1/4. 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 = pain syndrome (Clic here for more details about this article) |
2/4. Can vitamin d deficiency produce an unusual pain syndrome?An unusual pain occurred in five patients in the presence of compromised vitamin D status and resolved 5 to 7 days after supplementation with vitamin D in the form of ergocalciferol. The pain had a hyperesthetic quality and did not respond to the use of analgesics, including opiate derivatives. Treatment with therapeutic levels of a tricyclic antidepressant did not bring relief of symptoms. In one case, months after treatment and subsequent improvement of vitamin D status and pain, the vitamin D status again declined and the pain recurred. The pain again resolved with vitamin D replacement and improvement of levels. There may be a pain syndrome associated with vitamin D depletion that appears as hyperesthesia worsened by light, superficial pressure or even small increments of movement. This pain restricts mobility and function and may lead to further complications, such as pressure sores.- - - - - - - - - - ranking = 5keywords = pain syndrome (Clic here for more details about this article) |
3/4. Neurologic injuries with the Galveston technique of L-rod instrumentation for scoliosis.A group of surgeons who used the Galveston technique for L-rod instrumentation (LRI) were surveyed to learn their experience with associated neurologic injuries. Among 507 LRIs for scoliosis there were two partial cord syndromes (0.4%), 13 "nerve root hyperesthesias" (2.6%), and two other nerve injuries (0.4%). All patients, except one with mild residuals after a partial cord injury, fully recovered from their neurologic problem. Experience in spinal surgery, education about LRI strategies and techniques, hands-on technical instruction, and use of an established process for LRI are believed to be the factors that enabled these surgeons to perform this complex procedure with relative safety.- - - - - - - - - - ranking = 4.5500390623802E-5keywords = complex (Clic here for more details about this article) |
4/4. Sympathetically mediated pain after reduction mammoplasty: an unusual complication.We present a case report of a patient who developed an unusual bilateral breast pain syndrome after a reduction mammoplasty. Her symptoms and physical examination findings resolved after four stellate ganglion blocks, of which two on each side were performed over a period of 2 weeks. The case serves to alert clinicians to the possibility of a patient developing a sympathetically mediated pain syndrome after reduction mammoplasty.- - - - - - - - - - ranking = 2keywords = pain syndrome (Clic here for more details about this article) |