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PubMed1992

Neuromuscular transmission studies in the healthy dog: EMG and muscle force measurement after repetitive nerve stimulation.

In 10 healthy anaesthetized female dogs the ulnar and the mandibular nerve were stimulated supramaximally by repetitive electric impulses according to a fixed programme. To evaluate the neuromuscular transmission system the course of the evoked compound muscle action potential and the near-isometric force of forelimb and masticatory muscles were studied respectively. The presented results are comparable to values obtained from small hand muscles of conscious, healthy human subjects. The simultaneous measurement of both the electrical and the force response may improve the diagnostic accuracy of the examination in presumed neuromuscular transmission failure in the dog, as it does in humans.

Action Potentials↗
PubMed1981

[Neuroanatomy of the optic, trigeminal, facial, glossopharyngeal, vagus, accessory and hypoglossal nerves (author's transl)].

1. The intracranial and intraorbital course of the optic nerve is described concisely, the intracanicular one in full details. Apart from the wide and small sections of the optic canal, its axis opposite to the cranial planes, the coating of the canal and the adjacency to the paranasal sinuses and arteries are exactly described. 2. At the trigeminal nerve the trigeminal ganglion, its roots and also the mandibular nerve have great importance in the practical medicine considering thermo-coagulation or surgery of the trigeminal nerve. This segments and also the adjacency of the fifth nerve to the internal carotid artery and subarachinoid brain vessels are exactly, the nuclei areas and central tracts are briefly explained. 3. The nuclei of the facial nerve the intracerebral and intracisternal course and its development, the facial canal and its narrow passes are described. Also the position of the internal acoustic pore in the skull, the dimensions of the internal acoustic meatus and the relations between nerves and vessels are explained. In addition to the geniculate ganglion and the chorda tympani the communications of the facial nerve inside the temporal bone, the tympanic intumescentia (ganglion) and the nervus intermedius, also the petrosal nerves are included in the description. The sheaths of the segments of the seventh cranial nerve and also the fasciculation are exactly, the somatotopic organization is briefly described. 4. The extracranial course of the glossopharyngeal nerve is briefly, its intracranial sections are included exactly in the investigation. 5. The nuclei of the vagus nerve and the intra- und extracranial course are described. 6. The accessory nerve, its nucleus and the intra- and extracranial course are concisely explained. 7. The hypoglossal nerve, its nucleus, the emergence of the fibres and also the relations of nerves and vessels in the posterior cranial fossa are described. The hypoglossal canal and also the extracranial course are explained as briefly as possible.

Accessory Nerve↗
PubMed2004

The anatomical basis for surgical preservation of temporal muscle.

OBJECT: Mobilizing the temporal muscle is a common neurosurgical maneuver. Unfortunately, the cosmetic and functional complications that arise from postoperative muscular atrophy can be severe. Proper function of the muscle depends on proper innervation, vascularization, muscle tension, and the integrity of muscle fibers. In this study the authors describe the anatomy of the temporal muscle and report technical nuances that can be used to prevent its postoperative atrophy. METHODS: This study was designed to determine the susceptibility of the temporal muscle to injury during common surgical dissection. The authors studied the anatomy of the muscle and its vascularization and innervation in seven cadavers. A zygomatic osteotomy was performed followed by downward mobilization of the temporal muscle by using subperiosteal dissection, which preserved the muscle and allowed a study of its arterial and neural components. The temporal muscle is composed of a main portion and three muscle bundles. The muscle is innervated by the deep temporal nerves, which branch from the anterior division of the mandibular nerve. Blood is supplied through a rich anastomotic connection between the deep temporal arteries (anterior and posterior) on the medial side and the middle temporal artery (a branch of the superficial temporal artery [STA]) on the lateral side. CONCLUSIONS: Based on these anatomical findings, the authors recommend the following steps to preserve the temporal muscle: 1) preserve the STA; 2) prevent injury to the facial branches by using subfascial dissection; 3) use a zygomatic osteotomy to avoid compressing the muscle, arteries, and nerves, and for greater exposure when retracting the muscle; 4) dissect the muscle in subperiosteal retrograde fashion to preserve the deep vessels and nerves; 5) deinsert the muscle to the superior temporal line without cutting the fascia; and 6) reattach the muscle directly to the bone.

