Nerve Sensory Changes Research Articles

The Use of magnetic-laser Therapy in the Rehabilitation period for patients with Infraorbital nerve Damage

Aim: The aim of the study was to assess the effectiveness of magnetic-laser therapy in complex treatment of patients with zygomatic fractures accompanied by the infraorbital nerve damage. materials and methods: The study included 32 patients with single fractures of the zygomatic bone accompanied by infraorbital nerve injury. Patients were divided into two groups: the main group (n=17) and the control one (n=15). In both groups the complex treatment was used, which included: the fragment reposition operation, broad-spectrum antibiotic, nonsteroidal anti-inflammatory drug, anti-edematous therapy, vitamin B complex. In the main group of patients in the postoperative period the magnetic-laser therapy was applied. Assessment of qualitative and quantitative indices of pain was carried out on the 1st, 7th and 14th days of treatment. Results: In the main group of patients the magnetic-laser therapy significantly reduced the intensity of nociceptive pain, led to moderate regression of all types of neuropathies associated with infraorbital nerve damage. When comparing 2 groups the best pain relief had patients of the main group. At the end of treatment a significant positive dynamics of improving the electrical sensory of infraorbital nerve has been noted, as indicated by recovery of sensory threshold, pain threshold and pain tolerance almost to the level of intact contralateral side. Conclusions: The use of magnetic-laser therapy in the combined treatment of infraorbital nerve damage allows to improve the recovery of infraorbital nerve sensory changes following zygomatic fractures, reduce the pain, increase the effectiveness of treatment and provide rapid postoperative rehabilitation of patients.

A modified mandibular ramus osteotomy for orthognathic surgery

Several procedures have been described for correction of orthognathic deformities of the mandible. Currently, the bilateral sagittal split osteotomy (BSSO) maintains its popularity because of its versatility and its amenability to rigid fixation techniques. The distal segment of the mandible can be repositioned in all planes of space, and the bony interface along the osteotomy results in predictable healing. However, there are well-known disadvantages to the procedure, which include neurosensory disturbance, 1 Pratt CA Labial sensory function following sagittal split osteotomy. Br J Oral Maxillofac Surg. 1996; 34: 75 Abstract Full Text PDF PubMed Scopus (43) Google Scholar , 2 Posnick J Alteration in facial sensibility in adolescents following sagittal split and chin osteotomies of the mandible. Plast Reconstr Surg. 1996; 97: 920 Crossref PubMed Scopus (67) Google Scholar , 3 Lemke RR Effects of hypesthesia on oral behaviors of the orthognathic surgery patient. J Oral Maxillofac Surg. 1998; 56: 153 Abstract Full Text PDF PubMed Scopus (26) Google Scholar , 4 Jacks SC A retrospective analysis of lingual nerve sensory changes after mandibular bilateral sagittal split osteotomy. J Oral Maxillofac Surg. 1998; 56: 700 Abstract Full Text PDF PubMed Scopus (50) Google Scholar , 5 Fujioka M Comparative study of inferior alveolar disturbance restoration after sagittal split osteotomy by means of bicortical versus monocortical osteosynthesis. Plast Reconstr Surg. 1998; 102: 37 Crossref PubMed Scopus (45) Google Scholar , 6 Blomqvist JE Sensibility following sagittal split osteotomy in the mandible: A prospective clinical study. Plast Reconstr Surg. 1998; 102: 325 Crossref PubMed Scopus (52) Google Scholar , 7 August M Neurosensory deficit and functional impairment after sagittal ramus osteotomy: A long-term follow-up study. J Oral Maxillofac Surg. 1998; 56: 1231 Abstract Full Text PDF PubMed Google Scholar , 8 Westermark A Inferior nerve function after mandibular osteotomies. Br J Oral Maxillofac Surg. 1998; 36: 425 Abstract Full Text PDF PubMed Scopus (174) Google Scholar , 9 Westermark A Inferior alveolar nerve function after sagittal split osteotomy of the mandible: Correlation with degree of intraoperative nerve encounter and other variables in 496 operations. Br J Oral Maxillofac Surg. 1998; 36: 429 Abstract Full Text PDF PubMed Scopus (139) Google Scholar condylar displacement, 10 Magalh-aes AE Changes in condylar position following bilateral sagittal split ramus osteotomy with setback. Int J Adult Ortho Orthognath Surg. 1995; 10: 137 PubMed Google Scholar , 11 Van Sickels JE Condylar torque as a possible cause of hypomobility after sagittal split osteotomy: Report of three cases. J Oral Maxillofac Surg. 1997; 55: 398 Abstract Full Text PDF PubMed Scopus (20) Google Scholar , 12 Nishimura A Positional changes in the mandibular condyle and amount of mouth opening after sagittal split ramus osteotomy with rigid or nonrigid osteosynthesis. J Oral Maxillofac Surg. 1997; 55: 672 Abstract Full Text PDF PubMed Scopus (33) Google Scholar , 13 Van Sickels JE Condylar position with rigid fixation versus wire osteosynthesis of a sagittal split advancement. J Oral Maxillofac Surg. 1999; 57: 31 Abstract Full Text PDF PubMed Scopus (32) Google Scholar and unfavorable splits. 14 Martis CS Complications of the mandibular sagittal split osteotomy. J Oral Maxillofac Surg. 1984; 42: 101 Abstract Full Text PDF PubMed Scopus (146) Google Scholar , 15 Van Sickels JE Jeter JE Theriot BA Management of an unfavorable lingual fracture during a sagittal split osteotomy. J Oral Maxillofac Surg. 1985; 43: 808 Abstract Full Text PDF PubMed Scopus (26) Google Scholar , 16 Turvey TA Intraoperative complications of sagittal osteotomy of the mandibular ramus: Incidence and management. J Oral Maxillofac Surg. 1985; 43: 504 Abstract Full Text PDF PubMed Scopus (104) Google Scholar , 17 Marquez IM Modification of the sagittal split osteotomy to avoid unfavorable fracture around impacted third molars. Int J Adult Ortho Orthognath Surg. 1998; 13: 183 PubMed Google Scholar

