1/2. Neuropathic complications of mandibular implant surgery: review and case presentations.Injuries to trigeminal nerves during endosseous implant placement in the posterior mandible appear to occur acutely in approximately 5-15 of cases, with permanent neurosensory disorder resulting in approximately 8%. Nerve lateralization holds even higher risks from epineurial damage or ischaemic stretching. Neuropathy from implant compression and drill punctures can result in neuroma formation of all types, and in some cases precipitate centralized pain syndrome. Two patterns of clinical neuropathy are seen to result; hypoaesthesias with impaired sensory function, often seen with phantom pain, and hyperaesthesias with minimal sensory impairment but presence of much-evoked pain phenomena. The clinician must differentiate, through careful patient questioning and stimulus-response testing, those patients who are undergoing satisfactory spontaneous nerve recovery from those who are developing dysfunctional or dysaesthetic syndromes. Acute nerve injuries are treated with fixture and nerve decompression and combined with supportive anti-inflammatory, narcotic and anti-convulsant therapy. Surgical exploration, neuroma resection and microsurgical repair, with or without nerve grafting, are indicated when unsatisfactory spontaneous sensory return has been demonstrated, and in the presence of function impairment and intractable pain.- - - - - - - - - - ranking = 1keywords = hyperaesthesia (Clic here for more details about this article) |
2/2. Contralateral trigeminal dysaesthesias associated with second cervical nerve compression: a case report.This 70-year-old woman presented with a left C2 solitary metastatic lesion producing ipsilateral occipital pain associated with contralateral fronto-orbital dysaesthesias. Examination revealed analgesia in the left C2 dermatome and hyperaesthesia in the right forehead. These symptoms and findings resolved following a course of radiation therapy to the C2 metastasis. Ipsilateral trigeminal dysaesthesias produced by cervical lesions have been described, however, contralateral cervicogenic trigeminal dysaesthesias have not. Relevant experimental data are analysed; neural pathways are suggested by which a cervical lesion, especially at C2 or C3, may produce trigeminal dysaesthesias referred ipsilaterally or contralaterally.- - - - - - - - - - ranking = 1keywords = hyperaesthesia (Clic here for more details about this article) |