Atrophy↗
PubMed1991

[Problem of anesthetic failure].

Failure of local anesthetics is a common problem in dentistry. A sample of 210 dental practitioners was chosen at random and asked to evaluate the significance of anesthesia failure, comparing different injecting techniques. A standardized questionnaire, including a visual analogue scale for quantitative data, was distributed among the participants. The frequency of failure was indicated by most of the participants at 2% to 5% total. Considerably higher assessments were apparent in endodontics and abscess incisions. Rates of failure were said to be low in infraorbital nerve block, average in infiltration anesthesia and high in mandibular nerve block. These preliminary results indicate that a reliable anesthetic in dental treatment cannot always be provided.

Anesthesia, Dental↗
PubMed2004

Clinical significance of the structural integrity of the superior aspect of the mandibular canal.

BACKGROUND: Sparse data can be found regarding the structural integrity of the superior aspect of the mandibular canal. In many cases, the mandibular canal must be carefully evaluated prior to defining patient treatment. METHODS: In this case report, a 54-year-old patient presented with a periapical infection involving the mesial root of the mandibular right second molar (#31). Radiographic evaluation revealed that the periapical lesion extended from the apex of the tooth to the superior aspect of the mandibular canal. Upon surgical removal of the tooth, an apical communication between the extraction socket and mandibular nerve was located. A guided bone regeneration procedure was performed to protect the nerve from subsequent damage and to prepare the site for future implant placement. Implants were placed in the area approximately 5 months following the regenerative procedure. RESULTS: After implant placement, the patient experienced normal function and no mandibular symptomatology. Implants have been in function for the past 4 years. CONCLUSIONS: Many factors, both pathologic and developmental, can lead to a discontinuity of the superior aspect of the mandibular canal. Normally, a thin cortical plate of bone protects the nerve. When a lack of structural integrity of the canal roof is discovered, enucleation of a periapical infection or subsequent implant placement can lead to potential disruption of the nerve. Limited information is available regarding the integrity of this protective cover. This case report underscores the importance of proper clinical diagnosis before implant placement in the posterior mandible.

Bone Regeneration↗
PubMedDate not supplied

[Paresthesia of the inferior dental nerve: clinical signs, etiological diagnosis and prognosis 1].

This article is about the different iatrogenic (or others) mechanical and/or chemical trauma that can affect the mandibular nerve and which can lead to paresthesia. Depending on the different causes of the paresthesia, the prognosis for nerve sensitivity regeneration will vary: In some cases treatment is necessary to make the symptoms disappear, in others expectation will be the rull and the prognosis is very poor.

Cranial Nerve Diseases↗
PubMed2001

Anatomic position of the lingual nerve in the mandibular third molar region with special consideration of an atrophied mandibular crest: an anatomical study.

The position of the lingual nerve in the mandibular third molar region was measured and documented in 68 cadaver dissections (34 adult cadaver heads). In 8.8% of the dissections, the lingual nerve was found at or above the level of the alveolar crest. In the horizontal plane, the nerve contacted the lingual plate of the third molar in 57.4% of the specimens. There was also a significant relationship between the degree of mandibular crest atrophy and the distance from the nerve to the molar region. The distance decreased with the degree of atrophy. There was no significant difference between the two sides of the head. These results demonstrate the vulnerability of the lingual nerve as it medially passes the mandibular third molar and may help avoid lingual damage during surgery in the third molar and retromolar region of the mandible.

Aged↗
PubMed1991

Trigeminal neuralgia--treatment of the third division by radiologically controlled cryoblockade of the inferior dental nerve at the mandibular lingula: a study of 31 cases.

Cryoblockade of the peripheral nerve affected by trigeminal neuralgia is an established technique for treatment. Freezing the inferior dental nerve using C-arm image-intensification control, and a nerve stimulator to guide the slim Spembly Lloyd probe, offers an additional technique for treatment of a small number of patients with trigeminal neuralgia. This paper reports the results of 31 cryoblockades of the inferior dental nerve in 11 patients.

Adult↗
PubMed2005

Assessment of material- and technique-related complications following sagittal split osteotomies stabilized by biodegradable polylactide screws.

