Innervation Area Research Articles

Efficacy of epinephrine-free articaine compared to articaine with epinephrine (1:100000) for maxillary infiltration, a randomised clinical trial.

The selection of local anaesthetic in dental practice is essential to the patient's comfort and the success of the treatment. Many patients prefer anaesthesia even for short treatments. Articaine is a local anaesthetic commonly used for dental practice. The duration of the effect of articaine on the nerve fibres is not yet precisely reported. This study was aimed to evaluate the clinical efficacy of 4% articaine with and without epinephrine in treatment of occlusal caries. Thirty healthy patients were included in this randomised double-blind study. Each subject received 4% articaine with and without epinephrine (1:100000). Maxillary infiltration was used for occlusal caries of the maxillary premolars on right and left sides. Quantitative sensory testing (QST) was performed in the innervation area of the infraorbital nerve, and pulp vitality test was performed on restoration-free canines. Duration of anaesthesia was longer when articaine with epinephrine was used. Articaine without epinephrine showed faster recovery of sensory blockade compared to articaine with epinephrine. The epinephrine-containing agent, when compared to the plain articaine solution, showed significantly stronger and longer anaesthetic efficacy on the soft tissue by all parameters of QST. Articaine with epinephrine caused a more reliable pulpal analgesia. A pain-free treatment of the soft tissue up to 15minutes can be performed under the vasoconstrictor-free anaesthetic without causing long-lasting numbness. Epinephrine-containing articaine delivers a longer, more effective anaesthesia and is preferable for caries treatments and longer invasive treatments of the soft tissue.

(Invited) Imaging Dopamine Neuromodulation with Single Wall Carbon Nanotube Sensors

Neurons communicate through chemical neurotransmitter signals that either terminate at the postsynaptic process (“wired transmission”) or diffuse beyond the synaptic cleft to modulate the activity of larger neuronal networks (“volume transmission”). Molecules such as dopamine belong to the latter class of neurotransmitters, for which real-time imaging of the signal’s spatial propagation would constitute a major advance in neurochemical imaging. To this end, we present a nanoscale near-infrared fluorescent sensor for dopamine and demonstrate its efficacy for imaging dopamine volume transmission in the extracellular space of the brain striatum and prefrontal cortex. The sensor is developed from polymers pinned to the surface of single wall carbon nanotubes (SWNT) in which the surface-adsorbed polymer is the recognition moiety and the carbon nanotube the fluorescence transduction element. Using this paradigm, we describe the design, characterization, and implementation of polymer-functionalized SWNT nanosensors and present recent progress in imaging the dynamics of evoked and spontaneous dopamine release in mouse acute brain slices. Fluorescence imaging of dopamine volume transmission with our probes provides much needed spatial information and high resolution of dopamine dynamics in contrast with traditional electrochemical dopamine measurements obtained with fast scan cyclic voltammetry (FSCV). Whereas FSCV measures dopamine concentration at a single point arising from the activity of a large number of dopamine terminals, our probes capture local release arising from single and multiple terminals within the imaging field of view. From imaging data, we can describe localized release and clearance kinetics of dopamine neuromodulation. In the brain striatum, the nanosensors record spatially and temporally resolved dynamic behavior of dopamine on length scales that encompass single terminals and inter-terminal distances, and enable investigation of the effect of antidepressant drugs such as Nomifensine on dopamine dynamics. In the prefrontal cortex (PFC), an area of sparse dopaminergic innervation, dopamine nanosensors capture dynamics elicited by single terminals. In both the striatum and PFC, optogenetics enables selective stimulation of dopaminergic terminals to evoke dopamine release. We further describe how nanoparticle exciton engineering can be used to tune sensor performance and design sensors best suited for in vivo experimentation. Molecular dynamics modeling elucidates the physicochemical phenomena underlying the dopamine sensing process and stochastic simulations reveal that optical nanosensors can capture millisecond-scale changes during phasic and tonic firing of dopaminergic neurons. Combining our experimental and computational work, we outline the functional range of this technology for imaging dopamine neuromodulation in biologically complex and optically dense live brain. Our experimental and theoretical results show that near-infrared (nIR) neurotransmitter nanosensor constructs can relay information about neuronal signaling in the tissue-compatible nIR optical window, with spatiotemporal scales that capture both single synaptic release events and ensemble terminal behavior suitable for in vivo behavioral experimentation.

