[Left-sided thoracic pain in a 56-year old man followed by double vision and paresthesias of the left hand].
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A case of a traumatic bone cyst is reported because of the unusual nature of the chief complaint. The initial symptom of the disease was mandibular nerve neuropathy with numbness of the left side of the lower lip and chin.
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The tips of 100 needles that had been used clinically for the administration of mandibular block anesthesia (50 by students and 50 by staff) were examined individually under a dissecting microscope. Sixty percent of these needles were found to be barbed. With the use of an animal laboratory simulation, it has been shown that the tips of standard needles as used in general dental practice will barb if allowed to touch bone (medial aspect of the mandibular ramus) during the administration of a mandibular block for dentistry using the direct approach and that a relationship exists between the pattern of this barbing, the disposition of the bevel of the needle at the time of its insertion, and the likelihood of lingual or inferior dental nerve involvement on withdrawal of the barbed needle. Simple precautions are advanced for reducing the possibility of nerve or other tissue damage from this source.
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The present study was designed to examine the prevalence and characteristics of painful and paresthetic sensations in a group of patients with healed burns. Adult patients who had been hospitalized for burn injuries during a 7-yr period were contacted and given a structured interview that included a series of questions about their present condition. Patients' medical charts were reviewed to obtain relevant demographic and medical information. The results show that abnormal sensations in healed burns are frequently reported as long as several years after the injury. Of 104 patients interviewed 1 yr or more after a burn injury, 82% reported paresthetic sensations such as tingling, stiffness, cold sensations, and numbness; and 35% complained of pain in the scarred tissue. The prevalence of these sensations was not related to age, sex, or etiology of the burns, but was associated with burn size and skin grafting. The theoretical and clinical implications of these results are discussed with particular emphasis on the need to pursue research on the long-term adverse effects of burn injuries.
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