ABSTRACT
Apical lesions of endodontic origin can be classified as either granulomas or cysts. In rare cases, respiratory epithelium can proliferate and encapsulate a lesion, forming a cyst. Moreover, the innervation of apical lesions has only been previously reported in animal models of apical periodontitis. This report demonstrates an unusual case in which tooth #15 was initially treated with nonsurgical root canal therapy. Still, the patient remained in moderate to severe pain for several days following the procedure. Next, an intentional replantation was performed in which a periapical cyst was curetted from the alveolus. The patient experienced immediate pain relief following the procedure. Histological analysis revealed that the periapical cyst was lined entirely with respiratory epithelium, and immunohistochemical analysis showed it to be densely innervated. In addition, these nerve fibers expressed the LPS receptor, TLR4. This is the first demonstration of the innervation pattern of a periapical cyst. Further studies are warranted to evaluate innervation in apical lesions and its correlation with pre- and intra-operative symptoms and their participation in the pathogenesis of apical periodontitis.
Subject(s)
Periapical Periodontitis , Radicular Cyst , Humans , Radicular Cyst/pathology , Nociceptors/pathology , Periapical Periodontitis/therapy , Root Canal Therapy/methods , PainABSTRACT
A Dor Neuropática é definida como dor causada por lesão ou disfunção do sistema nervoso, como resultado da ativação anormal da via nociceptiva (fibras de pequeno calibre e trato espinotalâmico). As principais causas desta síndrome são: diabetes melito, neuralgia pós-herpética, neuralgia trigeminal, dor regional complexa, acidente vascular encefálico, esclerose múltipla, lesão medular, entre outros. Nos últimos anos, a Dor Neuropática vem recebendo especial atenção por dois motivos principais: 1) refratariedade terapêutica de várias síndromes dolorosas com componentes neuropáticos predominantes e 2) desenvolvimento de ferramentas diagnósticas para o reconhecimento deste tipo de dor. O presente artigo de revisão fornece informações relevantes para o entendimento e reconhecimento da Dor Neuropática, bem como quanto à abordagem terapêutica baseada em evidências.
Neuropathic Pain is defined as pain caused by lesion or dysfunction of the nervous system, as a result of abnormal activation of the nociceptive pathway (small fibers and spinothalamic tracts). The most common causes of this syndrome are the following: diabetes, post-herpetic neuralgia, trigeminal neuralgia, complex regional pain syndrome, stroke, multiple sclerosis, spinal cord injury, among others. In the last few years, the Neuropathic Pain, has been receiving special attention for two main reasons: 1) therapeutical refractoriness of a variety of pain syndromes with predominant neuropathic characteristics and 2) the development of diagnostic tools for Neuropathic Pain complaints. The present paper provides relevant information on the understanding and recognition of Neuropathic Pain, as well as therapeutic evidence-based-medicine approaches.