RESUMO
INTRODUCTION: There is a possibility of neurotmesis of the inferior alveolar nerve (IAN) in mandibular fractures, which leads to neurosensory impairment. In this study, we aimed to investigate the efficacy of photobiomodulation therapy (PBMT) in patients with neurotmesis following trauma and mandibular fracture. MATERIALS AND METHODS: This triple-blind randomized trial was carried out on patients who suffered neurotmesis of the IAN following mandibular angle and body fracture at least for 6 months. In the intervention group, laser irradiation was applied with a low-level GaAlAs diode laser (continuous wave of 810 nm wavelength, power of 200 mW, and energy density of 12-14 J/cm2). In the control group, the laser probe was turned off and placed on the affected area. LLLT was done for 12 sessions (2 times/week for 6 weeks). Light touch sensations, two-point discrimination, thermal discrimination (cold and warm stimulus), electric pulp test (EPT), and oral health impact profile (OHIP)-14 questionnaire were performed before the intervention, immediately after each PBMT session, and after 3, 6, 9 and 12 months. RESULTS: In both groups, 3 and 23 patients were female and male, respectively. The results showed significantly improved light (cotton swab), light (wooden cotton swab), and sharp (dental needle) touch sensations, and two-point discrimination test in the PBMT group after the 10th, 11th, 10th, and 10th session, respectively. Two-way repeated measure ANOVA revealed that the trend of light touch sensation with cotton swab and two-point discrimination test was statistically significant (p-value = 0.002 and 0.001, respectively). The results of OHIP-14 test showed a significantly higher mean in the PBMT group 3 months after PBMT. There was no statistically significant difference in EPT and thermal discrimination tests regarding the patients' group. CONCLUSION: PBMT could be an effective treatment for late post-traumatic nerve neurotmesis following a traumatic mandibular fracture.
Assuntos
Terapia com Luz de Baixa Intensidade , Fraturas Mandibulares , Traumatismos do Sistema Nervoso , Feminino , Humanos , Lasers Semicondutores/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Masculino , Fraturas Mandibulares/radioterapia , Nervo Mandibular/efeitos da radiaçãoRESUMO
INTRODUCTION: Zygomatic fractures are usually accompanied with neural complications, which are routinely treated by surgery or medication. However, photobiomodulation has been proven as a non-invasive method with better results in nerve's regeneration and repair. Therefore, in this study, we aimed to investigate the healing effect of photobiomodulation on neurosensory defect after facial trauma. PATIENTS AND METHODS: In this parallel controlled clinical trial, 35 control cases and 36 patients with zygomaticomaxillary complex (ZMC) fractures as well as the sustained infraorbital nerve paresthesia were included. Afterward, Laser irradiation was applied using a GaAlAs diode laser (810 nm, 27 J/cm2, 200 mW) on 12 points on malar area of paresthesia during 12 sessions within six weeks. Neurosensory evaluations were performed in four sessions as follows: at baseline, the end of treatment, one month, and three months after the last session of irradiation, which were achieved through three tests including visual analogue scales (VAS) for general sensitivity, two-point discrimination, and pain discrimination. Repeated measure ANOVA, independent t-test, and Chi-square test were used for comparing time trends, each time point, and gender, respectively. P-values less than 0.05 were considered to be statistically significant. RESULTS: The patients and controls were matched in both terms of age and gender. Baseline results showed non-significant differences between the two groups based on the VAS, pain, and two-point discrimination. Moreover, for VAS scale, some significant differences were observed between the groups by passing "one month and three months from therapy". Pain and two-point discriminations showed a significant difference between the intervention and control groups in "one month after therapy" and "at the end of the therapy, one month after therapy, and three months after therapy", respectively. CONCLUSION: Photobiomodulation could be considered as an effective treatment option for post-traumatic neurosensory disturbance of facial area in terms of VAS, pain and two-point discrimination, even if not performed early after trauma.
Assuntos
Lasers Semicondutores/uso terapêutico , Fraturas Zigomáticas/radioterapia , Adolescente , Adulto , Feminino , Humanos , Terapia com Luz de Baixa Intensidade , Masculino , Nervo Mandibular/fisiologia , Nervo Mandibular/efeitos da radiação , Dor/patologia , Doses de Radiação , Resultado do Tratamento , Adulto JovemRESUMO
The inferior alveolar nerve and facial nerve are the two most important nerves in the dental and maxillofacial region. The injury to them is one of the major postoperative complications after alveolar surgery and orthognathic surgery. However, recovering the nerve function after injury takes a long time and the recovery effect tends to be unsatisfactory. In recent years, an intensively investigated technique, low level laser which has been applying in assisting the recovery of nerve function, has been gradually proved to be effective in clinically treating postoperative nerve injury. In this article we review in terms of the mechanisms involved in low level laser-assisted functional restoration of nerve injury and its clinical application in the recovery of nerve function in the dental and maxillofacial area as well.
