Post-traumatic trigeminal neuropathy. A study of 63 cases

Introduction. Trigeminal neuropathy is most often secondary to trauma. The present study explores the underlying causes and the factors that influence recovery. Material and methods. A retrospective case study was made involving 63 patients with trigeminal neuropathy of traumatologic origin, subjected to follow-up for at least 12 months. Results. Fifty-four percent of all cases were diagnosed after mandibular third molar surgery. In 37 and 19 patients the sensory defect was located in the territory innervated by the mental and lingual nerve, respectively. Pain was reported in 57% of the cases, and particularly among the older patients. Regarding patient disability, quality of life was not affected in three cases, while mild alterations were recorded in 25 subjects and severe alterations in 8. Partial or complete recovery was observed in 25 cases after 6 months, and in 32 after one year. There were few recoveries after this period of time. Recovery proved faster in the youngest patients, who moreover were the individuals with the least pain. Conclusion. Our patients with trigeminal neuropathy recovered particularly in the first 6 months and up to one year after injury. The older patients more often suffered pain associated to the sensory defect. On the other hand, their discomfort was more intense, and the patients with most pain and the poorest clinical scores also showed a comparatively poorer course. © Medicina Oral

Neuropatías trigeminales tumorales: presentación de 7 casos

Las neuropatías del trigémino de origen tumoral suponen un bajo porcentaje de las neuropatías trigeminales, pero pueden tener muy mal pronóstico. Es importante descartar una neoplasia en los pacientes con adormecimiento en el territorio del trigémino. Presentamos 7 casos de neuropatías trigeminales secundarias a tumores; en 4 existían antecedentes de neoplasias sistémicas previas y en 3 la neuropatía fue el primer signo de la enfermedad tumoral. En tres ocasiones la lesión se localizó en mandíbula, una en base de cráneo, una en troncoencéfalo, una a nivel cerebral y en una no se encontró el nivel lesional. La evolución fue muy mala en 5 pacientes; sólo se recuperó un caso en el que tras la resección de un neurinoma del acústico desaparecieron los síntomas. Las lesiones que producen neuropatías trigeminales tumorales pueden localizarse a lo largo de todo el trayecto trigeminal y las neoplásicas tienen un pronóstico ominoso.Trigeminal neuropathy of neoplastic origin accounts for a small percentage of trigeminal neuropathies, though the prognosis may be very poor. It is important to discard neoplastic processes in patients with numbness of the trigeminal territory. We present 7 cases of trigeminal neuropathy secondary to tumors: in four cases there were antecedents of systemic neoplastic disease, while in the remaining three cases neuropathy was the first manifestation of the tumor. The lesion was located in the mandible in three cases, in the region of the skull base in one patient, and in the brainstem and brain in one case each. In one case the lesion level could not be identified. The course was very poor in 5 cases. Recovery was only recorded in one patient in whom the symptoms were seen to disappear after acoustic nerve neurinoma resection. The lesions underlying neoplastic trigeminal neuropathy can be located at any point along the trajectory of the trigeminal nerve, and their prognosis is very poor

Neoplastic trigeminal neuropathy : presentation of 7 cases

Trigeminal neuropathy of neoplastic origin accounts for a small percentage of trigeminal neuropathies, though the prognosis may be very poor. It is important to discard neoplastic processes in patients with numbness of the trigeminal territory. We present 7 cases of trigeminal neuropathy secondary to tumors: in four cases there were antecedents of systemic neoplastic disease, while in the remaining three cases neuropathy was the first manifestation of the tumor. The lesion was located in the mandible in three cases, in the region of the skull base in one patient, and in the brainstem and brain in one case each. In one case the lesion level could not be identified. The course was very poor in 5 cases. Recovery was only recorded in one patient in whom the symptoms were seen to disappear after acoustic nerve neurinoma resection. The lesions underlying neoplastic trigeminal neuropathy can be located at any point along the trajectory of the trigeminal nerve, and their prognosis is very poor

