Cases reported "Taste Disorders"

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1/10. Secretory function of the salivary gland in patients with taste disorders or xerostomia: correlation with zinc deficiency.

    A notable proportion of patients with taste disorders complain of xerostomia and when zinc is prescribed the xerostomia is often improved in conjunction with the taste disorder. To study the relationship between taste disorders, zinc deficiency and xerostomia, we measured salivary gland function and zinc levels in 93 patients with hypogeusia and/or xerostomia and 60 patients with unilateral acute peripheral facial palsy who served as controls. We then prescribed zinc for patients with low serum zinc levels and evaluated xerostomia and taste sensation after 6 months of this treatment. The salivary gland secretory ratio (SGSR), determined by dynamic salivary 99mTc scintigraphy, was found to be an objective measure of salivary gland function and was reduced in patients with xerostomia. patients with salivary gland dysfunction also had abnormal morphology of the papillae of the tongue. No significant relation was found between the severity of taste disorders and SGSR values, but low SGSR values were found in patients with zinc deficiency. patients with taste disorders and/or xerostomia who were treated with zinc had relief of symptoms at 6 months, indicating that both taste disorders and xerostomia are among the symptoms of zinc deficiency.
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2/10. Taste disorder involving Hunter's glossitis following total gastrectomy.

    We treated five patients with Hunter's glossitis following total gastrectomy. The major complaints of the patients were taste disorder and abnormal glossal sensation. In all five cases, the patient's tongue was red and smooth, and laboratory testing showed the presence of macrocytic anemia and decreased serum concentration of vitamin B12 (cyanocobalamin). Gustometry was carried out in four cases and the results documented the presence of taste disorder. All five patients were treated by administration of vitamin B12, which led to improvements in the appearance of the tongue, the patients' subjective complaints and the results of taste testing. When patients present with a red, smooth tongue, Hunter's glossitis (which can easily be improved by administration of vitamin B12) should be considered in the differential diagnosis.
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3/10. Course of recovery from taste receptor disturbance.

    The course of recovery from taste receptor disturbance was studied in 119 patients with moderate-to-severe taste receptor disturbance that was cured or improved with zinc therapy. Taste receptor disturbance was idiopathic in 45 patients, drug-induced in 38 and due to zinc deficiency in 36. Recovery of taste, evaluated by filter paper disk testing and electrogustometry, followed 1 of 3 patterns: (i) in 54 (45.4%) of the 119 cases, taste improved simultaneously in the anterior (innervated by the chorda tympani nerve) and posterior (innervated by the glossopharyngeal nerve) portions of the tongue; (ii) in 53 (44.5%) of the cases, taste improved in the posterior portion first; and (iii) in 12 (10.1%) of the cases, taste improved in the anterior portion first. zinc therapy was more effective in patients with the "posterior" pattern of recovery, and these patients also recovered the ability to sense sweet and bitter tastes earlier than other tastes. These results indicate that recovery of taste begins on the posterior portion of the tongue, which has an abundance of taste buds. The results of electrogustometry were not helpful in assessing recovery from taste disturbance, but testing for taste using the filter paper disk method on the posterior portion of the tongue was useful for identifying the onset of recovery.
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4/10. Taste disturbance in two patients after dental anesthesia by inferior alveolar nerve block.

    We report two cases of temporary taste disturbance after inferior alveolar nerve block. The first patient to present with this rare complication of anesthesia for dental surgery was a 41-year-old woman. She lost the sense of taste on the left side of her tongue after local anesthesia for treatment of a left mandibular molar and first visited our outpatient clinic complaining of taste disorder 3 months later. Electrogustometry (EGM) and filter paper disk (FPD) testing revealed a taste disturbance in the innervation area of the left chorda tympani nerve and atrophy of the fungiform papillae on the left side of the tongue was observed. Eleven months after the dental treatment, the fungiform papillae and the results of EGM were normal. The second patient, a 22-year-old woman, received local anesthetic for extraction of a right mandibular molar and subsequently developed loss of taste on the right side of the tongue. When she visited our outpatient clinic 3 months later, atrophy of the fungiform papillae on the right side was observed. Her gustatory sense began to improve 4 months after the dental surgery and was normal at 13 months. From these findings we conclude that taste disturbance on the same side as the inferior alveolar nerve block in each case was due to direct injury to the chorda tympani and lingual nerves during administration of the local anesthetic. The results of EGM and FPD testing were diagnostic: atrophy of the fungiform papillae on the same side and disappearance of taste on the same side in the intravenous taste test provided complementary diagnostic information. The outcome was satisfactory in both cases.
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5/10. Buccal mucosal cancer patient who failed to recover taste acuity after partial oral cavity irradiation.

