1.0 mg in divided doses twice daily and gabapentin 300 mg in divided doses 3 times daily. In the second case, the patient had significant relief of pain with a monotherapy of gabapentin 1200 mg in divided doses 3 times daily.
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Affiliation(s)
- Junad Khan
- Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, C 850, 07103, Newark, NJ, USA
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Mohanavalli S, Suma E, Senthamarai G, Vijayabala GS. Ocular Injuries in Association with Middle Third Facial Injuries in Developing Countries: A Prospective Study. ACTA ACUST UNITED AC 2016. [DOI: 10.5005/jp-journals-10015-1382] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Introduction
The middle third of the face is the most common site of injury and is frequently complicated by associated ocular injuries. It may be simple laceration, ecchymosis, circumorbital edema, or severe as globe injury or injury to the optic nerve and vision loss. Even severe injury like internal bleeding causes increased intraocular pressure and damages the optic nerve; if managed earlier, it could prevent further damage and dysfunction of the eye. Midfacial fractures associated with ocular injuries should have an early ophthalmological examination to detect ocular injuries. Little is known about the current epidemiology of midface fractures and associated ocular injuries in Tamil Nadu, the state of India. The aim was to study the etiology and pattern of middle third fracture and associated ocular injuries.
Materials and methods
This prospective study on midface fractures was carried out in the Department of Dentistry to analyze etiology, incidence, and patterns of midface fractures and associated ocular injuries. A total of 201 patients who reported with the history of midface injuries were included in the study. These patients were examined clinically and routine radiographs and computerized tomography magnetic resonance imaging (MRI) were taken to confirm the diagnosis. All the patients sustaining confirmed middle third fractures with or without eye signs were referred to an ophthalmology department for the evaluation and management of associated ophthalmic injury. Statistical Package for the Social Sciences software version 16.0 was used for data analysis. The outcome of the study was measured using percentages, mean, standard deviation, and test of proportion as appropriate.
Results
Traffic accident was the major cause of injury, mainly by motorized two wheelers (MTWs). Males in the 21 to 40 age group were common victims. Zygomatic complex fracture was the most common fracture type. Subconjunctival hemorrhage and infraorbital nerve injuries were common clinical findings.
Conclusion
Midthird facial injury cases should have an early ophthalmological examination for timely management to prevent dysfunction of the eye.
How to cite this article
Mohanavalli S, Suma E, Senthamarai G, Vijayabala GS. Ocular Injuries in Association with Middle Third Facial Injuries in Developing Countries: A Prospective Study. World J Dent 2016;7(3):135-140.
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Das AK, Bandopadhyay M, Chattopadhyay A, Biswas S, Saha A, Balkrishna UM, Nair V. Clinical Evaluation of Neurosensory Changes in the Infraorbital Nerve Following Surgical Management of Zygomatico-Maxillary Complex Fractures. J Clin Diagn Res 2015; 9:ZC54-8. [PMID: 26816993 DOI: 10.7860/jcdr/2015/16511.7008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/06/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Zygomatico-orbital fractures are the second most common facial injuries. Trauma to mid-facial region can lead to an alteration or loss of sensation in the facial region which sometimes requires early surgical intervention to aid in an early recovery. AIM To evaluate the different neurosensory changes in the infraorbital nerve function following common treatment modalities used in the management of zygomatico-maxillary complex fractures. MATERIALS AND METHODS Thirteen patients selected for the study had unilateral zygomatic complex fracture with altered sensation in the region of distribution of the infraorbital nerve. The fractures were managed either by reduction followed by internal fixation with mini-plates (Group A), reduction alone (Group B) or conservatively (Group C). Infraorbital nerve function tests were done by mechanical, heat and pain threshold detection. Evaluation was done on 1(st), 3(rd), 7(th) day, one month, three months and six months interval in a manner similar to that done at the beginning of the study (Day0). RESULTS A male predominance with male:female ratio of 5.5:1 and an age range of 21 to 50 years was found with the right side mostly affected. Road traffic accident was the most common aetiology. Most common clinical presentations were sub-conjunctival haemorrhage (84.61%), flattening of the malar prominence (69.23%) with deficit in neurosensory function of infra orbital nerve. Recovery in the infraorbital nerve function was relatively complete in 76.92% cases with partial recovery in 23.07% of the patients. CONCLUSION Marked improvement in the neurosensory function of the infraorbital nerve was found when some form of treatment either in the form of Open Reduction and Internal Fixation (ORIF) or approach through Gillie's temporal or Keen's intraoral approach were applied as compared to when conservative treatment was provided. In zygomatic complex fractures, any form of treatment employed brought about decompression of the infraorbital nerve which aided in the recovery of the nerve within a span of 1-6 months, except when no treatment was applied.
