Anesthetic efficacy of a combination of hyaluronidase and lidocaine with epinephrine in inferior alveolar nerve blocks.
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The purpose of this prospective, randomized, double-blind study was to determine the anesthetic efficacy of a buffered lidocaine with epinephrine solution compared to a combination buffered lidocaine with epinephrine plus hyaluronidase solution in inferior alveolar nerve blocks. Thirty subjects randomly received an inferior alveolar nerve block using 1 of the 2 solutions at 2 separate appointments using a repeated-measures design. Mandibular anterior and posterior teeth were blindly pulp tested at 4-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Anesthesia was considered successful when 2 consecutive readings of 80 were obtained. A postoperative survey was used to measure pain and trismus. The results demonstrated 100% of the subjects had profound lip numbness with both solutions for inferior alveolar nerve blocks. The anesthetic success rates for individual teeth ranged from 20 to 80%. There were no significant differences (P > .05) between the 2 solutions. However, the combination lidocaine/hyaluronidase solution resulted in a significant increase in postoperative pain and trismus. It was concluded that adding hyaluronidase to a buffered lidocaine solution with epinephrine did not statistically increase the incidence of pulpal anesthesia in inferior alveolar nerve blocks and, because of its potential tissue damaging effect, it should not be added to local anesthetic solutions for inferior alveolar nerve blocks. (+info)
Clinicostatistical study of ameloblastoma treatment.
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The purpose of this study was to investigate the treatment of 190 cases of ameloblastoma in our department from 1966 to 1994. The statistical results with regard to age, sex and region agreed with those of other investigators. Thirty-five of 43 (81.4%) cases underwent enucleation in 1960s, but the sixteen of 27 (59.3%) cases underwent partial resection of mandible in 1990s. The defect of mandible was reconstructed with iliac bone grafting since 1968, grafts with a mixture of iliac blocked bone and PCBM (particulate cancellous bone and marrow) have been used since 1975. Grafting of the inferior alveolar nerve with the great auricular nerve to the defect has been performed in our department since 1977. Recently, technique involving pull-through of the inferior alveolar nerve bundle has been used in our department. When the reconstruction method for the mandible and nerve has been established, it becomes possible to operate radically and positively. Recurrence occurred in 17 cases after the primary enucleation. It is thought that the primary treatment of ameloblastoma must be as radical as possible. It appears to be necessary to observe progress and perform follow-up in cases of ameloblastoma for more than ten years, because there was one recurrence at 9 years and 4 months after the first operation. In fact, three quarters of our cases were lost to follow-up. Such losses can problems in confirming recurrence and responding rapidly. (+info)
Putative feed-forward control of jaw-closing muscle activity during rhythmic jaw movements in the anesthetized rabbit.
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When a thin plastic test strip of various hardness is placed between the upper and lower teeth during rhythmical jaw movements induced by electrical stimulation of the cortical masticatory area (CMA) in anesthetized rabbits, electromyographic (EMG) activity of the masseter muscle is facilitated in a hardness-dependent manner. This facilitatory masseteric response (FMR) often occurred prior to contact of the teeth to the strip, and thus preceded the onset of the masticatory force. Since this finding suggests involvement of a feed-forward mechanism in the induction of the FMR, the temporal relationship between the onset of the FMR and that of the masticatory force was analyzed in five sequential masticatory cycles after application of the strip. The FMR was found to precede the onset of masticatory force from the second masticatory cycle after application of the strip, but never did in the first cycle. This finding supports the concept of a feed-forward control mechanism that modulates FMR timing. Furthermore, the FMR preceding the force onset disappeared after making a lesion of the mesencephalic trigeminal nucleus (MesV) where the ganglion cells of the muscle spindle afferents from the jaw-closing muscles are located. In contrast, no such change occurred after blocking periodontal afferents by transection of both the maxillary and the inferior alveolar nerves. The putative feed-forward control of the FMR is therefore dependent mainly on sensory inputs from the muscle spindles, but little on those from the periodontal receptors, if any. We further examined the involvement of the CMA with the putative feed-forward control of the FMR via the transcortical loop. For this purpose, rhythmical jaw movements were induced by stimulation of the pyramidal tract. No significant change in the timing of the FMR occurred after the CMA ablation, which strongly suggests that the CMA is not involved in the putative feed-forward control of the FMR. The FMR was also noted to increase significantly in a hardness-dependent manner even after the MesV lesion, although the rate of increment decreased significantly. Contribution of muscle spindles and periodontal receptors to the hardness-dependent change of the FMR is discussed. (+info)
Alteration of medullary dorsal horn neuronal activity following inferior alveolar nerve transection in rats.