Bilateral taste disorders in patients with Ramsay Hunt syndrome and Bell palsy.

Ramsay Hunt syndrome (RHS) and Bell palsy (BP) are typically known as facial nerve motor syndromes and are primarily unilateral. The aim of this study was to challenge this assertion, because both conditions are also known to be associated with viruses that typically affect several nerves. Ten participants with RHS, 12 with BP, all clinically unilateral, and 12 healthy controls were prospectively enrolled. Electrogustometric thresholds were measured bilaterally in the areas of the chorda tympani, the glossopharyngeal, and the major petrosal nerve. Also bilaterally, the taste function was tested using chemogustometry with different tastant concentrations. Again bilaterally, the morphology of the mucosa and the vessels of the anterior fungiform papillae were examined by contact endoscopy. Statistically, RHS and BP participants were compared with the healthy controls, and the paretic sides of RHS and BP were compared pairwise with their mobile sides. Electrogustometrically, perception was reduced bilaterally in RHS (10-19dB, p < 0.001) and BP (3-5dB, p = 0.011-0.030) in all 3 innervation areas. Chemogustometrically, it was also reduced bilaterally in RHS (20-70%) and BP (8-50%). Papillary atrophies were increased 100% in RHS (p = 0.001) and BP (p < 0.001). They were more increased on the paretic side in RHS (30%, p = 0.078) and BP (83%, p < 0.001). In these 2 clinically unilateral conditions, the gustatory perception and morphology are bilaterally affected, more in RHS and more on the paretic side. BP, known as an isolated motor condition, appears to be a cranial polyneuritis. A bilateral examination and therapeutic gustatory monitoring might follow these observations in evidence-based practice. Ann Neurol 2018;83:807-815.

СOMPLICATIONS OF ENDODONTIC TREATMENT: PECULIARITIES OF CLINICAL SIGNS, DIAGNOSIS

Endodontic lesions take leading positions in the structure of modern dentistry. General areas of the displacement of filling material or instruments because of the poor quality of endodontic treatment have been established, and the features of clinicoroentgenological and neurological manifestations of the complications of endodontic dentistry have also been determined.&#x0D; Due to the poor quality of endodontic treatment, general areas of the displacement of filling material or instruments have been identified, they are the mandibular canal, the maxillary sinus and periapical bone tissue.&#x0D; We have performed the examination of 32 patients with various complications after endodontic treatment during 2017 to 2018.&#x0D; The majority of patients were adults – 28(87,5%), over the age of 60 – 4(12,5%), there were 84,4% females and 15,6% males within the group.&#x0D; The patients were divided into 3 groups according to localization of foreign bodies: the first group contained patients with foreign bodies present in the area of mandibular canal – 5(15,6%); the patients represented by the material in the maxillary sinus cavity made up the second group – 9(28,1%); the group of patients whose material was localized behind the tooth apex in the bone tissue included 18(56,2%)persons. The greatest number of complications after endodontic therapy was observed during the treatment of molars– 67,9%.&#x0D; Duration of disease (from the end of endodontic treatment to the hour of addressing the clinic) varied from 1 to 6 months.&#x0D; For the purpose of identification, the foreign material localization along with traditional clinic examination, which includes complaints analysis, anamnesis data, estimation of general health status and local manifestations of the disease, the dental intraoral X-ray, plain roentgenography and computed tomography of the bones of the jaws were performed. Assessment of the tissues sensitivity was conducted by the method of comparative palpation of the skin and mucosa at the areas of innervation of the trigeminal nerve branches.&#x0D; As a result of the investigation we have determined that regardless of exact localization of the foreign material, surgical complications after endodontic treatment were always accompanied with pain syndrome of different intensity, reduction of sensitivity during the placement of the filling material in the area of mandibular canal (extra- or intracanal), signs of inflammation development (bounded or generalized adjacently to mucosa of maxillary sinus) or persistent pain syndrome during displacement of filling material into the bone tissue behind the tooth apex.&#x0D; To specify areas and borders of the localization of the foreign body, the findings of the roentgenological investigations, in particular computed tomography, were critical.

Lipofibromatous Hamartoma of the Plantar Nerve An Extremely Rare Localization.