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Affiliation(s)
- Asish Kumar Das
- Associate Professor, Department of Oral & Maxillofacial Surgery, Burdwan Dental College & Hospital , Burdwan, West Bengal, India
| | - Monimoy Bandopadhyay
- Professor, Department of Oral & Maxillofacial Surgery, Dr. R. Ahmed Dental College & Hospital , Kolkata, West Bengal, India
| | - Abira Chattopadhyay
- Assistant Professor, Department of Oral & Maxillofacial Surgery, Burdwan Dental College & Hospital , Burdwan, West Bengal, India
| | - Sailendranath Biswas
- Associate Professor, Department of Oral & Maxillofacial Pathology, Burdwan Dental College & Hospital , Burdwan, West Bengal, India
| | - Anindita Saha
- Clinical Tutor, Department of Oral & Maxillofacial Pathology, Burdwan Dental College & Hospital , Burdwan, West Bengal, India
| | - Uke Manjeet Balkrishna
- PGT (Final year), Department of Oral & Maxillofacial Surgery, Dr. R. Ahmed Dental College & Hospital , Kolkata, West Bengal, India
| | - Vineet Nair
- Assistant Professor, Department of Periodontology, Burdwan Dental College & Hospital , Burdwan, West Bengal, India
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Abstract
The infraorbital nerve (ION) is a cardinal cutaneous nerve that provides general sensation to the mid face. Its twigs are vulnerable to iatrogenic damage during medical and dental manipulations. The aims of this study were to elucidate the distribution pattern of the ION and thus help to prevent nerve damage during medical procedures and to enable accurate prognostic evaluation where complications do occur. This was achieved by treating 7 human hemifaces with the Sihler modified staining protocol, which enables clear visualization of the course and distribution of nerves without the accidental displacement of these structures that can occur during classic dissection. The twigs of the ION can be classified into the usual 5 groups: inferior palpebral, innervating the lower eyelid in a fan-shaped area; external and internal nasal, reaching the nosewing and philtrum including the septal area between the nostrils, respectively; as well as medial and lateral superior labial, supplying the superior labial area from the midline to the mouth corner. Of particular note, the superior labial twigs fully innervated the infraorbital triangle formed by the infraorbital foramen, the most lateral point of the nosewing, and the mouth corner. In the superior 3-quarter area, the ION twigs made anastomoses with the buccal branches of the facial nerve, forming an infraorbital nervous plexus. The infraorbital triangle may be considered a dangerous zone with respect to the risk for iatrogenic complications associated with the various medical interventions such as implant placement.