A retrospective analysis of lingual nerve sensory changes after mandibular bilateral sagittal split osteotomy

This contribution adds to our growing understanding of the side effects of the bilateral sagittal split osteotomy @SSO). Although a hypothesis is not specifically stated, the study goal is to increase understanding of lingual nerve (L.m injury after BSSO, because the incidence and duration of this complication are not well documented, and risk factors have not been identified. The authors acknowledge the retrospective, subjective nature of the study and offer it as such at this level in the evidenced-based heirarchy.’ The low patient response percentage is typical of such projects, but nevertheless provides some valuable information. As stated, the reported initial incidence of 19.4% lingual nerve (LN) injury is probably higher than the actual occurrence in the total patient population because patients with complaints may be more prone to answer. Six percent of the patients had LN changes lasting more than 1 year. One would hope that an incidence of 1 in 5 initially and 1 in 17 long-term for LN injury grossly overestimates the actual incidence. Given these limitations, there are several significant findings from this study; 1) the ratio of LN (19.4%) to inferior alveolar nerve (IAN) (95.5%) injuries, 2) the different rates of improvement over one year postoperatively (LN, 69.3%; resolved vs. 27.3% for IAN), 3) the greater alteration in daily activity caused by L.N injuries, 4) the lack of a relationship between LN or IAN changes and such risk factors as age, gender, surgeon, surgical movement, removal of third molars, or intraoperative complications, and 5) the relationship of the three types of fixation to LN injury. Of particular interest is the last finding, that a combination of rigid fixation (RF) with screws plus circumandibular wires resulted in twice the LN sensory change as did RF or skeletal wire fixation alone. Unfortunately, it is not clear whether circumandibular wires were used with the skeletal wire fixation group, but I assume that they were from the discussion. The discussion references literature indicating that subjective IAN neurosensory complaints are greater initially than objective test findings, but that these same patient observations are less than the objective test findings in the longterm.*s3 Therefore, in the current study, one would expect objective testing to find more than 19.4% LN deficits. However, because of the different nature of tongue function versus lip function, the differences between the findings on objective and subjective testing at early and late periods may not apply to LN injuries as it does to the IAN. Although it is probable that there is a greater tendency for those with sensory changes to respond to a questionnaire than those without complaints, the speculation about what the probable outcome would be if all 316 questionnaires were returned seems unnecessary. Also, the subjective LN sensory changes seen in the genioplasty group (GP) were of such short duration they may simply represent the patient’s sensory confusion after surgical trauma. The GP sensory changes seem to disappear about the same time that swelling and outward visual evidence of surgery normally resolve. No doubt, a short questionnaire brings a better response than a lengthy one, but the answers to several additional questions would have been interesting. Would the patients have surgery again? If not, is the paresthesia the reason? The number of patients with long-term (permanent?) altered daily activity is not clear. Because we are frequently asked by patients whether numbness will ever end, and if so, when, it would be valuable to know whether the paresthesia that lasted for more than a year ultimately resolved. What was the sensory level after 18 months, 2 years or more, especially in light of data from 5 and 16 years*? Most importantly, was the paresthesiapainful? Hypesthesia is annoying, but dysesthesia is quite another story. Perhaps if this information is available, the authors can update us on these data.