Neoplastic trigeminal neuropathy : presentation of 7 cases

Trigeminal neuropathy of neoplastic origin accounts for a small percentage of trigeminal neuropathies, though the prognosis may be very poor. It is important to discard neoplastic processes in patients with numbness of the trigeminal territory. We present 7 cases of trigeminal neuropathy secondary to tumors: in four cases there were antecedents of systemic neoplastic disease, while in the remaining three cases neuropathy was the first manifestation of the tumor. The lesion was located in the mandible in three cases, in the region of the skull base in one patient, and in the brainstem and brain in one case each. In one case the lesion level could not be identified. The course was very poor in 5 cases. Recovery was only recorded in one patient in whom the symptoms were seen to disappear after acoustic nerve neurinoma resection. The lesions underlying neoplastic trigeminal neuropathy can be located at any point along the trajectory of the trigeminal nerve, and their prognosis is very poor

Usos actuales de las plataformas transanales en la cirugía del cáncer de recto. revisión bibliográfica

El cáncer de recto se ha tratado clásicamente de manera muy radical, realizándose resecciones muy amplias, que dejaban defectos esfinterianos, genitourinarios y ostomías con mala calidad de vida. Antes de elegir el tipo de tratamiento que se va a realizar, hay que hacer una correcta evaluación preoperatoria con ultrasonidos y resonancia magnética (RM). Con ambas técnicas se ha conseguido un buen estadiaje para el tamaño (T), pero la valoración de los ganglios (N) sigue siendo poco precisa. Se han desarrollado técnicas endoscópicas para la escisión de lesiones benignas, pero no permiten hacer una valoración adecuada de los márgenes de resección, por lo que su empleo se ha limitado a poca patología. Con el fin de realizar tratamientos conservadores pero oncológicamente seguros, se han creado plataformas transanales como son microcirugía endoscópica transanal (TEM), cirugía transanal mínimamente invasiva (TAMIS) y cirugía de un solo puerto (SILS), que se colocan en el canal anal y permiten introducir herramientas como las de cirugía laparoscópica y realizar la escisión de la lesión con amplios márgenes de resección. Ambas técnicas se están utilizando para el tratamiento de adenomas y carcinomas T1 con éxito y también para T2 y T3 después de tratamiento neoadyuvante. El uso de estas técnicas se está intentado extender para poder realizar escisiones más amplias como la escisión mesorrectal total por vía transanal. De momento se ha conseguido con éxito realizar la escisión mesorrectal total transanal con asistencia laparoscópica y se está investigando con modelos animales y cadáveres realizar una auténtica cirugía endoscópica transluminal por orificio natural (NOTES) sin la necesidad de utilizar asistencia laparoscópica. Cáncer de recto; Microcirugía endoscópica transanal; Cirugía endoscópica transanal mínimamente invasiva; Escisión mesorrectal total transana

Clinical course of patients with episodic cluster headache treated with corticosteroids inproximity to the sphenopalatine ganglion : a preliminary study of 23 patients

Objective: A study is made of the clinical course of patients with episodic cluster headache following the injection of corticosteroids in the proximity of the sphenopalatine ganglion of the affected side. Study Design: A retrospective observation study was made corresponding to the period between 2006 and 2010. Patients with episodic cluster headache received corticosteroid infiltrations in the vicinity of the sphenopalatine ganglion. Data were collected to assess the clinical course, quantifying pain intensity and quality of life. A total of 23 patients (11 women and 12 men) with a mean age of 50.4 years (range 25-65) were included. Forty percent of the patients had undergone dental extractions in the quadrant affected by the pain, before the development of episodic cluster headache, and 37.8% underwent extractions in the same quadrant after appearance of the headache. Results: Most of the patients suffered 1-3 attacks a day, with a duration of pain of between 31-90 minutes. The mean pain intensity score during the attacks at the time of the first visit was 8.8 (range 6-10), versus 5.4 (range 3-9) one week after the first corticosteroid injection. On the first visit, 86.9% of the patients reported unbearable pain, versus 21.7% after one week, and a single patient after one month. Conclusions: The evolution of episodic cluster headache is unpredictable and variable, though corticosteroid administration clearly reduces the attacks and their duration

Comorbidity between attention deficit hyperactivity disorder and reading disabilities: implications for assessment and treatment

