Inferior Alveolar Nerve Paresthesia Research Articles

Treatment of mandibular malignant fibrous histiocytoma during pregnancy

A 30-year-old pregnant woman was referred to the University Hospital at 19 weeks gestation with a chief complaint of a rapidly progressing mass in the right cheek. Clinical examination showed a 2.4 2.4-cm rubbery hard, nontender, slightly mobile mass in the right mental region. The overlying mucosa appeared normal in color. There was no paresthesia of the right inferior alveolar nerve. The pregnancy, which was the patient’s first, had been uneventful up until the onset of the right cheek mass. Neither the history nor family history was significant. A panoramic radiograph showed no evidence of mandibular bone involvement. An incisal biopsy showed an unencapsulated proliferation of polygonal and multinucleated, pleomorphic, histiocytic-like and spindle-shaped fibroblast-like cells with small amounts of intervening collagenous stroma (Fig 1A). The neoplastic elements were arranged in a storiform, or cartwheel-like pattern (Fig 1B). The cells showed large atypical nuclei with multiple nucleoli; there were numerous mitotic figures. Immunohistochemical staining of formalin-fixed sections showed positive reactivity for vimentin, but the tumor cells were negative for cytokeratin, neuron-specific enolase, S100, and epithelial membrane antigen. The compositive histologic features were consistent with a diagnosis of pleomorphic MFH.1 Preoperative computed tomography (CT) showed a slightly raised mass of soft tissue with isodensity overlying the mental foramen (Fig 2). Abdominal magnetic resonance imaging (MRI) and thoracic CT scanning showed no evidence of metastatic disease. With the informed consent of both parents and her husband, surgical treatment was performed under general anesthesia at 23 weeks gestation. Wide resection of the primary tumor and an upper neck dissection were performed. The resulting jaw deformity was reconstructed with titanium plates (Fig 3). On sectioning, the surgical specimen had a dark yellow color. There was evidence of compressive bone resorption near the mental foramen (Fig 4). The tumor appeared to invade the surrounding subcutaneous adipose tissue. Five weeks after tumor surgery, at 28 weeks gestation, Cesarean delivery was performed. Both the mother and child recovered well. Scintigraphs after delivery showed no evidence of distant metastasis. Four weeks postpartum, she received 5 courses of multiagent MAID chemotherapy, which included mesna, doxorubicin, ifosfamide, and dacarbazine (Table 1). At 1-year follow-up, there was no evidence of local recurrence or of metastases.

Infection-related mental and inferior alveolar nerve paresthesia: Literature review and presentation of two cases

A review of the literature on infection-related mental and inferior alveolar nerve paresthesia is given. This is followed by 2 case reports. The first case is of a mandibular left second molar in which a chloropercha overfill puff occurred in the vicinity of the inferior alveolar canal. The tooth remained asymptomatic until 2 and 1/2 yr later, when the periapical lesion enlarged and swelling, pain, and paresthesia developed. The paresthesia resolved 2 weeks following periapical surgery. The second case is of a mandibular right first premolar in which paresthesia began 1 day after the initial endodontic treatment. The intracanal medication was formocresol on a cotton pellet that was squeezed dry. The paresthesia was treated by irrigation, antibiotics, and dexamethasone. The paresthesia lasted 7 weeks, and when it resolved the root canal was filled with gutta-percha/eucapercha. Almost 9 months later, the tooth remained asymptomatic.

Implant survival rates in partially edentulous patients: A 3-year prospective multicenter study

Purpose: This multicenter investigation is an interim 3-year survival report of a 5-year prospective study using Brånemark osseointegrated implants in partially edentulous patients. Materials and Methods: Previously defined patient characteristics and clinical parameters were related to implant survival using lifetable analysis. Results: Three years after prosthesis insertion, 460 implants placed in 139 patients remained in the study. Cumulative success rates for maxillary implants (92.5%) were less than for mandibular implants (94.8%), with an overall cumulative success rate of 93.9%. Conclusion: Failures were associated with poor bone quality, smaller implant sizes, and a higher plaque index, and were more likely to occur before loading. A 4% incidence of residual long-term inferior alveolar nerve paresthesia was higher than previously reported.

Mandibular paresthesia secondary to cerebrovascular changes

An unusual case of mandibular paresthesia as the only presenting symptom of a cerebrovascular accident is presented. The differential diagnosis of inferior alveolar nerve paresthesia is discussed. Obtaining a definitive diagnosis depends on a thorough medical and dental history complemented by a complete clinical and radiographic examination. The etiology of cerebral vascular accidents is reviewed, as well as risk factors that may increase the possibility of a cerebrovascular accident.