Assuntos
Nervo Facial/fisiopatologia , Nervo Facial/efeitos da radiação , Terapia com Luz de Baixa Intensidade , Nervo Mandibular/fisiopatologia , Nervo Mandibular/efeitos da radiação , Maxila/inervação , Dente/inervação , Face/inervação , Humanos , Recuperação de Função FisiológicaRESUMO
Postoperative sensory disturbances of inferior alveolar nerve (IAN) are major challenges in dental procedures. We aimed to investigate the effect of photobiomodulation therapy (PBMT) with 810 nm and 980 nm diode lasers on behavioral and immunological factors in a rat IAN crush model. Seventy-two rats were randomly assigned to the four groups of 810 nm laser (crush injury+810 nm laser; 6 J/cm2, 15 sessions, every 48 h), 980 nm laser (crush injury+980 nm laser; same protocol), control (crush injury without irradiation), and sham surgery (no crush injury and no irradiation). The neurosensory response of IAN was evaluated by Von Frey behavioral test before (baseline) and post-surgery in a period of one month. Changes of nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), nuclear factor-kappa B (NF-κB), TNF-α, and IL-1ß, were assessed on days 2 and 30 post injury. Data were analyzed for significant differences by repeated measures and one-way ANOVA (p < .05). One day after surgery, all rats subjected to nerve injury showed significant increase in the withdrawal threshold of von Frey test compared to the baseline (p = .02 for control and p = .03 for laser groups). The threshold gradually returned to the baseline scores in 810 nm, 980 nm, and control groups from days 11, 17, and 29, respectively. There was a significant lower withdrawal threshold in 810 nm and 980 nm laser groups compared to the control group in days 11 to 19 and 9 to 23, respectively. At both time points, the levels of NGF and BDNF were significantly higher in 810 nm laser group compared to the control group. There was a significant difference between laser and control groups regarding NF-κB expression (all p values<.001). TNF-α and IL-1ß were significantly lower in laser groups compared to the control group (all p values < .001). PBMT with 810 and 980 nm diode laser protocol used in this study, promoted the neurosensory recovery of IAN after crush injury in rats. In addition, application of 810 nm diode laser was associated with more improvement in immunological responses compared to that of 980 nm laser.
Assuntos
Lasers Semicondutores , Nervo Mandibular/efeitos da radiação , Animais , Comportamento Animal/efeitos da radiação , Fator Neurotrófico Derivado do Encéfalo/metabolismo , Modelos Animais de Doenças , Regulação para Baixo/efeitos da radiação , Interleucina-1beta/metabolismo , Terapia com Luz de Baixa Intensidade , Masculino , Nervo Mandibular/imunologia , Nervo Mandibular/metabolismo , Traumatismos do Nervo Mandibular/imunologia , Traumatismos do Nervo Mandibular/metabolismo , Traumatismos do Nervo Mandibular/radioterapia , NF-kappa B/metabolismo , Fator de Crescimento Neural/metabolismo , Ratos , Ratos Wistar , Fator de Necrose Tumoral alfa/metabolismo , Regulação para Cima/efeitos da radiaçãoRESUMO
The aim of the present study was to investigate the therapeutic effects of 660-nm and 880-nm photobiomodulation therapy (PBMT) following inferior alveolar nerve (IAN) crush injury. Following the nerve crush injuries of IAN, 36 Wistar rats were randomly divided into three groups as follows: (1) control, (2) 660-nm PBMT, and (3) 808-nm PBMT (GaAlAs laser, 100 J/cm2, 70 mW, 0.028-cm2 beam). PBMT was started immediately after surgery and performed once every 3 days during the postoperative period. At the end of the 30-day treatment period, histopathological and histomorphometric evaluations of tissue sections were made under a light and electron microscope. The ratio of the inner axonal diameter to the total outer axonal diameter (g-ratio) and the number of axons per square micrometer were evaluated. In the 808-nm PBMT group, the number of nerve fibers with suboptimal g-ratio ranges of 0-0.49 (p < 0.001) is significantly lower than expected, which indicates better rate of myelinization in the 808-nm PBMT group. The number of axons per square micrometer was significantly higher in the 808-nm PBMT group when compared with the control (p < 0.001) and 660-nm PBMT group (p = 0.010). The data and the histopathological investigations suggest that the PBMT with the 808-nm wavelength along with its settings was able to enhance IAN regeneration after nerve crush injury.