Comorbidity of attention deficit hyperactivity disorder (ADHD) and reading disabilities (RD) is greater than what would occur by chance. Considering the well-documented adverse impact of both ADHD and RD on development, the presence of both conditions may lead to particularly poor outcomes for affected people. This chapter, which reviews 43 research studies carried out in the last decade that have focused on the link between ADHD and RD, is divided into two broad nuclei of contents. First, studies are described that contribute information about characteristics of the comorbid phenotype. Second, studies related to procedures directed toward evaluation and intervention in this problem are analyzed. The review carried out does not make it possible to extract definitive results on the exact nature of ADHD and RD comorbidity or, even less, reach conclusions about its causes. However, the literature-based evidence shows a cognitive profile of ADHD+RD characterized by failure of various functions that can produce more severe functional deficits and worse neuropsychological, academic, and behavioral outcomes. Furthermore, the analysis of the set of results from the studies shows a limited efficacy of pharmacological and psychopedagogical treatments, and highlights the need for continued research on this topic. From a clinical and educational standpoint, the conclusions derived from this review underline the importance of performing an exhaustive evaluation of children and adolescents with symptoms of ADHD and/or RD, in order to be able to plan interventions with greater possibilities of success in each cas

Bisphosphonates and dental implants: current problems

Osteonecrosis of the jaw has been described in patients taking bisphosphonates after oral surgery procedures, including the placement of dental implants. This review is an update of the relationship between bisphosphonates and dental implants.Results obtained by different authors are compared, contrasting earlier studies where an improvement in implant osseointegration using bisphosphonates was observed, with ones where statistically significant differences were found, and more recent studies disagreeing with the use of bisphosphonates for causing necrosis of the jaw. The differing results obtained between animal studies and the situation observed in humans may be due to a short medication and follow-up period, as well as to the existence of few research studies where dental implants are placed in the oral cavity.Currently, dental implants are contraindicated in patients being treated with intravenous bisphosphonates. In 2007, the American Association of Oral and Maxillofacial Surgeons suggested guidelines for patients treated with oral bisphosphonates, based on the clinical situation of the patient and the length of treatment with the drug, and that greater caution prior and subsequent to surgery should be taken for three years after treatment. All patients treated with bisphosphonates must have the risk of possible loss of implants and the risk of suffering a bony necrosis of the operated jaw explained to them, and give their informed consent prior to dental implant surgery

Dental implants in patients with oral mucosal alterations : an update

Objective: To determine whether a series of diseases of the oral mucosa - Sjögren syndrome, ectodermal dysplasia, epidermolysis bullosa and lichen planus - reduce the survival rate of dental implants. Material and Method: A Medline search was carried out using the key words: "Sjögren syndrome", "ectodermal dysplasia", "epidermolysis bullosa", "lichen planus" and "dental implants", including those publications involving clinical series comprising more than one patient with the mentioned disorders and treated with dental implants, in the last 10 years. Results: The study included three articles involving patients with Sjögren syndrome subjected to dental implant treatment, representing a total of 12 patients and 86 implants, with a mean pondered success rate of 86.33%. As regards ectodermal dysplasia, we included 14 articles, of which 11 corresponded to clinical series, two were reviews and one constituted a survey of dental professionals. The percentage success rate of the implants varied between 35.7-100%. In relation to epidermolysis bullosa, we included 6 articles corresponding to clinical series, with a total of 16 patients and 92 implants, and a success rate between 75-100%. In the case of oral lichen planus we found only two articles corresponding to clinical case series, with a total of 5 patients and 14 implants, and an implant survival rate of 100%. Conclusions: Based on our review of the literature, dental implant rehabilitation in patients of this kind is seen to be a valid treatment option, with a high percentage success rate. Long-term patient follow-up is essential in order to periodically monitor the condition of the disease and of the implants. © Medicina Oral S. L

Bone necrosis around dental implants: a patient treated with oral bisphosphonates, drug holiday and no risk according to serum CTX

Osteonecrosis of the jaw (ONJ) may appear following certain oral surgery procedures in patients treated with oral bisphosphonates (OB). Guidelines for the treatment of these patients were set out in the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on Bisphosphonate-Related Osteonecrosis of The Jaws (Position Paper) and Approved by the Board of Trustees in September 2006. For the AAOMS the placement of implants in these patients is not contraindicated. In addition, the serum C-terminal telopeptide bone suppressor marker (CTX) test is available to determine the risk of ONJ. A case is presented of ONJ in a patient with 6 months of OB discontinuation ('drug holiday') before dental implant placement (following the guidelines of the AAOMS) and with no risk of osteonecrosis according to the serum CTX value (340 pg/ml). The wound healed favorably with complete healing at 7 months. In this case, the serum CTX test must be questioned as to its predictive value of ONJ, and more reliable markers of this risk are needed