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Infraorbital nerve posttraumatic deficit and displaced zygomatic fractures: a double-center study. J Craniofac Surg 2015; 24:2044-6. [PMID: 24220401 DOI: 10.1097/scs.0b013e3182a41c9d] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Typical associated signs and symptoms of displaced zygomatic fractures include lack of zygoma projection, diplopia, and sensory disturbances of the infraorbital nerve (ION). The aim of this article was to assess eventual associations between ION sensory disturbances and zygomatic fractures patterns. This study is based on 2 databases that have continuously recorded patients hospitalized with maxillofacial fractures in 2 Departments of Maxillofacial Surgery in Amsterdam, The Netherlands, and Turin, Italy between 2001 and 2010. The following data for patients surgically treated for displaced zygomatic fractures were considered: gender, age, site and severity of facial fractures, etiology, and presenting symptoms. Statistically significant associations were found between ION sensory disturbances and assaults (P = 0.007) and sport accidents (P = 0.00003), as well as between ION sensory disturbances and isolated zygomatic fractures (P = 0.000002) and between ION sensory disturbances and diplopia (P = 0.00009).The severity of injury and the absorption of middle-energy and high-energy forces by the zygomatic complex only were associated with ION sensory disturbances. The etiology and severity of the injury as well as the presence of associated symptoms should be thoroughly investigated when a zygomatic fracture is suspected.
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Single buccal sulcus approach with fluoroscan assistance for the management of simple zygomatic fractures. Ann Plast Surg 2015; 74 Suppl 2:S80-4. [PMID: 25695447 DOI: 10.1097/sap.0000000000000469] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Zygomatic fractures are associated with functional and aesthetic problems. The purpose of this study was to evaluate the adequacy of management and the surgical satisfaction of patients with simple zygomatic fractures treated through a single buccal sulcus approach and fluoroscan assistance. METHODS Between 2008 and 2012, 42 patients with simple zygomatic fractures were included in the study. The surgical procedure was performed through a single buccal sulcus incision. The fracture sites were aligned under direct vision and fluoroscan assistance and stabilized with rigid internal fixation. The adequacy of reduction was evaluated based on postoperative plain radiographic films and computed tomographic scans using mirror image analyses. The satisfaction of functional and aesthetic results was also evaluated subjectively using a visual analog scale during follow-up. RESULTS Twenty-nine male and thirteen female patients with a mean age of 33.2 years were evaluated. Motorcycle crashes (78.6%) were the most common mechanism of trauma. Based on follow-up imaging studies, 2 patients had inadequate reduction of zygomatic body, and there was a slight depression of the zygomatic arch in one patient. Ninety-three percent (39/42) of patients had satisfactory results, although one patient complained of malar asymmetry and another felt a depression in the arch area. Two patients complained of persistent hypesthesia during follow-up at 6 months. CONCLUSIONS Our results suggest that a single buccal sulcus approach without lower eyelid or lateral eyebrow incision in the repair of simple fractures of the zygoma can be achieved with high patient satisfaction if the reduction and fixation are adequate and stable.
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Abstract
Patients will often visit their primary medical practitioner with orofacial pain complaints. Hence, it is important to recognize and have an understanding of these conditions to properly evaluate and potentially manage these disorders. If the practitioner is uncertain or uncomfortable with these conditions, then patient referral to a knowledgeable health care practitioner should be considered for further evaluation and management. In this article, the evaluation and management of various neuropathic, neurovascular, and vascular pains are discussed.
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Affiliation(s)
| | - Gary D Klasser
- School of Dentistry, Louisiana State University, New Orleans, LA, USA
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Bali RK, Sharma P, Jindal S, Gaba S. To evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures: A prospective study. Natl J Maxillofac Surg 2014; 4:167-72. [PMID: 24665170 PMCID: PMC3961889 DOI: 10.4103/0975-5950.127645] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: The present study was undertaken to evaluate the efficacy of biodegradable plating system for fixation of maxillofacial fractures and to study the morbidity associated with the use of biodegradable plates and screws. Materials and Methods: This prospective study consisted of 10 patients with maxillofacial fractures requiring open reduction and internal fixation. Fractures with infection, comminuted and pathological fractures were excluded. All were plated with biodegradable system (Inion CPS) using standard plating principles and observed for a total period of 24 weeks. Characteristics of the fractures, ease of use of bioresorbable plate/screw system and post operative complications were assessed. Results: Of total 10 patients, eight patients were of midface fracture and two pediatric patients with mandibular fracture, with nine male and one female. The mean age was 32.8 years. Out of 20 plates and 68 screws applied to the 10 fractures sites; there were three incidences of screw breakage with no other intraoperative difficulties. Paresthesia of the infraorbital nerve was present in two patients, and recovered completely in four weeks after surgery. Fracture reduction was considered to be satisfactory in all cases. One patient developed postsurgical infection and was managed with oral antibiotics and analgesics. Conclusions: Favorable healing can be observed through the use of biodegradable plates and screws to stabilize selected midface fractures in patients of all ages, as well as mandible fractures in early childhood, however further studies with more sample size are required.