Lipofibromatous hamartoma (LFH) is a rare, benign, tumor-like soft-tissue lesion that affects the peripheral nerves and forms a palpable neurogenic mass. Lipofibromatous hamartoma is associated with pain and sensory and/or motor deficits in the area of innervation of the affected nerve. This report describes a rare case of LFH of the plantar nerve. A 48-year-old woman presented to our outpatient orthopedic clinic with pain and a burning sensation on her left foot. The patient had a history of Morton's neuroma and had undergone a tarsal tunnel operation 2 years earlier at another center. None of her symptoms was alleviated by two previous operations. Magnetic resonance imaging with contrast revealed tenosynovitis of the flexor hallucis longus tendon and signal changes at deep tissue planes of the foot at the levels of the second and third toes, on the dorsal site and subcutaneous soft-tissue planes, suggesting edema and Morton's neuroma. The lesion was excised under spinal anesthesia, and histopathologic examination of the specimen revealed a diagnosis of LFH. The patient was discharged without any symptoms and her foot was normal at 8-month outpatient follow-up, with no indications of postoperative complications and/or recurrence.

Lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa in surgery for meningoencephalocele of the lateral sphenoid recess

The study included 4 patients with meningoencephalocele of the lateral recess of the sphenoid sinus (1 male and 3 females; mean age, 46.8 years). All patients underwent resection of meningoencephalocele and repair of a skull base defect using the lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa (transpterygoid approach). In all patients, meningoencephalocele was resected to the bone defect level. There was no postoperative liquorrhea. Complications included bacterial meningitis (1 case), asymptomatic imbibition of the temporal lobe pole (1 case), and temporary numbness in the V2 innervation area of the trigeminal nerve (1 case). The paper describes and demonstrates advantages of the lateral extended transsphenoidal endoscopic approach through the pterygopalatine fossa (transpterygoid approach) for surgical treatment of patients with meningoencephalocele of the lateral sphenoid recess.

Anterior subcutaneous transposition versus anterior subfascial transposition of the ulnar nerve in the treatment of cubital tunnel syndrome

Objective To compare the clinical effects of anterior subcutaneous transposition and anterior subfascial transposition of the ulnar nerve in the treatment of cubital tunnel syndrome. Methods A total of 37 patients with cubital tunnel syndrome were retrospectively analyzed. 18 cases were treated with subcutaneous transposition of ulnar nerve, and 19 cases with anterior transposition of ulnar nerve. The scores of sensory deficits in the ulnar nerve innervation area, the intrinsic muscle strength, claw deformity and ulnar nerve conduction velocity were compared between the two groups. Results Postoperative follow-up period ranged from 6 to 18 months. There was no significant difference between anterior subcutaneous and anterior subfascial transposition of the ulnar nerve. The clinical effects of patients with moderate cubital tunnel syndrome treated by the two anterior transposition operations were much better than that of patients with severe cubital tunnel syndrome. Conclusion There was no difference between the two methods of anterior subcutaneous transposition and anterior subfascial transposition. However, the anterior subfascial transposition combines the advantages of anterior subcutaneous transposition and anterior submuscular transposition. Cubital tunnel syndrome should be actively intervened after being definitely diagnosed. Key words: Cubital tunnel syndrome; Treatment outcome; Anterior subcutaneous transposition; Anterior subfascial transposition

Effectiveness of wrist tube inside and outside releasing for treating median nerve double entrapment at wrist

