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At least 289 records · Page 16Linked to original sources
PubMed1995

Local anesthetic effects in the presence of chronic osteomyelitis (necrosis) of the mandible: implications for localizing the etiologic sites of referred trigeminal pain.

The aims of this study were: (1) to demonstrate how reproducible variations in incomplete anesthesia of the inferior alveolar nerve can be used as a guide to locate the etiologic sites of referred trigeminal pain emanating from the mandible; (2) to describe the salient histopathologic features of a lowgrade, nonsuppurative osteomyelitis seen in this patient population. Forty-six patients with idiopathic facial pain were subjected to a specific protocol of local anesthetic injections to sequentially block branches of the mandibular nerve to determine the effects on his/her pain. If this significantly reduced or altered the pain on three separate appointments, then exploratory surgery was conducted near identified zones of unanesthetized gingiva. Blocking (92%), bridging (4%), and divergence (4%) were observed patterns of anesthetic resistance of the mucogingival tissues used to categorize the incomplete anesthesia. A 100% correlation was found between the identified zones of unanesthetized gingiva and the discovery of intramedullary pathology. Medullary fibrosis with ischemic and degenerative changes in the cancellous bone were common findings, along with chronic inflammatory cell infiltrates and clusters of lymphocytes. It is concluded that Ratner's method of diagnostic anesthesia be implemented when searching for occult pain producing pathology of the jaws.

Adult↗
PubMed2004

Mandibular third molar removal: risk indicators for extended operation time, postoperative pain, and complications.

OBJECTIVES: The aim of this study was to identify risk indicators for extended operation time and postoperative complications after removal of mandibular third molars. STUDY DESIGN: There were 388 molars included in the study. The teeth were removed using the buccal approach under local anesthesia. Four hours postoperatively the patient recorded his or her pain perception on a visual analogue scale (VAS). After surgery a surgeon recorded parameters regarding the tooth and if the mandibular nerve had been visible during the operation. One week postoperatively the postoperative pain and complications were recorded. Logistic regression models were made to identify risk indicators for extended operation time, postoperative pain, and complications. RESULTS: Females were at higher risk for postoperative pain and dry socket than males. Older patients were at higher risk for extended operation time than younger patients. Radiographically fully impacted molars increased the risk of postoperative general infection. If the nerve was visible during surgery there was a higher risk of a high VAS score, postoperative pain, and general infection than if the nerve had not been visible. CONCLUSION: Several indicators were found to increase the risk of postoperative complications, but a visible alveolar inferior nerve during the operation was repeatedly found to be the highest single risk indicator.

Adolescent↗
PubMed1982

A comparative study of wire osteosynthesis versus bone screws in the treatment of mandibular prognathism.

In sagittal split osteotomies as well as in vertical osteotomies for reduction of the mandible, wire and bone screw osteosynthesis has been used in the Department of Oral and Maxillofacial Surgery of the University of Erlangen-Nuremberg within the last few years in a total of 221 cases of mandibular prognathism. In about one half of these cases a conventional wire osteosynthesis was performed, and in the other half a stable osteosynthesis with bone screws was used. One hundred twenty-one cases could be included in a follow-up study, and a true comparison could be made between the two methods. The results of our study were quite interesting: There were no signs of an increase in temporomandibular joint problems when the bone screw technique was used. However, slightly more alterations in the mandibular nerve were found. The relapse tendency, on the other hand, was minimal in cases in which bone screws were applied, in comparison with those in which wire osteosynthesis was used.

Bone Screws↗
PubMed1979

The effect of denervation on trauma from occlusion.

Trauma from occlusion was induced by inserting cantilever bridges bilaterally in the mandibles of two monkeys. In one monkey the mandibular nerve was cut on one side; in the other on both sides. By this procedure possible protective action of nerve receptors in the periodontal membrane was reduced. The occlusal trauma resulted in severe damage to the pulp and resorption of the roots, but no appreciable downgrowth of the crevicular epithelium.

Animals↗
PubMed1999

Trigeminal nerve peripheral branch phenol/glycerol injections for tic douloureux.