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Affiliation(s)
- Rishi K Bali
- Department of Oral and Maxillofacial Surgery, D.A.V. Dental College and Hospital, Yamuna Nagar, Haryana, India
| | - Parveen Sharma
- Department of Oral and Maxillofacial Surgery, D.A.V. Dental College and Hospital, Yamuna Nagar, Haryana, India
| | - Shalu Jindal
- Department of Oral and Maxillofacial Surgery, D.A.V. Dental College and Hospital, Yamuna Nagar, Haryana, India
| | - Shivani Gaba
- Department of Oral and Maxillofacial Surgery, D.A.V. Dental College and Hospital, Yamuna Nagar, Haryana, India
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Singh RK, Sinha VP, Pal US, Yadav SC, Singh MK. Pregabalin in post traumatic neuropathic pain: Case studies. Natl J Maxillofac Surg 2013; 3:91-5. [PMID: 23251069 PMCID: PMC3513820 DOI: 10.4103/0975-5950.102175] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Pregabalin is effective in the treatment of peripheral and central neuropathic pain. This study evaluated the effectiveness of pregablin in management of post traumatic peripheral nerve injury facial pain not responding to other medication like analgesics. Pregabalin was well tolerated. The most common adverse effects were dizziness and tiredness.
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Affiliation(s)
- Rakesh Kumar Singh
- Department of Oral and Maxillofacial Surgery, CSM Medical University, Lucknow, Uttar Pradesh, India
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Peris-Celda M, Pinheiro-Neto CD, Scopel TF, Fernandez-Miranda JC, Gardner PA, Snyderman CH. Endoscopic endonasal approach to the infraorbital nerve with nasolacrimal duct preservation. J Neurol Surg B Skull Base 2013; 74:393-8. [PMID: 24436942 DOI: 10.1055/s-0033-1347372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 03/10/2013] [Indexed: 10/26/2022] Open
Abstract
Objectives Infraorbital nerve (ION) decompression, excision to remove intrinsic tumors, and resection with oncological margins in malignancies with perineural invasion or dissemination are usually accomplished with an open approach. The objective is to describe the surgical anatomy, technique, and indications of the endonasal endoscopic approach (EEA) to the ION with nasolacrimal duct preservation. Design Eleven sides of formalin-fixed specimens were dissected. An anterior maxillary antrostomy was performed. The length of the ION prominence within the sinus and anatomic features of the covering bone were studied. A 45-degree endoscope visualized the infraorbital prominence endonasally. An angled dissector and dural blade allowed for dissection and resection of the ION ipsilaterally and contralaterally. Results The bone features of the ION prominence allowed for ipsilateral dissection in 10 out of 11 sides. In one case with the ION surrounded by thick cortical bone, the dissection could only be started by drilling contralaterally. The 45-degree endoscope visualized 92.2% and 100% of the length of the nerve using the ipsilateral and contralateral nostrils, respectively. Ipsilaterally, 83% of its length was resected, and 96.3% was resected contralaterally. Conclusion The ION can be approached using an ipsilateral EEA with nasolacrimal duct preservation in most cases. The contralateral approach provides a wider angle to access the ION. This technique is primarily indicated in cases where the EEA can be used for tumor resection and oncological margins within the ION.