To investigate the effectiveness of wrist tube inside and outside releasing for treating median nerve double entrapment at wrist. Thirty-one patients of median nerve double entrapment at wrist were treated between April 2011 and May 2014. There were 8 males and 23 females with an age of 33-69 years (mean, 56.4 years). In palm lateral three and a half finger, the two-point discrimination was 7-14 mm (mean, 9.5 mm), in which 24 cases were 4-10 mm and 7 cases were more than 10 mm. Carpal tunnel median nerve Tinel sign was positive; there was weak and acid swollen felling when press big thenar muscle on median nerve return branch palm surface projection points. Electromyography examination showed that median nerve endings movement incubation period was 4.5-10 ms in 22 cases, more than 10 ms in 9 cases; fibrillation potentials and positive phase voltage happened in 6 cases; the median nerve sensory conduction velocity of all patients was slow, and the motor conduction velocity also slowed down; the motor amplitude was 5-10 mV in 19 cases, less than 5 mV in 12 cases. The disease duration was 3-8 months (mean, 5.5 months). Surgical exploration of wrist median nerve in carpal tunnel and median nerve return branch outside carpal tunnel were performed in patients, especially completely released the variety entrapment factors such as thickening bow at starting point of short hallux flexor tendon, fiber bundles at ulnar side of short hallux flexor tendon, deep layer fiber of the palmar aponeurosis, and variant shallow head of short hallux flexor. All the wounds healed by first intention without wound scar pain. The patients were followed up 24-59 months (mean, 33 months). Night numbness and pain disappeared, and weak and acid swollen feeling in big thenar muscle on median nerve return branch points also disappeared. The sensation recovered to S 4 in 28 patients in palm lateral three and a half finger, the index and middle fingertip sensation recovered to S3+ in 3 cases. In the median nerve innervation area, the two points discrimination was 4-6 mm (mean, 4.8 mm). The thumb opposition function returned to normal in 29 cases and mild confinement in 2 cases. The grip strength of all the 31 cases recovered, and 1 of them increased significantly. In preoperative big thenar muscle atrophy cases, muscle strength recovered to S 5 in 4 cases, S 4 in 2 cases. At 2 years after operation, according to the functional assessment of carpal tunnel syndrome recommend by GU Yudong, the results were excellent in 29 cases and good in 2 cases, with an excellent and good rate of 100%. When treating the nerve double entrapment in wrist using wrist tube inside and outside releasing method, the variety entrapment factors of return branch of median nerve should be completely released, so the effectiveness can be improved.

Reduced muscle strength in ether lipid-deficient mice is accompanied by altered development and function of the neuromuscular junction.

Inherited deficiency in ether lipids, a subgroup of phospholipids whose biosynthesis needs peroxisomes, causes the fatal human disorder rhizomelic chondrodysplasia punctata. The exact roles of ether lipids in the mammalian organism and, therefore, the molecular mechanisms underlying the disease are still largely enigmatic. Here, we used glyceronephosphate O‐acyltransferase knockout (Gnpat KO) mice to study the consequences of complete inactivation of ether lipid biosynthesis and documented substantial deficits in motor performance and muscle strength of these mice. We hypothesized that, probably in addition to previously described cerebellar abnormalities and myelination defects in the peripheral nervous system, an impairment of neuromuscular transmission contributes to the compromised motor abilities. Structurally, a morphologic examination of the neuromuscular junction (NMJ) in diaphragm muscle at different developmental stages revealed aberrant axonal branching and a strongly increased area of nerve innervation in Gnpat KO mice. Post‐synaptically, acetylcholine receptor (AChR) clusters colocalized with nerve terminals within a widened endplate zone. In addition, we detected atypical AChR clustering, as indicated by decreased size and number of clusters following stimulation with agrin, in vitro. The turnover of AChRs was unaffected in ether lipid‐deficient mice. Electrophysiological evaluation of the adult diaphragm indicated that although evoked potentials were unaltered in Gnpat KO mice, ether lipid deficiency leads to fewer spontaneous synaptic vesicle fusion events but, conversely, an increased post‐synaptic response to spontaneous vesicle exocytosis. We conclude from our findings that ether lipids are essential for proper development and function of the NMJ and may, therefore, contribute to motor performance. Read the Editorial Highlight for this article on page 463.

A Novel Egr-1-Agrin Pathway and Potential Implications for Regulation of Synaptic Physiology and Homeostasis at the Neuromuscular Junction.