OBJECT: Trigeminal neuralgia or tic douloureux is a disease affecting older individuals, and thus, office-based "minimally invasive" therapy is inherently attractive. The author sought to determine whether injection of peripheral trigeminal branches with neurolytic solutions offers a simple, less invasive therapy, with low risk for patients with one- or two-division trigeminal neuralgia that is unresponsive to pharmacotherapy. METHODS: This retrospective study focused on a review of case charts from 18 patients treated for tic douloureux. Sixty injections of 10% phenol in glycerol were given to the 18 patients, six of whom had undergone other neurosurgical procedures. The median patient age was 74 years, ranging from 36 to 94 years. There were nine women and nine men. Forty-six injections were administered into the infraorbital nerve in its canal in the midface, 11 percutaneous injections were administered into the mandibular nerve just proximal to the mandibular canal in the ramus of the jaw, and three injections were administered into supraorbital nerves. Eighty-seven percent of injections brought marked or total relief initially. Of those injections that provided initial relief, 37% still provided relief after 1 year and 30% after 2 years, with relief lasting for a median of 9 months after each injection. Most patients whose pain recurred after months of relief requested a repeated procedure, rather than undergo a ganglion nerve block procedure or open surgery. There were no serious complications or dysesthetic pain. Facial sensory loss generally recovered within 6 months and was well tolerated. CONCLUSIONS: Office-based injection of trigeminal branches is a useful technique for neurosurgeons who treat trigeminal neuralgia. It is easily repeated and can provide immediate pain relief of intermediate duration.

Adult↗
PubMedDate not supplied

[Gow-Gates block for beginners].

The study was carried out with two groups of 49 patients to evaluate the incidence of failures and re-injections when the blockade of the mandibular nerve was carried out according to Gow-Gates by untrained young dentists. Such an incidence was compared to that of the blockade of the inferior alveolar nerve by the same dentists trained for this specific task. Both the observed failures and re-injections in the Gow-Gates blockade progressively decrease and disappear, theoretically, after 50 blockades, while they remain almost constant in the inferior alveolar nerve blockade. The induction of the blockade was more prolonged after the Gow-Gates blockade (9 minutes) compared to the inferior alveolar nerve blockade (7 minutes). The pain induced by the injection, that due to the anesthetic and that experienced during the subsequent surgery were lower after the Gow-Gates blockade.

Adult↗
PubMed1980

Dysesthesia after mandibular third molar surgery: a retrospective study and analysis of 1,377 surgical procedures.

To statistically associate specific factors of surgical extraction of third molars with mandibular nerve dysesthesia, records of patients were reviewed for preoperative panoramic radiographs, complete operative and anesthetic records, preoperative and postoperative notes, and histories. Data were then tabulated and the cases of altered sensation were compared with cases of unaltered sensation.

Adolescent↗
PubMed1993

An anatomical study of the laterotrigeminal venous system.

The middle cranial fossa of 100 cadavers were dissected under stereoscopic loupe in order to identify and systematize the venous vessels located along the lateral margin of the trigeminal cave. The author found that at the sensitive root and trigeminal ganglion level a dural venous canal was present in most individuals examined and that the upper side of this canal communicated with the superior petrosal sinus. However, at the level of the lateral border of the intracranial segment of the mandibular nerve, venous lacunae were found to prevail, and these lacunae communicated with several other venous formations in the peritrigeminal region. The author concludes that the venous vascularization of this area constitutes a major risk in surgical interventions made in the middle cranial fossa. In addition, it is a relevant factor in the hemodynamics of the intracranial circulation.

Adult↗
PubMed1986

Peripheral streptomycin/lidocaine injections in the treatment of idiopathic trigeminal neuralgia. A preliminary report.

Streptomycin sulphate dissolved in 2% lidocaine solution was deposited adjacent to peripheral branches of maxillary or mandibular nerves in 20 patients with idiopathic trigeminal neuralgia. The patients were given five injections at approximately one week intervals. In the postinjection period, once the local anaesthetic had worn off, apparently normal sensation returned. All patients obtained pain relief, only four having a recurrence of symptoms. The remaining 16 patients remained free of pain after periods of up to 30 months.

Adult↗
PubMed1980

Accessory medial pterygoid muscle.