    PURPOSE: We report a patient who suffered from prolonged loss of taste acuity after partial oral cavity irradiation. methods: The electric taste threshold (ETT) of each point in the oral cavity was measured with an electric gustometer to evaluate quantitative local taste acuity. A subjective total taste acuity (STTA) scale was used to evaluate subjective total taste acuity. CASE: A 61-year-old male patient with right buccal mucosal cancer underwent radiation therapy more than 11 years ago, and has suffered from loss of taste acuity since then. He received electron beam irradiation to part of the oral cavity and right upper neck, mainly the right buccal mucosa near the retromolar trigone and a metastatic right submandibular node. He did not receive irradiation to the anterior portion of the tongue or left side of the posterior portion of the tongue. His ETT scores for each point were equal to or greater than 26, and his STTA score was grade 3. CONCLUSION: The present case implies that radiation damage to part of the oral cavity can cause the loss of subjective total taste acuity.
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6/10. herpes zoster oticus associated with facial, auditory and trigeminal involvement.

    We report a case of herpes zoster oticus with involvement of the mandibular division of the trigeminal nerve and loss of taste sensation in the anterior two third of the tongue. Infranuclear facial palsy and sensorineural deafness were also present.
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7/10. Hemiageusia, hemianaesthesia and hemiatrophy of the tongue.

    A patient with a submandibular gland carcinoma was found clinically to have a unilateral chorda tympani, lingual and hypoglossal nerve deficit. This unique neurological entity of loss of taste sensation of one-half of the tongue (hemiageusia), hemianaesthesia and hemiatrophy of the tongue, has not previously been reported.
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8/10. Ipsilateral disturbance of taste due to pontine haemorrhage.

    A patient with haemorrhage in the right tegmentum of the pons demonstrated ipsilateral disturbance of taste on both the anterior two-thirds and posterior one-third of the tongue. The contralateral medial lemniscus was not disturbed, contrary to the early descriptions that the secondary gustatory neurons from the nucleus of the solitary tract cross and turn upwards in the pons through the contralateral medial lemniscus. This finding would accord with the concept of the pontine taste area which receives ipsilaterally the secondary gustatory neurons from the anterior pole of the nucleus of the solitary tract.
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9/10. Localization of the gustatory pathway in the human midbrain.

    The localization of the secondary gustatory pathway in the human brainstem still remains uncertain. Here we report two patients with small vascular lesions in the unilateral midbrain tegmentum who presented with taste disturbance on the ipsilateral side of the tongue. In both cases, the dorsomedial mesencephalic tegmental region lateral to the oculomotor nucleus, including the central tegmental tract and the ventral part of the periaqueductal gray, was involved commonly in the lesions. The secondary gustatory pathway arising from the nucleus of the solitary tract appears to run rostrally, without crossing, to the ipsilateral thalamic nucleus through the dorsomedial part of the tegmental region at the rostral level of the midbrain.
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10/10. Post-yersinotic Reiter's disease in a physician treated with osmium tetroxide.

    A case of general yersinosis in a male physician is described. Most probably the infection was acquired nosocomially in a paediatric ward. The infection affected several organs including the liver, but osmium tetroxide was nevertheless used to perform chemical synovectomy in a knee joint suffering from active arthritis. The arthritis was cured, and the already existing liver affection did not progress. The only complaint from the patient, months after the osmic acid injection, was a strong metallic taste on the tongue. More than a year after the intra-articular injection, the metallic taste disappeared. The amount of osmium in the patient's blood was then calculated to be less than 100 molecules of osmium per ml blood.
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