Synaptic transmission requires intricate coordination of the components involved in processing of incoming signals, formation and stabilization of synaptic machinery, neurotransmission and in all related signaling pathways. Changes to any of these components cause synaptic imbalance and disruption of neuronal circuitry. Extensive studies at the neuromuscular junction (NMJ) have greatly aided in the current understanding of synapses and served to elucidate the underlying physiology as well as associated adaptive and homeostatic processes. The heparan sulfate proteoglycan agrin is a vital component of the NMJ, mediating synaptic formation and maintenance in both brain and muscle, but very little is known about direct control of its expression. Here, we investigated the relationship between agrin and transcription factor early growth response-1 (Egr-1), as Egr-1 regulates the expression of many genes involved in synaptic homeostasis and plasticity. Using chromatin immunoprecipitation (ChIP), cell culture with cell lines derived from brain and muscle, and animal models, we show that Egr-1 binds to the AGRN gene locus and suppresses its expression. When compared with wild type (WT), mice deficient in Egr-1 (Egr-1−/−) display a marked increase in AGRN mRNA and agrin full-length and cleavage fragment protein levels, including the 22 kDa, C-terminal fragment in brain and muscle tissue homogenate. Because agrin is a crucial component of the NMJ, we explored possible physiological implications of the Egr-1-agrin relationship. In the diaphragm, Egr-1−/− mice display increased NMJ motor endplate density, individual area and area of innervation. In addition to increased density, soleus NMJs also display an increase in fragmented and faint endplates in Egr-1−/− vs. WT mice. Moreover, the soleus NMJ electrophysiology of Egr-1−/− mice revealed increased quantal content and motor testing showed decreased movement and limb muscle strength compared with WT. This study provides evidence for the potential involvement of a novel Egr-1-agrin pathway in synaptic homeostatic and compensatory mechanisms at the NMJ. Synaptic homeostasis is greatly affected by the process of aging. These and other data suggest that changes in Egr-1 expression may directly or indirectly promote age-related pathologies.

TAC-302 promotes neurite outgrowth of isolated peripheral neurons and prevents bladder denervation related bladder dysfunctions following bladder outlet obstruction in rats.

To evaluate the ability of TAC-302, a cyclohexenoic fatty alcohol derivative, to enhance neurite outgrowth in cultured rat dorsal root ganglion (DRG) neurons, and the preventive effects of TAC-302 on bladder denervation-related storage and voiding dysfunctions in rats with bladder outlet obstruction (BOO). Rat DRG neurons were cultured in the presence of TAC-302. Cell numbers and neurite lengths were quantified after a 24 h culture. BOO was achieved by partial ligature of the proximal urethra in female rats. BOO rats were divided into three groups and orally treated with vehicle of 3 or 30 mg/kg TAC-302 twice a day for 4 weeks. Cystometry was performed under conscious conditions. Immunohistochemical staining using anti-PGP9.5 of the bladder muscle layer was performed, and the innervation area was scored. TAC-302 significantly and dose-dependently increased neurite outgrowth in cultured DRG neurons. BOO rats showed a decreased innervation area in the urinary bladder compared to sham-operated rats. BOO-induced denervation of the urinary bladder was partially prevented by oral treatment with TAC-302. TAC-302 significantly reduced the frequency of non-voiding contraction (NVC) and residual urine volume (RUV) compared with the BOO vehicle group (P < 0.05). The innervation area score exhibited significant negative correlations with NVC and RUV, indicating that they increased according to the progression of denervation. Our data indicate that TAC-302 promotes neurite outgrowth in vitro. In addition, TAC-302 prevents BOO-induced bladder dysfunction in rats, and has a protective effect on bladder denervation.

Visualization of the tentorial innervation of human dura mater.

Posterior projections of the ophthalmic division of the trigeminal nerve (the ophthalmic nerve) are distributed in the tentorium cerebelli as recurrent meningeal branches. We investigated the morphological tentorial distribution of the ophthalmic nerve. Fifty-two sides of the tentorium cerebelli and adjacent dura mater obtained from 29 human specimens were stained using Sihler's method to examine the nerve fibres in the dural sheets. The innervation patterns of the tentorium cerebelli were classified into the following four types according to their distributions: Type 1, where nerve fibres projected to both the straight and transverse sinuses; Type 2, where nerve fibres projected only to the transverse sinus and lateral convexity; Type 3, where nerve fibres projected medially only to the straight sinus and the posterior part of the falx cerebri; and Type 4, where the nerve fibres terminated within the tentorium cerebelli. Images of the tentorium cerebelli were superimposed to identify areas of dense innervation. The incidence rates of Types 1-4 were 71.2% (n=37), 21.2% (n=11), 3.8% (n=2) and 3.8% (n=2), respectively. More branches of nerve fibres traversed towards the transverse sinus posterolaterally than towards the straight sinus medially. The space between the anterior half of the straight sinus and the medial tentorial notch can be considered a safe surgical area where innervation is scarce. The posterior part of the falx cerebri was innervated by the ophthalmic nerve that traversed to the straight sinus. The parietal branches of the middle meningeal artery in the lateral convexity that were projected orthogonally by the ophthalmic nerve traversed the transverse sinus, implicating their vulnerability and possible sensitivity under physiological or neurosurgical conditions. This study has revealed the macroscopic tentorial innervation of the dura mater in humans, which could be useful information for both neurosurgeons and neurologists.