A previously undescribed accessory medial pterygoid muscle occurred uniformly in the dissection room population studied. The origin extends from the superior margin of the pterygoid plate and skirts medially of foramen spinosum and ovale, finally terminating on the carotid canal rim. The flat triangular muscle descends to insert its apex into the medial surface of the medial pterygoid muscle about 1 cm below its exit from the pterygoid fossae. Histologic examination confirmed striated muscle. Independent innervation arises from the medial surface of the mandibular nerve trunk just below the foramen ovale and enters the accessory medial pterygoid lateral surface at about the upper third, centrally. Muscle function is suggested as a discriminating action, rein-like in nature, probably corresponding to Bennett movement. Variation in size of this muscle may also explain the range observed for Bennett movement. The dental occlusal action field is suggested to be the buccal aspect of the last molar tooth.

Adipose Tissue↗
PubMedDate not supplied

Anatomic study of the otic ganglion in humans.

The presentation in the literature of the anatomy of the human otic ganglion (OG) has not varied much over the past three quarters of a century. Precise, similar descriptions of its size, color, shape, and relation with neighboring structures are portrayed in numerous textbooks and articles. We have carried out a study of the OG in 30 infratemporal fossae of 15 cadavers. Otic ganglia resembling the classic description were found in less than 60% of the cases. In 13%, some thickening could be seen adjacent to the mandibular nerve and in 27%, no definite structure could be observed. Except for a fleeting mention of this occurrence in a textbook from 1927, substantiated by personal communication with an authority in the field, we could find no record of the possible absence of this structure in the available literature. We describe our findings and stress the apparent anatomic variability of the OG. The pertinent literature is reviewed.

Adult↗
PubMed2002

Unilateral trigeminal anaesthesia modifies postural control in human subjects.

The influence of trigeminal afferences on postural stabilization was tested. Twenty-seven subjects were recruited to evaluate the impact of trigeminal disturbance on orthostatic postural control before and after unilateral truncular anaesthesia of the mandibular nerve. Balance control quality was assessed using static posturography by means of statokinesigrams and lateral deviation. Postural control monitored by measuring the area covered by the centre of foot pressure decreases after anaesthesia in the eyes open condition. Postural deviation in the eyes closed condition was observed after anaesthesia in the controlateral side of anaesthesia. These data document the effects of trigeminal afferences on postural stabilization.

Adult↗
PubMed2001

Partial lip resection with orbicularis oris transposition for lower lip correction in unilateral facial paralysis.

Malfunction of the marginal mandibular nerve, either in combination with a generalized facial palsy or in isolation, can cause an unpleasant and disturbing appearance around the mouth. In total palsy, a cross-facial nerve graft combined with a free vascularized muscle transplant will usually deal with this problem successfully; however, all older procedures used in this situation are unpredictable. For the isolated palsy, procedures such as digastric muscle transfer or sling suspension are not uniformly successful. A method using the contralateral, nonaffected lower lip orbicularis muscle is described. A wedge is removed from the paralyzed lower lip and the orbicularis is advanced to the modiolus to provide a functional orbicularis all the way across the lower lip up to the angle of the mouth. This is a simple outpatient procedure that has produced satisfactory results in most cases.

Facial Paralysis↗
PubMedDate not supplied

Bilateral versus unilateral mandibular block anesthesia in a pediatric population.

PURPOSE: This prospective study aimed to evaluate unilateral versus bilateral mandibular nerve block anesthesia with regard to post-operative soft tissue trauma and other complications in a pediatric population. METHODS: A total of 320 patients age 2 to 18 years were appointed for routine operative treatment. There were no age, gender, behavior, or general health exclusions. Oral and written post-operative instructions were given to parents, as well as a survey preview. A phone survey was conducted after treatment to determine a number of variables, including soft tissue trauma. RESULTS: A total of 13% of all patients experienced post-operative soft tissue trauma. By age group, trauma frequency was 18% (< 4 yrs.), 16% (4-7 yrs.), 13% (8-11 yrs.) and 7% (> 12 yrs.). Comparing unilateral versus bilateral subjects as to trauma revealed that in the < 4 age group trauma was higher for the unilateral subjects (35% vs. 5%, P < .02). Non-significant trends showed increased trauma in unilateral groups at ages 8-11 and > 12 years. CONCLUSION: This study represents the first documentation of post-anesthetic soft tissue trauma prevalence in a pediatric population. The results reveal no contraindication to the use of bilateral mandibular block anesthesia.