OBJECTIVE: The aim of this retrospective clinical study was to determine whether there are any material-related problems and increased occurrence of postoperative mandibular nerve and temporomandibular joint dysfunctions in connection with the use of biodegradable self-reinforced poly-L-lactide (SR-PLLA) screws for bone fixation after bilateral sagittal split osteotomies (BSSO). STUDY DESIGN: Forty consecutive patients who underwent BSSO and mandibular advancement that included fragment fixation using SR-PLLA screws were monitored for an average of 2.2 years postoperatively. RESULTS: The osteotomy sites healed uneventfully with no adverse reactions. The incidence of postoperative sensory disturbances of the inferior alveolar nerve was 27%. Symptoms of temporomandibular joint disorders (TMJD) observed preoperatively in 73% of patients were reduced to 48% after surgery. CONCLUSION: The occurrence of postoperative sensory disturbances and TMJD symptoms in this study did not deviate strikingly from that of other studies using conventional osteosynthesis. No specific complications related to the screw material were observed.

Absorbable Implants↗
PubMed1992

Effects of nerve growth factor on craniofacial onlay bone graft survival: preliminary findings.

A study was undertaken to evaluate the effects of nerve growth factor (NGF), which had previously demonstrated bone formation around mandibular nerve regenerates, on resorption of onlay bone grafts to the rabbit skull. Iliac grafts were onlayed on the parietal bone bilaterally and immobilized with wire ligatures in 15 animals. NGF and a control solution were introduced into the grafts through subcutaneous osmotic pumps. After 60 days, graft survival was compared by weights, histology, and fluorochrome labels. NGF-treated grafts were characterized by an average of 88.4% weight retention, preservation of the outer cortical plate with firm fixation to the underlying calvarium, and fluorescent labels localized to the inner cortex. Conversely, control grafts had an average weight retention of 42.8% (p < 0.01), nearly complete outer cortical plate loss with increased mobility of the residual inner cortex, and a lack of fluorescence in any part of the grafts. Despite the incongruous name, NGF exhibited a beneficial effect on onlay bone graft volume maintenance in this study. Although the mechanism and the long-term effects are unknown, inhibition of graft resorption rather than enhancement of bone formation is suggested.

Animals↗
PubMed2001

Clinical audit on the incidence of inferior alveolar nerve dysfunction following mandibular sagittal split osteotomies at the Derby Royal Infirmary, England.

This retrospective clinical audit identified the incidence of inferior alveolar nerve dysfunction following mandibular sagittal split osteotomies for a period of 1 year at the Derby Royal Infirmary. The clinical notes of 50 consecutive patients treated with a bilateral sagittal split osteotomy over the last 5 years were used to collect information on the following: age, sex, type of mandibular movement (advancement or setback), recorded nerve damage during surgery, "good" or "bad" split, and the presence of nerve dysfunction at representative postoperative intervals, up to 1 year. One hundred procedures were essentially audited, as the surgery was carried out on both sides. The mean age of patients undergoing this procedure was 23 years. Thirty-four patients were female and 16 were male. Thirty-three patients underwent advancements and 17 underwent setbacks. The only nerve damage recorded was stretching; this occurred in 11 procedures. The incidence of nerve dysfunction recorded postoperatively was: 22% to 78% immediately, 29% to 61% after 1 week, 23% to 45% after 1 month, 8% to 34% after 3 months, 5% to 26% after 6 months, and 22% to 78% after 1 year. The findings from this clinical audit show that the incidence of inferior alveolar nerve dysfunction at the Derby Royal Infirmary is comparable to, if not less than, what was reported in previous studies. Hence, there is evidence of a reasonably high standard of care taken to prevent this damage, and no changes in the way the surgical procedure is carried out is indicated at present. However, this clinical audit did highlight the lack of documentation and standardization of postoperative assessment for nerve dysfunction. There may be a need for the introduction of a pro forma assessment system to the department.

Adult↗
PubMed1983

Cranial nerve injury during carotid arterial reconstruction.

