1/3. Enigmatic trigeminal sensory neuropathy diagnosed by facial skin biopsy.Facial paraesthesia due to perineural malignant infiltration is a well recognised complication of basal and squamous cell carcinomas of the head and neck. Perineural involvement was originally attributed to involvement of the perineural lymphatics; however subsequent studies have demonstrated conclusively that these lymphatics do not exist and that the invasion occurs along the line of least resistance. Previous studies on perineural spread of carcinomas of the head and neck have emphasised diagnostic biopsy of an involved nerve (e.g. the infraorbital, mental or major branches of the trigeminal nerve), or at times craniectomy with exploration of the gasserian ganglion. We suggest that in many cases the diagnosis can be obtained by biopsy of the anaesthetic skin alone, without recourse to more involved biopsy techniques. The following case report illustrates this point.- - - - - - - - - - ranking = 1keywords = paraesthesia (Clic here for more details about this article) |
2/3. Temporary mental nerve paraesthesia secondary to orthodontic treatment--a case report and review.patients complaining of facial paraesthesia may present to the dental practitioner. The differential diagnosis includes malignant neoplastic disease and therefore warrants prompt hospital referral. Mental nerve paraesthesia during orthodontic treatment is a very rare occurrence. A case of mental paraesthesia during fixed upper and lower orthodontic treatment is presented. This report highlights the importance of thorough investigation of patients presenting with a history of facial numbness, and provides a review of the aetiology and management of this problem for the dental practitioner. Guidelines for referral have been suggested where orthodontic treatment is suspected as the cause.- - - - - - - - - - ranking = 7keywords = paraesthesia (Clic here for more details about this article) |
3/3. Unilateral trigeminal and facial nerve palsies associated with epidural analgesia in labour.PURPOSE: To report a rare complication related to epidural analgesia for obstetrics: the association of unilateral trigeminal and facial nerve palsies in a patient with the clinical syndrome of intracranial hypotension. CLINICAL FEATURES: A 38-yr-old woman was admitted in pre-term labour (at 35 wk gestation). She was receiving 40 mg methadone po daily for opioid addiction. Epidural analgesia for labour was established with 9 ml bupivacaine 0.25%. The patient underwent normal vaginal delivery of a 2500 g female infant. She developed post-dural puncture headache (PDPH) on the third postpartum day which was managed by palliative measures: bed rest (patient's position of choice), increased hydration (water: 3 litres po per day), lysine acetyl salicylate (5.4 g po per day) and caffeine (600 mg po per day). She developed paraesthesiae and numbness of the right side of the face one day after the onset of PDPH and unilateral facial nerve palsy two days later. There was no evidence of dural puncture and no cause was found. Treatment of the nerve palsies with epidural blood patch or epidural dextran 40 was not considered to be indicated. Headache disappeared on the 10th postpartum day and trigeminal palsy regressed. At the time of discharge, on the 17th postpartum day, neurological examination showed minimal facial assimetry. The patient refused further exploration and follow-up. CONCLUSION: Post delivery trigeminal and facial nerve palsy in a 38 yr old woman recovered spontaneously with conservative therapy.- - - - - - - - - - ranking = 1keywords = paraesthesia (Clic here for more details about this article) |