Assessment of dysgeusia and taste identification in patients undergoing chemotherapy for breast cancer.

e21668 Background: Dysgeusia is a common side effect of chemotherapy (CT) and often impacts negatively on QOL. This study analyzed the prevalence of gustatory test abnormalities in breast cancer (BC) patients undergoing CT. Methods: We enrolled 33 BC patients who were undergoing CT (26 adjuvant CT and 7 CT for advanced BC) and conducted 2 gustatory tests on CT day. In the test of sensitivity using the instillation method (IM), 4 basic taste stimuli (sweet, salty, sour, and bitter) at 5 concentrations were applied to the entire oral cavity. For the electrogustometry method (EM), we measured the amount of current for perception of metallic tastes, examining the front two thirds of the tongue (cranial nerve VII) and the back third of the tongue (cranial nerve IX). We compared awareness of dysgeusia with results of the 2 gustatory tests. Results: Median CT duration was 83 days (12–1,353). Fifteen (45%) patients had awareness of dysgeusia (Grade 1: 11, Grade 2: 4). IM revealed 8 (24%) patients with abnormalities, 7 in a single taste species and 1 in 3 taste species. EM revealed 20 (61%) patients withabnormalities, 7 in the cranial nerve VII and 20 in the cranial nerve IX innervation area. All patients with abnormalities in the cranial nerve VII innervation area also had abnormalities in the cranial nerve IX innervation area. Among 15 patients with awareness of dysgeusia, there were 5 (33%) IM abnormalities and 12 (80%) EM abnormalities (4 in the cranial nerve VII and 12 in the cranial nerve IX innervation area). Among 18 patients without awareness of dysgeusia, there were 3 (16%) IM abnormalities and 8 (44%) EM abnormalities (3 in the cranial nerve VII and 8 in the cranial nerve IX nerve innervation area). Patients with IM abnormalities had a higher frequency of abnormalities in the cranial nerve VII innervation area than the normal range (50% and 12%, respectively; p = 0.04); there was no significant difference in the cranial nerve IX innervation area. Conclusions: Nearly half of the patients reporteddysgeusia, but most of these could correctly identify the four basic tastes. Further studies to clarify the discrepancy between subjective and objective observations could lead to effective prevention and treatment of dysgeusia.

High Voltage Pulsed Radiofrequency for the Treatment of Refractory Neuralgia of the Infraorbital Nerve: A Prospective Double-Blinded Randomized Controlled Study

Background: A recent study showed that 50% of patients who suffered from refractory neuralgia of the infraorbital nerve obtained satisfactory efficacy after pulsed radiofrequency (PRF) treatment. A pilot study showed that increasing the output voltage of PRF significantly improved the efficacy for trigeminal neuralgia; however, whether increasing the output voltage of PRF can improve the treatment outcomes for neuralgia of the infraorbital nerve is unknown. Objective: To evaluate the efficacy and safety of high voltage PRF treatment in comparison with standard voltage PRF for neuralgia of the infraorbital nerve. Study Design: Prospective, single-center, double-blinded, randomized, controlled trial. Setting: Beijing Tiantan Hospital, Capital Medical University. Methods: A total of 60 patients with refractory neuralgia of the infraorbital nerve were randomly divided into the high voltage PRF group and the standard voltage PRF group to treat their infraorbital nerves. Neither the patients, pain physicians, nor the follow-up evaluators knew the patient group assignments. The primary outcome measure was the one-year response rate. The secondary outcome measures included the time to take effect after PRF, the one-month, 3-month, and 6-month response rates, the relapse rate, and adverse reactions. Results: The intent-to-treat analysis showed that the one-month, 3-month, 6-month, and oneyear response rates were all 90% in the high voltage group, which were significantly higher than the rates in the standard voltage group (67% [P &lt; 0.05], 67% [P &lt; 0.05], 63% [P &lt; 0.05], and 60% [P &lt;0.01], respectively). Furthermore, 27% of the patients in the high-voltage group and 13% of the patients in the standard voltage group experienced minor transient (10 – 30 days) numbness in the innervation area after PRF; no other serious adverse reactions were observed in the 2 groups (P &gt; 0.05). Limitations: We did not investigate the dose-effect relationship between the output voltage and efficacy or the effect of a higher pulse dose on efficacy. This study was a single-center study, and multi-center, randomized, controlled studies are needed to obtain the highest level of empirical evidence. Additionally, the follow-up period lasted only one year in this study; thus, long-term efficacy needs to be further confirmed. Conclusions: The results showed that high voltage PRF was effective and safe for patients with refractory neuralgia of the infraorbital nerve and could become a treatment option in patients who do not respond to conservative treatment. Key words: Neuralgia, infraorbital nerve, pulsed radiofrequency, numeric rating scales, treatment