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Affiliation(s)
- Maria Peris-Celda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carlos D Pinheiro-Neto
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Tiago F Scopel
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Juan C Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Paul A Gardner
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
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Gentile MA, Tellington AJ, Burke WJ, Jaskolka MS. Management of midface maxillofacial trauma. Atlas Oral Maxillofac Surg Clin North Am 2013; 21:69-95. [PMID: 23498333 DOI: 10.1016/j.cxom.2012.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The management of midface trauma continues to challenge maxillofacial surgeons. The complex local anatomy and functional and cosmetic importance of the region make precise surgical correction and reconstruction essential to success.
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Affiliation(s)
- Michael A Gentile
- Department of Oral and Maxillofacial Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889, USA.
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Heir GM, Nasri-Heir C, Thomas D, Puchimada BP, Khan J, Eliav E, Benoliel R. Complex regional pain syndrome following trigeminal nerve injury: report of 2 cases. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:733-9. [DOI: 10.1016/j.oooo.2012.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 05/29/2012] [Accepted: 06/01/2012] [Indexed: 11/27/2022]
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Evaluation of Neurosensory Changes in the Infraorbital Nerve following Zygomatic Fractures. J Maxillofac Oral Surg 2012; 11:394-9. [PMID: 24293929 DOI: 10.1007/s12663-012-0348-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 02/07/2012] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To evaluate the incidence and recovery of persistent sensory disturbances of the infraorbital (IO) nerve after isolated zygomatic complex fractures with various treatment methods. METHODS AND RESULTS The study was inclusive of isolated unilateral zygomatic complex fractures and fractures of IO rim .Tests performed were Pin prick and Electrical detection threshold test. The evaluation was done preoperatively, after 1 month and after 6 months of surgery. The results suggested that neurosensory disturbance was present in all the patients with zygomatic complex fractures. At 1 month post-operatively some sensory deficit was present in all the patients on the affected side. After 6 months all the patients showed near to normal improvement comparable to normal side. CONCLUSION Study shows that earlier the surgical intervention, more the recovery of the nerve injury is appreciable during the 1 and 6 months follow up period.
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Nasri-Heir C, Gomes J, Heir GM, Ananthan S, Benoliel R, Teich S, Eliav E. The role of sensory input of the chorda tympani nerve and the number of fungiform papillae in burning mouth syndrome. ACTA ACUST UNITED AC 2011; 112:65-72. [PMID: 21601494 DOI: 10.1016/j.tripleo.2011.02.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Revised: 02/16/2011] [Accepted: 02/20/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate patients suffering from burning mouth syndrome (BMS) and control subjects by means of sensory testing and fungiform papillae count. STUDY DESIGN The left and right anterior two-thirds of the tongue of of 25 BMS subjects and 20 healthy control subjects were evaluated for electric taste and electric detection threshold. The number of fungiform papillae/cm(2) was evaluated by using close-up digital photography. RESULTS The electric taste/tingling detection threshold ratio was significantly higher in BMS compared with control subjects (P = .041). No difference was found between the number of fungiform papillae/cm(2) in the BMS compared with the control subjects (P = .277). Patients suffering from BMS for a prolonged period of time presented with a significantly elevated electric taste/tingling detection threshold ratio (P = .031). CONCLUSIONS BMS may be a neurodegenerative process with chorda tympani nerve hypofunction potentially playing a role in the pathophysiology of this disorder.
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Affiliation(s)
- Cibele Nasri-Heir
- Orofacial Pain Center, Department of Diagnostic Sciences, University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07101-1709, USA.
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Prolonged gingival cold allodynia: a novel finding in patients with atypical odontalgia. ACTA ACUST UNITED AC 2011; 111:312-9. [DOI: 10.1016/j.tripleo.2010.10.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 10/03/2010] [Accepted: 10/08/2010] [Indexed: 11/22/2022]
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Affiliation(s)
- Kenneth M Hargreaves
- Departments of Endodontics, Pharmacology, Physiology and Surgery, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA
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