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Immediate and late (up to 4 years) results of acupuncture are described in 42 patients with oral mucosa paresthesias. The data suggest that this is an efficient technique.
Lingual paresthesia following the surgical placement of implants does not occur frequently. When it does occur, a serious problem may result for the practitioner, especially if the patient has not been informed of the risk before surgery. This report emphasizes the importance of practitioner experience and competence. It also addresses the need for knowledge of the course of the lingual nerve and preoperative planning of implant placement in the mandible.
Can proximal nerve lesions cause a distal "Tinel-like" sign? We present the case studies of two patients with documented cervical root lesions who exhibited percussion paresthesiae distally in the absence of any clinical or nerve conduction evidence of distal pathology. The possible mechanisms underlying such manifestation, which has been previously reported in the literature, are explored, and a case is made for the phenomenon being related to the "distortion" of a normal sensory signal when it encounters an area of spatial inhomogeneity proximally along the nerve.
Paresthesia, pain and coldness of the upper limb strongly suggest ischemia. The questions raised concern the etiology and treatment. 1) Treatment is based on confirmation of the unilateral nature of the disorder requiring search for the a locoregional cause (examination of the subclavian outlet) and on elimination of a cardiac or general origin. Two noninvasive examinations are indicated. An X-ray examination of the upper chest bones is performed to search for an abnormal formation, usually a cervical rib. Presence of a cervical rib indicates a possible damage to the sub-clavian artery in the thoraco-brachial outlet and, inversely, absence of a cervical rib suggests either arterial damage or a fibromuscular cause. Ischemia of the upper limb results from repeated microtrauma to the sub-clavian artery due to a bone-ligament anomaly resulting in thickening and parietal ulceration, and sometimes post-stenosis embolism or in situ thrombosis. Duplex Doppler may be able to identify the nature of the cause without dynamic manoeuvres. An arteriography is essential to confirm the level of the obstacle, its nature, the status of the downstream bed and possible relationship between a bone anomaly and the sub-clavian artery. Several incidences may be required. 2) Therapeutic modalities must take into account the ischemia and its cause. Surgery is required to remove the obstacle and repair the arterial damage, and possibly to remove an embolus. It is relatively easy to remove a cervical rib or repair a bone muscle anomaly, allowing arterial repair with or without venous bypass. Embolectomy of an earlier embolus may require major reconstruction vascular surgery.
The axillary brachial plexus blockade by means of stimulating paresthesia and single local anesthetic injection was examined during one year long routine activity in a plastic surgery division. Two-hundred-five blocks were performed evaluating the success percentage, the execution mean time, a sedation utility and the sequelae incidence. The technique was confirmed usefull, easy to perform, well tolerated from the patients. The technique validity, versus the suspiciousness considered by several Authors, is confirmed.
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