Assessment of lingual nerve functions after smoking cessation

Objective: Cigarette smoking is associated with a variety of oral diseases. A previous study showed a reduction of thermal sensitivity in the innervation area of the lingual nerve in smokers possibly caused by a degeneration of thermosensitive receptors as a consequence of smoking. The current study investigates somatosensory changes in ex-smokers.Materials and methods: Sensory functions in innervation areas of lingual nerve were investigated in 40 ex-smokers by psychophysical means. Functions of lingual nerve in 40 ex-smokers were compared to those in 40 smokers and 40 non-smokers. Subjects were investigated using quantitative sensory testing (QST, cold and warm detection, thermal sensory limen, heat and cold pain, and mechanical detection).Results: Significant differences were found in both groups, ex-smokers and smokers compared to non-smokers. Cold (p < .001), warm (ex-smokers: p < .01; smokers: p < .001) detection thresholds and thermal sensory limen (p < .001) showed significantly lower sensitivity in ex-smokers and smokers in comparison to non-smokers.Conclusions: The lower temperature sensitivity of ex-smokers compared to that in non-smokers indicates a reduction of somatosensory function of the tongue, possibly caused by irreversible nerve degeneration associated with smoking. Influencing factors leading to sensory changes could be modulation of thermo-receptors, demyelination as well as a change of the epithelial structure.

Profiling intraoral neuropathic disturbances following lingual nerve injury and in burning mouth syndrome

BackgroundThe aim of the study was to analyse intraoral neurophysiological changes in patients with unilateral lingual nerve lesions as well as patients with Burning Mouth Syndrome (BMS) by applying a standardized Quantitative Sensory Testing (QST) protocol.MethodsThe study included patients suffering from a peripheral lesion of the lingual nerve (n = 4), from BMS (n = 5) and healthy controls (n = 8). Neurophysiological tests were performed in the innervation areas of the tongue bilaterally. For BMS patients the dorsal foot area was used as reference.ResultsFor patients with peripheral lesion of the lingual nerve the affected side of the tongue showed increased thresholds for thermal (p < 0.05–0.001) and mechanical (p < 0.01–0.001) QST parameters, indicating a hypoesthesia and thermal hypofunction. In BMS patients, a pinprick hypoalgesia (p < 0.001), a cold hyperalgesia (p < 0.01) and cold/warmth hypoesthesia (p < 0.01) could be detected.ConclusionsThe results of this study verified the lingual nerve lesion in our patients as a peripheral dysfunction. The profile showed a loss of sensory function for small and large fibre mediated stimuli. A more differentiated classification of the lingual nerve injury was possible with QST, regarding profile, type and severity of the neurologic lesion. BMS could be seen as neuropathy with variable central and peripheral contributions among individuals resulting in chronic pain.

Case report. Endodontic treatment of lower molar in a patient with paraesthesia of inferior alveolar nerve – A Case Report

Summary Root canal (endodontic) treatment is demanding and complex procedure. A variety of difficulties can occur in different phases of endodontic procedure. Complex anatomorphological tooth structure, curved canals, close proximity of lower molars and premolars to inferior alveolar nerve make endodontic treatment even more challenging. During endodontic treatment, an inferior alveolar nerve may become traumatized and symptoms may vary from mild neurosensory dysfunction to a complete loss of sensation in the innervation area of damaged nerve. The aim of this paper is to present a clinical case of endodontic treatment of lower second molar with C-shaped root canal in a patient with paraesthesia of inferior alveolar nerve due to endodontic origin.