In a series of 109 carotid arterial reconstructions cranial nerve injury was observed in 14 of 102 patients. Ipsilateral peripheral hypoglossal nerve injury occurred in nine patients with carotid occlusive disease. The marginal mandibular nerve was injured in three patients and recurrent laryngeal nerve dysfunction was noted in four patients. Two cranial nerves were injured in two patients. Full recovery of hypoglossal dysfunction was seen within 2-52 weeks (average 20 weeks). The nerves are injured by retraction to clear the operative field or by postoperative haematoma. Risk factors include crossing of the hypoglossal nerve close to the carotid bifurcation or procedures requiring long arteriotomy or skeletonization of the internal carotid artery. Unilateral cranial nerve injury is usually mild but will require delay of controlateral carotid reconstruction to avoid severe bilateral cranial nerve palsy.

Adult↗
PubMed1980

Facial nerve paralysis secondary to mandibular fracture.

When facial nerve paralysis complicates a mandibular fracture, it may be difficult to locate the point of injury, since the nerve may be injured in the fallopian canal by a secondary temporal bone fracture or in soft tissue by mandibular fragments. Following a review of eight previously reported cases, this paper presents two additional cases, one with bilateral, complete paralyses and the other with a unilateral paresis. In the first, the condyles were driven posteriorly, resulting in bilateral temporal bone fractures, a unilateral external canal stenosis, and a unilateral sensorineural hearing impairment. Good functional return followed decompression of the intratemporal facial nerves. In the second patient, facial function returned spontaneously. When the temporal bone is fractured, therapy follows guidelines for facial paralysis associated with basilar skull fractures from other causes. If soft tissue injury is suspected, the decision must be made whether to explore the nerve or wait for spontaneous recovery.

Adolescent↗
PubMed1987

Cranial nerve injuries during carotid endarterectomy.

Our experience with patients undergoing carotid endarterectomy over a 10 year period has been retrospectively reviewed. Nerve injuries were detected by reviewing postoperative progress and clinic notes. One hundred twenty-nine procedures were performed on 112 patients, 12 of whom (9.3 percent) sustained major nerve injuries. These included five vagal nerve injuries causing ipsilateral vocal cord paralysis and hoarseness, four injuries of the marginal mandibular nerve, and three injuries of the hypoglossal nerve. Evidence of nerve dysfunction was not present preoperatively. None of the patients with nerve injury sustained a stroke as a result of carotid operation. Vocal cord paralysis was documented by indirect laryngoscopy. The incidence of cranial nerve injury during carotid endarterectomy appears to be higher than expected, particularly if asymptomatic patients are investigated; however, most injuries are transient and result not from transection but from trauma during dissection, retraction, and clamping of the vessels. The pertinent anatomy and techniques for preventing these injuries have been reviewed.

Carotid Artery Diseases↗
PubMed2006

Facial malignant peripheral nerve sheath tumors.

BACKGROUND/PURPOSE: Malignant peripheral nerve sheath tumors (MPNSTs) are rare neoplasms, only sporadically reported involving the maxillo-mandibular region (ten cases with CT or MR data). We present here five additional cases with CT and MR findings along with an extensive review of the literature. RESULTS: Accurate diagnosis of MPNSTs is difficult because pathological like radiological criteria are often non specific. Radiological features display a large spectrum of abnormalities from a well-delineated heterogeneous appearance simulating benign schwannoma to extensive erosive patterns. Their development along the mandibular nerve, the absence of any target or central dot sign, their strong predominant peripheral enhancement must suggest the diagnosis of MPNSTs while irregular bone destruction or the detection of poorly defined margins with muscular infiltration are the most reliable criteria of malignancy. Unfortunately, MPNSTs also display a considerably varied histology. Careful clinical and radiological correlation should bring pathologists to examining large samples of the lesion to better evaluate the overall organisation of the lesion and detect some evocative criteria often only present in some areas of the sample as the peculiar curlicue or whorled arrangement of the spindle cells or the alternation of densely cellular fascicles with hypocellular, myxoid zones. Focal, limited immunostaining for S-100 protein is one of the most important additional criterion. CONCLUSION: If accurate early diagnosis often remains difficult, careful correlation of clinical, pathological and radiological data should in most cases suggest a diagnosis of MPNSTs which display a poor prognosis and requires early and adapted treatment.

Adult↗
PubMed1985

Hemifacial spasm: results of electrophysiologic recording during microvascular decompression operations.

