The use of nonopioid drugs in management of chronic orofacial pain

The neurosensory deficit of inferior alveolar nerve following bilateral sagittal split osteotomy: a prospective study

OBJECTIVES

Investigation in Saudi Arabia or the Arab Gulf States to assess the unfavorable impacts of the bilateral sagittal split osteotomy (BSSO) is non-existent, so questions have been raised about the success rate of this operation and the frequency of unwilling outcome. To address these worries, we directed a case series study to evaluate the hypoesthesia, a type of neurosensory deficit (NSD) of the inferior alveolar nerve (IAN) after BSSO, and if the hypoesthesia outcome will improve if the surgeries performed by a single surgeon.

PATIENTS AND METHODS

This was a prospective case series study for the patient who underwent BSSO in a medical complex that is considered one of the largest in Saudi Arabia (Riyadh). The inclusion criteria include patient aged 18-40 years, any gender, and American Society of Anesthesiologists (ASA) class I. They will undergo BSSO for either mandibular, retrognathia, prognathic, or to follow the maxilla. The outcome will be measured after evaluating the neurosensory by four means light touch (LT), pinprick (PP), 2-point discrimination (2PD), and thermal sensations (TT) in four repeated measurements (preoperatively, 1 week, 1 month, 3 months postoperatively) as the primary outcome. Other confounding factors were the secondary outcome (age, gender, visualization of the I.A.N, the type of mandibular movement, split favorability, mandibular canal location, and patient reports about paresthesia or dysesthesia on any given side); these data analyses were carried out using SPSS ver. 25 data processing software.

RESULTS

The nerve was visible in 93% of cases. During the operation, none of the nerves was transected. Hypoesthesia on the first follow-up was 94% of cases for LT, 92% for PP, 82% for TT, and 100% for the 2PD. On the last follow-up, the patients still had hypoesthesia for the LT 51%, PP 35%, TT41%, and 2PD 55%; age and sex did not significantly affect hypoesthesia outcomes. Nerve visibility and inferior alveolar nerve canal (IAC) distance did not influence the results. The level of confidence for all tests was set at p < 0.05.

CONCLUSIONS

The 2PD sensation was the most affected sense on the last visit, and the right side of the chin and lower lip was affected most both on early and long-term follow-up due to several reasons. A 3-month period was enough as a recovery time to restore 100% of neurological sensation for 45% of the sample, which is similar to several studies in the literature. A single surgeon did not show superior result compared to two surgeons' literature papers. Advancement movement was associated with a high percentage of hypoesthesia.

Botulinum toxin: new treatment for temporomandibular disorders

BACKGROUND

Temporomandibular disorders (TMDs) affect the face and jaws, and cause chronic pain and dysfunction in many people. As in other conditions involving the musculoskeletal system, controlling the myogenous component is an integral part of treatment. In this study, we evaluated subjective and objective responses to treatment with botulinum toxin A (BTX-A) in a group of 46 patients with TMDs.

METHODS

46 subjects with TMD were enrolled in this uncontrolled study and treated with BTX-A 150U. Both masseter muscles were injected with 50 U each and both temporalis muscles with 25 U each under electromyographic guidance. Subjects were assessed at two-week intervals for eight weeks. Outcome measures included subjective assessment of pain by visual analogue scale (VAS), measurement of mean maximum voluntary contraction (MVC), interincisal oral opening, tenderness to palpation, and a functional index based on multiple VAS. Medians of the data were taken for each outcome measure at each time point and subjected to Duncan's multiple range test.

RESULTS

There were significant (P<0.05) differences in all median outcome measures between the pre-treatment assessment and the four follow-up assessments except for MVC. Although MVC was significantly reduced midway through the study, it had returned to pretreatment values by the final two assessments. All other outcome measures remained significantly different from the pretreatment findings. Paired correlation of variables including age, sex, diagnosis, depression index, and time of onset showed no significant differences.

CONCLUSIONS

BTX-A injections produced significant improvements in pain, function, mouth opening, and tenderness to palpation. MVC initially diminished then returned to the initial values. Although the study was uncontrolled, the results strongly suggest that BTX-A reduces severity of symptoms and improves functional abilities for patients with TMD and that these extend beyond its muscle-relaxing effects.