1/37. Hyperactive rhizopathy of the vagus nerve and microvascular decompression. Case report. A 37-year-old woman underwent microvascular decompression of the superior vestibular nerve for disabling positional vertigo. Immediately following the operation, she noted severe and spontaneous gagging and dysphagia. Multiple magnetic resonance images were obtained but failed to demonstrate a brainstem lesion and attempts at medical management failed. Two years later she underwent exploration of the posterior fossa. At the second operation, the vertebral artery as well as the posterior inferior cerebellar artery were noted to be compressing the vagus nerve. The vessels were mobilized and held away from the nerve with Teflon felt. The patient's symptoms resolved immediately after the second operation and she has remained symptom free. The authors hypothesize that at least one artery was shifted at the time of her first operation, or immediately thereafter, which resulted in vascular compression of the vagus nerve. To the authors' knowledge, this is the first reported case of a hyperactive gagging response treated with microvascular decompression. The case also illustrates the occurrence of a possibly iatrogenic neurovascular compression syndrome. ( info) |
2/37. Elimination of hypersensitive gagging reaction to dentistry by propofol at subhypnotic doses. We describe a 44-year-old male patient with severe gagging reaction successfully treated without sedative effect by a continuous infusion of propofol. propofol at subhypnotic doses seemed to be effective in eliminating hypersensitive gagging reaction to dentistry. ( info) |
3/37. Desensitization of the gag reflex in an adult with cerebral palsy: a case report. Severe oral hypersensitivity and aversive oral behaviors present a significant barrier to dental treatment and compromise oral health status. Although several authors have addressed the reduction of oral hypersensitivity and aversive behaviors (such as gagging, retching, and vomiting) in the otherwise well dental patient, treatment for patients with severe disability has not been explored. The successful management of oral hypersensitivity and aversive behavior can have significant health benefits. These can be described via an outcomes paradigm as physical and social benefits for the patient, psychological benefits for the patient, carer, and practitioner, and organizational benefits for the institutions providing dental care and medical management. This paper summarizes the management of a severely disabled patient whose aversive behaviors were eliminated with non-invasive therapy techniques. oral hygiene was facilitated and health benefits were identified across a number of domains following successful multi-disciplinary management. ( info) |
4/37. The management of blood phobia and a hypersensitive gag reflex by hypnotherapy: a case report. Coping with a hypersensitive gag reflex can be a cause for concern for both the patient and the operator. This report describes a case of blood phobia directed solely towards the oral cavity, linked with the inability to tolerate dentures due to a hypersensitive gag reflex. Management by hypnotherapy using a systematic desensitization technique allowed for extraction of teeth and permanent elimination of the gagging problem. ( info) |
5/37. Treatment of a dental phobic with pronounced aversion to rubber gloves. This case illustrates where excessive dental stress on the swallowing reflex caused retching then nausea and eventually dental phobia. Swallowing relaxation enabled normal variable function to be quickly restored, which allowed the phobia to be brought under control. ( info) |
6/37. Oral dysfunction following Nissen fundoplication. In this case report we describe a child with mild neurologic impairment who developed debilitating gagging and retching, and severe oral-motor dysfunction following Nissen fundoplication and gastrostomy tube placement. All oral intake ceased after the operation. Evaluation for postoperative dumping syndrome was negative, and the child's symptoms failed to improve despite numerous medical and surgical measures. However, immediately following reversal of the Nissen fundoplication, the child's gagging and retching ceased, and his oral-motor function began to improve. This is a previously undescribed complication of Nissen fundoplication, a surgical procedure commonly employed in children with neurologic impairment. ( info) |
7/37. Treatment planning in a case of restoration of the maxilla and mandible using osseointegrated implants with four types of bone graft. A case is reported of a 66-year-old woman who could not use a conventional, full upper denture because of a gag reflex. In the maxillary alveolar ridge, restoration was performed on a moderately atrophied, edentulous anterior area and a small defect in the right-side posterior area. In the mandibular alveolar ridge, restoration was performed on a moderate osseous defect in each molar area resulting from tooth extraction due to severe periodontal disease. Based on careful treatment planning, four types of bone graft were used with previously designed osseointegrated implants. The atrophied maxillary alveolar ridge was restored with veneer iliac bone grafts to avoid fenestration during implant placement, while alveolar process deficiency was restored using inlay and sinus bone grafts as placements for long implant fixtures. The defects in the mandibular alveolar bone were filled with corticocancellous bone chips at the implant placement sites. A combination of immediate and secondary placement of Branemark fixtures was used. Bone-anchored bridge-type implant prostheses were fitted approximately twelve months after surgery. Three years later, there had been no failure of implant fixtures and satisfactory functional and cosmetic restoration had been maintained. ( info) |
8/37. Behavioral analysis and treatment of reflexive vomiting associated with visceral sensations: a case study of interoceptive conditioning? behavior analytic methods are applied to the conceptualization and treatment of a complex case of interoceptive classical conditioning. The subject exhibited a gagging and vomiting response to bladder and/or similar visceral sensations. A two-factor learning model of the problem led to a successful exposure and response prevention intervention, which was based on single-case experimental methodology. We discuss the possible relevance of this case in the context of the growing attention to interoceptive conditioning in behavioral problems, and comment upon the importance of behavior analytic principles and procedures to the behavioral clinician. ( info) |
9/37. "Hypnopuncture"--a dental-emergency treatment concept for patients with a distinctive gag reflex. The present case report describes a newly developed dental treatment concept for patients with a distinctive gag reflex. "Hypnopuncture" is a combination therapy of hypnosis and acupuncture. Its simple, fast, and effective application autonomous of the cause makes it a valuable tool for dental-emergency treatment procedures. Physiologic and psychological aspects of gagging are influenced at the same time. The protocol is illustrated in the case of a 76-year-old patient with a severe gag reflex who was successfully treated by this combination approach. Necessary and effective therapeutic measures from both acupuncture and hypnosis are portrayed. ( info) |
10/37. A long-term therapeutic treatment for patients with a severe gag reflex. "Hypnopuncture," a combination treatment of hypnosis and acupuncture, provides a therapeutic treatment plan for long-term therapy for patients with a distinctive gag reflex. The treatment is applied independently of the cause. In cases of emergency treatment in dentistry, the immediate compliance of a patient is of utmost importance. The long-term goal of any therapeutic measure is control of the gag reflex. A new treatment protocol is illustrated in the case of a 50-year-old patient with a severe gag reflex. After only 5 visits, dental treatment could be conducted without any auxiliary means. hypnosis is applied in the form of hypnosedation (not as psychotherapy), while stereognosis occupies a central position for desensitization. ( info) |