P083 Method for continuous multichannel measurement of impedance at the auricular sites innervated by various cranial nerves

Question External auricule receives afferent supply via vagal, trigeminal and cervical nerves ( Peuker and Filler, 2002 ). Reduced impedance of the auricular sites innervated by vagal and trigeminal nerves is associated with pain and malfunction of internal organs ( Oleson et al., 1980 ; Saku et al., 1993 ). The aim was to develop the robust method for continuous measurement of skin impedance at the sites of auricle, supplied by various cranial nerves. Methods Multichannel device for continuous impedance measurement, based on Atmel ATmega16 microprocessor with 1 kHz of probing alternating current frequency was controlled using Matlab environment via USB port. The device measures voltage difference between the reference electrode (right forearm) and the sites of interest (innervation areas of cranial nerves) and transforms the voltage values into impedance using the calibration measurements of known resistances. Surface ECG and stainless steel needle electrodes were used at the sites of interest on the right auricles of healthy volunteers. Impedance monitoring was performed at rest and under the heat pain stimuli, delivered via CHEPS thermode (MEDOC analyser, Israel). Results Reproducible stable data with the voltage of 1 V, current values of 100 μ A and impedance around 10 k Ω were acquired (Fig. 1 Download : Download high-res image (306KB) Download : Download full-size image ), whereas invasive measurement yielded less variable data than non- invasive procedure. Heat pain stimulation led to differential reduction of the impedance in the sites of cranial nerve innervation (Fig. 2), whereas the decreased impedance recovered to the baseline values (Fig. 2 Download : Download high-res image (266KB) Download : Download full-size image ). Conclusions The multichannel continuous measurement of impedance at the external auricle was feasible. Further investigations are warranted to clarify the differential impedance response from the auricular sites in healthy subjects under stress challenge and patients.

Frequency of infra-orbital nerve injury after a Zygomaticomaxillary complex fracture and its functional recovery after open reduction and internal fixation

Background: Maxillofacial injuries are on the rise and the etiology of maxillofacial injuries varies from one country to another because of social, cultural and environmental factors. Road traffic accidents (RTAs) are still the most common cause of maxillofacial injuries. Nerve injury following fracture may involve traction, pressure, ischemia, inflammation and physical damage; therefore fractures of Zygomaticomaxillary complex (ZMC) are characterized by sensory neuropathy in the area of innervation of infra-orbital nerve both as presenting symptom and as a postop complication. The objectives of the study were to investigate the frequency of infra-orbital nerve paresthesia following ZMC fractures and determine the frequency of functional nerve recovery in patients with paresthesia treated with open reduction and internal fixation.Methods: Patients (n = 75) qualifying our inclusion criteria were selected, examined, reduced by surgery and followed up.Results: A total of 75 patients were included in the study with male: female ratio of 5:3. Mean age was 37.43±3.78 years, with majority of patients (72 %) presenting with RTAs. Infra-orbital nerve paraesthesia was found to be positive in 70.67% (n = 53) patients with 62.26% (n = 33) patients with functional nerve recovery after 3 months.Conclusions: Prognosis of infra-orbital nerve recovery after a Zygomaticomaxillary complex fracture can be enhanced by open reduction and internal fixation.

Can We Perform Distal Nerve Block Instead of Brachial Plexus Nerve Block Under Ultrasound Guidance for Hand Surgery?

Distal nerve blocks are used in the event of unsuccessful blocks as rescue techniques. The primary purpose of this study was to determine the sufficiency for anesthesia of distal nerve block without the need for deep sedation or general anesthesia. The secondary purpose was to compare block performance times, block onset times, and patient and surgeon satisfaction. Patients who underwent hand surgery associated with the innervation area of the radial and median nerves were included in the study. Thirty-four patients who were 18-65 years old and American Society of Anesthesiologists grade I-III and who were scheduled for elective hand surgery under conscious nerve block anesthesia were randomly included in an infraclavicular block group (Group I, n=17) or a radial plus median block group (Group RM, n=17). The block performance time, block onset time, satisfaction of the patient and surgeon, and number of fentanyl administrations were recorded. The numbers of patients who needed fentanyl administration and conversion to general anesthesia were the same in Group I and Group RM and there was no statistically significant difference (p>0.05). The demographics, surgery times, tourniquet times, block perfomance times, and patient and surgeon satisfaction of the groups were similar and there were no statistically significant differences (p>0.05). There was a statistically significant difference in block onset times between the groups (p<0.05). Conscious hand surgery can be performed under distal nerve block anesthesia safely and successfully.