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The effects of inferior alveolar nerve (IAN) transection on escape behavior and MDH neuronal activity to noxious and nonnoxious stimulation of the face were precisely analyzed. Relative thresholds for escape from mechanical stimulation applied to the whisker pad area ipsilateral to the transection were significantly lower than that for the contralateral and sham-operated whisker pad until 28 days after the transection, then returned to the preoperative level at 40 days after transection. A total of 540 neurons were recorded from the medullary dorsal horn (MDH) of the nontreated naive rats [low-threshold mechanoreceptive (LTM), 27; wide dynamic range (WDR), 31; nociceptive specific (NS), 11] and sham-operated rats with skin incision (LTM, 34; WDR, 30; NS, 23) and from the ipsilateral (LTM, 82; WDR, 82; NS, 31) and contralateral MDH relative to the IAN transection (LTM, 77; WDR, 82; NS, 33). The electrophysiological properties of these neurons were precisely analyzed. Background activity of WDR neurons on the ipsilateral side relative to the transection was significantly increased at 2-14 days after the operation as compared with that of naive rats. Innocuous and noxious mechanical-evoked responses of LTM and WDR neurons were significantly enhanced at 2-14 days after IAN transection. The mean area of the receptive fields of WDR neurons was significantly larger on the ipsilateral MDH at 2-7 days after transection than that of naive rats. We could not observe any modulation of thermal responses of WDR and NS neurons following IAN transection. Also, no MDH neurons were significantly affected in the rats with sham operations. The present findings suggest that the increment of neuronal activity of WDR neurons in the MDH following IAN transection may play an important role in the development of the mechano-allodynia induced in the area adjacent to the area innervated by the injured nerve. (+info)
Mental nerve function after inferior alveolar nerve transposition for placement of dental implants.
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BACKGROUND: One option for successful placement of dental implants in an atrophic posterior mandible without injury to the inferior alveolar nerve (IAN) is to transpose or lateralize the nerve. This procedure carries the risk of numbness along the distribution of the nerve, the complication that the procedure is undertaken to avoid in the first place. The purpose of the present study was to assess mental nerve function after transposition of the IAN. METHOD: We determined the outcomes of 20 IAN transposition procedures in 12 consecutive patients at the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia. The study included objective testing of sensory nerve function as well as subjective assessment by the participants. RESULTS: All subjects reported initial transient sensory disturbance. Objective testing after a minimum of 6 months revealed that, for each patient, affected sites had the same level of sensation as unoperated areas. Eighty percent of the patients said that the lower lip and chin felt normal. The others said that these structures did not feel exactly normal but that the difference was of no consequence. CLINICAL SIGNIFICANCE: It is concluded that IAN transposition can be safely and predictably performed with low risk to the mental nerve sensibility. (+info)
Two phases of chorda-lingual induced vasodilatation in the cat's submandibular gland during prolonged perfusion with Locke solution.
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The effect of stimulation of the chorda-lingual nerve on the venous flow has been studied in cat submandibular glands perfused with Locke solution for 2-4 hr. When trains of pulses at 25 Hz were given for 1-5 sec, two distinct phases of vasodilatation were observed: a rapid initial phase of high amplitude and a slower developing more prolonged phase of smaller amplitude. Repeated stimulations did not lead to a reduction of the vasodilatory response. A close relationship was found between the duration and magnitude of the second phase of vasodilatation and the duration and magnitude of the post-stimulatory, active reuptake of potassium. When the active reuptake of potassium was prevented either by ouabain (which inhibits active transport) or by atropine (which abolishes the stimulation induced loss of potassium) the second phase of vasodilatation was severely reduced, while the initial phase remained virtually normal. It is concluded that the initial phase of vasodilatation probably is mediated by vasodilator nerve fibres. The second phase is perhaps causally related to the post-stimulatory, active transport of cations. An involvement of bradykinin formation is highly unlikely under the given experimental conditions. (+info)
Trigeminal and polyradiculoneuritis in a dog presenting with masticatory muscle atrophy and Horner's syndrome.
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A 9-year-old, spayed female, Airedale Terrier was euthanatized and necropsied after a progressive clinical course that included Horner's syndrome of the left eye and unilateral atrophy of the masticatory muscles. Although gross lesions were limited, a polyradiculoneuritis and ganglionitis that was most severe in the trigeminal nerves and ganglia were confirmed histologically. The inflammatory infiltrate consisted predominantly of macrophages and B and T lymphocytes that were phenotypically confirmed by immunostaining. Horner's syndrome was the result of damage to postganglionic sympathetic fibers that were incorporated in segments of the inflamed trigeminal nerve and its ophthalmic branch. Histologically, the character and distribution of the inflammation was similar to previously described syndromes of suspected immune-mediated etiology in humans and animals. (+info)
Properties of single nerve fibres that evoke blood flow changes in cat dental pulp.
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Single nerve fibres innervating tooth pulp were isolated from filaments dissected from the inferior alveolar nerve in 17 anaesthetized cats. The fibres were studied to determine whether electrical stimulation of single units produced detectable changes in pulpal blood flow. Single pulpal nerve fibres were electrically stimulated at just above their thresholds and blood flow was recorded with a laser-Doppler flow meter from the pulp of the ipsilateral canine. The thresholds of single fibres in dissected filaments were determined either by recording antidromic action potentials from the tooth or by using a novel technique based on collision. Units that produced blood flow changes were further characterized by recording their response to hot, cold, osmotic and hydrostatic pressure, and mechanical stimulation of exposed dentine and to drying the dentine. Of 93 units isolated, 14 produced changes in pulpal blood flow when stimulated electrically at 1 or 10 Hz. All had conduction velocities (0.8-2.0 m s(-1)) in the C-fibre range. Ten produced vasodilatation and the remaining four, vasoconstriction. Five of the fibres that produced vasodilatation also responded to the hot stimulus, suggesting that they may form part of an axon reflex or similar mechanism. The four vasoconstrictor units did not respond to any form of stimulus other than electrical and were presumed to be sympathetic post-ganglionic fibres. (+info)