Allen Fred Fielding

Lingual nerve paresthesia following third molar surgery: A retrospective clinical study

Lingual nerve anesthesia, paresthesia, and dysesthesia are possible side effects of third molar extraction. These unwanted complications are frequently disturbing to both the patient and practitioner. The incidence of lingual nerve damage following third molar surgery is more frequent than once thought. Six hundred questionnaires were sent to randomly selected Fellows of the American Association of Oral and Maxillofacial Surgeons in 50 states to determine the parameters surrounding this phenomenon. Of the 452 respondents, 76.05% reported having had patients with lingual anesthesia, dysesthesia, or paresthesia. Of all the reported cases, 18.64% of the cases failed to resolve. Of the reported cases, only three underwent surgical intervention. Because many cases of lingual nerve dysfunction do not resolve, it is important to inform patients that microsurgical nerve repair techniques are available as a modality of treatment following diagnosis. It has also been recommended that if the paresthesia does not resolve within 10 to 12 weeks, then management options including microsurgical nerve reconstruction within a short period of time should be discussed as a plan with the patient.

Facial bone fractures in children

From the aforementioned study, the following conclusions can be stated: (1) Patients ranged from 2 to 15 years of age, with no one age group being more susceptible to facial fractures. This fact is contrary to previous findings. (2) No true orbital blow-out fractures were found in patients less thn 7 years of age, primarily because of the lack of maxillary sinus development in that age group. The most rapid development of the maxillary sinus occurs between the ages of 7 to 15 years. (3) In patients from 2 to 7 years of age, fractures occurred at an even ratio of boys and girls. From 8 to 15 years of age there was a boy: girl ratio of about 4.5:1. Of the sixty-seven total patients in the study, boys outnumbered girls by a ratio fo 2.4:1. In order, the condyle, orbit, and mandible were the most common fracture sites observed in the study. This fact is in agreement with past studies. There was no predominant site for any age group or sex. While falls were singly responsible for the greatest number of facial fractures, automobile-related trauma accounted for 47.7 percent of facial fractures in children. In the majority of cases multiple mandibular fractures were of the bilateral condylar type. Hospitalization of patients with automobile-related fractures was approximately 3 days longer than that of patients whose fractures occurred from other causes. More than two thirds of the patients in the study had associated trauma-related medical and dental injuries.

Pathologic fracture of the mandible associated with simultaneous occurrence of an odontogenic keratocyst and traumatic bone cyst.

A case is presented which involved a pathologic fracture of the mandible associated with a large radiolucent lesion extending from the parasymphysis to the coronoid notch. The osseous defect was found to involve two separate lesions, identified histologically as a traumatic bone cyst in the anterior portion and an odontogenic keratocyst in the posterior aspect. The clinical course and treatment are discussed.

Bilateral lingual nerve anesthesia following mandibular third molar extractions

Despite the vulnerability of the lingual nerve to damage during third molar surgery, the incidence of permanent nerve anesthesia is relatively low. Bilateral lingual nerve anesthesia has not yet been reported in the literature. A case of bilateral lingual nerve anesthesia following mandibular third molar exodontia is presented, along with possible explanations as to the cause of anesthesia.

The Analgesic Interaction of Misoprostol with Nonsteroidal Anti-Inflammatory Drugs.

The purpose of this project was to evaluate the analgesic efficacy of misoprostol when combined with ibuprofen or diclofenac Na. Animal experiments using the inflamed rat paw formalin model suggested that misoprostol potentiates the analgesic effect of some NSAIDs (nonsteroidal anti-inflammatory drugs) including diclofenac Na but not propionic acid derivatives or opiates. The dental pain model was used to evaluate the clinical relevance of this interaction. Patients received a single oral dose of study medication following surgical removal of impacted teeth. Patients were medicated for moderate to severe postsurgical pain and then filled in an analgesic diary for a 6-h observation period. Several blood samples were taken over the observation period. In addition, microdialysis samples were taken directly from the extraction socket and were analyzed for immunoreactive prostaglandin E(2) levels. The studies were single-dose, parallel group and double-blind assays. In the first study, 70 patients received an oral dose of either placebo (n = 13), misoprostol 200 &mgr;g (n = 18), ibuprofen 200 mg (n = 19), or the combination of misoprostol + ibuprofen (n = 20). Misoprostol alone demonstrated a small analgesic effect compared to placebo. Both the ibuprofen and combination groups were substantially more effective than placebo but not different from each other. The combination group had higher ibuprofen blood levels during the first 45 min but had a lower C(max) and longer time to T(max). The second study evaluated oral doses of placebo (n = 11), misoprostol 200 &mgr;g (n = 21), diclofenac Na 50 mg (n = 18), and the combination of misoprostol + diclofenac Na (n = 20). Relative to placebo, misoprostol performance was similar to the first study. When the results of the two studies were combined, there was a small, but statistically significant, analgesic effect for misoprostol. Diclofenac Na was superior to both placebo and to misoprostol alone. The combination was the most effective treatment, and for hours 4--6 it was significantly better than diclofenac Na alone. Analysis of the blood samples showed an earlier and higher peak effect for the diclofenac Na group compared to the combination, and the combination again had a lower C(max). The microdialysis probe assays demonstrated that misoprostol depressed PGE(2) levels at the peripheral site of trauma over the first 2 h after surgery. These pilot studies used small samples, and the results only suggest trend effects. Both studies demonstrated that misoprostol 200 &mgr;g, a prostaglandin analog, does have an analgesic effect. When combined with ibuprofen, there was no potentiation of analgesia. In contrast, the combination of misoprostol + diclofenac Na demonstrated an enhanced peak effect, total effect for pain intensity difference and pain relief (sum pain intensity difference [SPID] and total pain relief [TOTPAR]), and

Osteomyelitis of the coronoid process secondary to chronic mandibular third molar pericoronitis

Abstract Pericoronitis is one of the most common complications associated with impacted third molars. It may remain localized or extend directly into the surrounding tissues. Odontogenic infections resulting in osteomyelitis of the mandibular body, ramus, and condyle have been reported by Thoma.1 However, osteomyelitis of the coronoid process as a direct consequence of third molar pericoronal infections has not been reported. The following report describes such a case.