Adolescent↗
PubMed1998

Stimulation-induced responses of the trigeminal caudal neurons in the brainstem preparation isolated from newborn rats.

The brainstem preparation with the trigeminal mandibular nerve attached was isolated from rats postnatal day 0-6 (P0-P6) to test if the potentiation could be induced in neonatal neurons in the trigeminal subnucleus caudalis by stimulation of the primary afferents. The stimulation-induced potentials in 92 neurons recorded extracellularly, and the synaptic potentials in 16 neurons recorded by the whole-cell patch clamp technique were examined. The extracellularly recorded neurons responded to stimulation (0.5 Hz) with either an increase, a decrease, or little change in spike numbers, and were classified as Type 1, Type 2, and Type 3, respectively. Type 1 neurons at P4 and older responded in a low Mg2+ solution with a progressive increase in spike number lasting for several minutes after the cessation of stimulation, i.e., short-term potentiation, STP. This potentiation was antagonized by 20 microM of (+)-MK-801 hydrogen maleate (MK-801) or 25 microM of 2-amino-5-phosphonovaleric acid. In contrast, Type 1 at P3 and younger did not exhibit STP. The age-related distinct response properties were observed between Type 1 neurons at P4-P6 and at P0-P3. The percentage of Type 1 in studied neurons increased from 24% at P0-P3 to 53% at P4-P6. In the intracellular experiment, the mean latency of excitatory postsynaptic potential (EPSP) of recorded neurons indicated that the conduction velocity of the convergent afferents was 0.37 m/s, in the range of C-fiber. Neurons were classified as Type E and Type I. Type E responded with EPSP only, or with both EPSP and inhibitory postsynaptic potentials (IPSP), while Type I responded with IPSP only. In Type E at P4 and older, a single stimulation produced a burst of spike discharges that lasted for several seconds. Stimulation at a hyperpolarized membrane potential showed that aggregated slow EPSPs lay under a burst of spike discharges, and that slow EPSPs, but not a short-latency EPSP, were completely blocked by MK-801. In contrast, Type E at P3 and younger did not evoke a burst of spikes. Morphological examination of recorded neurons showed that the formation of networks was sparse at P1 and rapidly developed up to P4. The results suggest that: (1) short-term potentiation is induced with the development of synaptic network formation in the caudal nucleus at P4 and older; (2) the summation of N-methyl-d-aspartate (NMDA)-mediated slow EPSPs build up a prolonged depolarization; and (3) the brainstem preparation is applicable for neurophysiological studies on the trigeminal pain system.

2-Amino-5-phosphonovalerate↗
PubMed1998

Parotid and submandibular sialadenitis treated by salivary gland excision.

BACKGROUND: The purpose of the present study was to compare and contrast the clinicopathological features and treatment outcome of chronic sialadenitis involving the parotid and submandibular glands, among patients who were treated by excision of the affected gland. METHODS: In a series of 88 patients treated over an 8-year period, 47 had parotid sialadenitis and 41 had submandibular sialadenitis. In the parotid group, 63% of patients were symptomatic for longer than 6 months compared with 27% in the submandibular group. Calculi were implicated in the disease process in 24% of patients with parotid sialadenitis, compared with 73% of patients with submandibular disease. RESULTS: Patients with parotid sialadenitis had superficial (n = 14) or near-total parotidectomy (n = 35), while those with submandibular sialadenitis underwent total gland excision. Complications occurred twice as frequently in the parotidectomy group. The rate of temporary facial nerve weakness was 29% after parotidectomy while marginal mandibular nerve dysfunction occurred after 12% of submandibular excisions. Both procedures were highly effective in permanently relieving the symptoms of sialadenitis. CONCLUSIONS: Parotid sialadenitis is infrequently associated with stones and tends to run a longer course before surgical intervention is necessary. Submandibular sialadenitis usually presents earlier, is secondary to calculi and requires early intervention.

Chronic Disease↗