Electrophysiologic recordings were made from patients with hemifacial spasm (HFS) during microvascular decompression (MVD) operations to see if spasm and synkinesis are caused by ephaptic transmission at the site of lesion (root entry zone [REZ] of the facial nerve). The response from the orbicularis oculi muscle to electrical stimulation of the marginal mandibular nerve had a 2.2-msec longer latency (average of 16 patients) than the sum of the conduction times of the parts of the facial nerve that would be involved if the response was the result of ephaptic transmission at the REZ of the seventh cranial nerve. Similar results were obtained when the zygomatic branch of the facial nerve was stimulated. These results indicate that the facial motonucleus is involved in HFS.

Action Potentials↗
PubMed1990

[Peripheral nerve injuries during carotid endarterectomy].

Our experience with patients undergoing carotid endoarteriectomy over a 10 year period has been retrospectively reviewed. Nerve injuries were detected by reviewing postoperative progress and clinical notes. One hundred thirty-four procedures were performed on 120 patients, to 15 of whom (9%) occurred major nerve injuries. These included seven vagal nerve injuries causing ipsilateral vocal cord paralysis and hoarseness, five injuries of the marginal mandibular nerve and three injuries of the hypoglossal nerve. None of the patients with nerve injury had a stroke as a result of carotid operation. Vocal cord paralysis was documented by laryngoscopy. The incidence of cranial nerve injury during carotid endoarteriectomy appears to be higher than expected, particularly if asymptomatic patients are controlled.

Aged↗
PubMed1994

[The extraction of the lower third molars: germectomy or late avulsion?].

INTRODUCTION: Lower third molars show the highest incidence of impaction and have been held responsible for pathologies such as pericoronitis, periodontitis, second molars tooth-crown resorption, pain, cysts or odontogenic tumors, primary or secondary crowding of the dentition. Early removal of these teeth to prevent the overmentioned problems is widely acknowledged, as many studies demonstrated a direct correlation between age and incidence of complications. These studies mostly refer to adult patients, while studies about germectomies are few. Because recent contributions showed that the risk of development of these pathologies in presence of impacted third molars is quite low while a certain morbidity associated to this procedure may be expected, a very careful risk to benefit ratio must be considered. The purpose of this study was therefore to compare the incidence of complications and side effects in three age groups, in order to obtain some informations about the choice of the best moment for operation. MATERIALS AND METHODS: The patients, 462 females and 406 males, were divided, according to age, in the following three groups: group A included patients from 9 to 16 years; group B included patients from 17 to 24 years; group C included patients over 24 years. All patients were treated under local anesthesia; surgical procedure and instruments were standardized. RESULTS: In group A, formed by 500 germectomies, the incidence of complications was 2.6% (10 instances of secondary infections, 2 instances of trismus, 1 instance of excessive postoperative bleeding). Group B included 570 procedures and the incidence of complications was 2.8% (3 instances of alveolar osteitis, 7 instances of secondary infections, 2 instances of excessive postoperative bleeding, 2 instances od second molar lesions, 1 instance of inferior alveolar nerve paresthesia, 1 instance of trismus). Group C included 430 procedures and the incidence of complications was 7.4% (2 instances of second molar lesions, 9 instances of alveolar osteitis, 8 instances of secondary infections, 4 instances of excessive postoperative bleeding, 6 instances of inferior alveolar nerve paresthesia, 3 instances of trismus). All complications were transient; in one instance only of mandibular nerve paresthesia in group C symptoms were still present 25 months after the operation. DISCUSSION AND CONCLUSIONS: This study has shown no significant differences between group A and B, while complications significantly increase in group C. Recent researches have shown that: a) there is a low risk of development of pathologies correlated to third molar impaction; b) nowadays there are not valid criteria to evaluate the future eruption of the impacted tooth; c) a direct correlation between third molar impaction and anterior dental crowding hasn't been demonstrated yet; d) morbidity of the procedure is relevant. Therefore germectomy should be performed: a) if morphostructural alterations or ectopic impactions are present; b) in case eruption is not allowed for dysplastic alterations of the germs or pathological processes of the mandible; c) to gain space in the posterior segments of the lower jaw when distalization of first and second molars is necessary; d) in case of excessive anterior-posterior mandibular growth.

Adolescent↗