Assuntos
Lesões por Esmagamento/radioterapia , Luz , Terapia com Luz de Baixa Intensidade , Nervo Mandibular/efeitos da radiação , Compressão Nervosa , Regeneração Nervosa/efeitos da radiação , Animais , Axônios/patologia , Axônios/efeitos da radiação , Feminino , Lasers Semicondutores , Nervo Mandibular/patologia , Ratos WistarRESUMO
Inferior alveolar nerve (IAN) damage is a common complication occurring after sagittal split osteotomy (SSO) and results in sensory disorders of the jaw region. In recent years, published experimental and clinical evidence suggests that low-level laser (LLL) radiation is effective in nerve recovery. Therefore, the aim of the present study was to review clinical trial studies investigating the effect of LLL radiation on improving the sensory defects of IAN after SSO. The keywords associated with SSO and LLL were searched in PubMed, Medline (via Ovid), Web of Science (WOS), Scopus, and Cochrane Library databases. Then, controlled clinical trial studies published before November 2017 regarding LLL radiation conducted on patients with IAN neuropathy due to SSO were investigated. The articles fulfilling the study criteria were further scrutinized and the necessary information was extracted from them. A total of seven papers were included in the study. The diode laser used had a wavelength range of 760-930 nm, radiation power of 20-200 mw, and radiation energy of 10.2-95 J (per point of radiation). In the mentioned studies, the patients underwent 3-20 sessions of laser irradiation and were monitored for an additional 0-23 months after completion of the laser intervention. The tests performed in the mentioned studies dealt with examining the perceptions of superficial touch and pressure, two-point discrimination, stimulus movement on skin, temperature, and pain. Furthermore, the patients' general awareness regarding sensory perception in the mandibular region was gauged. In six studies, laser irradiation caused relative improvement in the IAN sensory disorder for a subjective test as well as for one or more objective tests. In the reviewed clinical trial studies, LLL was generally found to be effective in improving the IAN sensory disturbance resulting from SSO, though there was no placebo effect.
Assuntos
Terapia com Luz de Baixa Intensidade , Nervo Mandibular/patologia , Nervo Mandibular/efeitos da radiação , Osteotomia/efeitos adversos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Viés de Publicação , Fatores de Risco , Resultado do TratamentoRESUMO
Orofacial pain is associated with peripheral and central sensitization of trigeminal nociceptive neurons. Nerve injury results in release of chemical mediators that contribute to persistent pain conditions. The activation of the transient receptor potential vanilloid 1 (TRPV1), promotes release of calcitonin gene-related peptide (CGRP) and substance P (SP) from trigeminal nerve terminals. CGRP and SP contribute to the development of peripheral hyperalgesia. The expression of SP and CGRP by primary afferent neurons is rapidly increased in response to peripheral inflammation. CGRP receptor activation promotes activation of AMPA receptors, leading to increased firing of neurons which is reflected as central sensitization. In this study we investigated whether inferior alveolar nerve (IAN) injury influences AMPA receptors, CGRP, SP and TRPV1 expression in the trigeminal ganglion (TG). The relative expression of the protein of interest from naive rats was compared to those from injured rats and animals that received low level laser therapy (LLLT). IAN-injury did not change expression of GluA1, GluA2 and CGRP, but increased the expression of TRPV1 and SP. LLLT increases GluA1 and GluA2 expression and decreases TVPV1, SP and CGRP. These results, together with previous behavioral data, suggest that IAN-injury induced changes in the proteins analyzed, which could impact on nociceptive threshold. These data may help to understand the molecular mechanisms of pain sensitization in the TG.
Assuntos
Traumatismos do Nervo Facial/radioterapia , Regulação da Expressão Gênica/efeitos da radiação , Terapia com Luz de Baixa Intensidade , Nervo Mandibular/efeitos da radiação , Gânglio Trigeminal/efeitos da radiação , Animais , Peptídeo Relacionado com Gene de Calcitonina/genética , Peptídeo Relacionado com Gene de Calcitonina/metabolismo , Traumatismos do Nervo Facial/genética , Traumatismos do Nervo Facial/metabolismo , Traumatismos do Nervo Facial/patologia , Masculino , Nervo Mandibular/metabolismo , Nervo Mandibular/patologia , Neurônios Aferentes/metabolismo , Neurônios Aferentes/patologia , Neurônios Aferentes/efeitos da radiação , Estimulação Luminosa/métodos , Ratos , Ratos Sprague-Dawley , Receptores de AMPA/genética , Receptores de AMPA/metabolismo , Transdução de Sinais , Substância P/genética , Substância P/metabolismo , Canais de Cátion TRPV/genética , Canais de Cátion TRPV/metabolismo , Gânglio Trigeminal/lesões , Gânglio Trigeminal/metabolismoRESUMO
OBJECTIVE: The purpose of this investigation was to evaluate the therapeutic efficacy of superpulsed, low-level laser therapy (SLLLT) on neurosensory recovery of the inferior alveolar nerve (IAN) after oral surgical injury. BACKGROUND DATA: A survey of the literature reveals the uncertainty of outcomes for the surgical management of IAN injury and the efficacy of low-level laser therapy in the treatment of IAN injury. METHODS: In this study, the authors report the results for SLLLT in 57 patients affected by paresthesia of the lip, chin, gingival, and buccal regions. Each patient was subjected to 10 laser treatments, once a week, with a GaAs diode laser. Clinical neurosensory tests (soft touch, 2-point discrimination, pin prick, thermal test) and the visual analogue scale were used before every treatment to evaluate the extent of neurosensory recovery. RESULTS: The authors' results demonstrate that 83.3% of the patients had a significant neurosensory recovery, as evident in the objective and subjective tests. CONCLUSION: The results reported in this study indicate that SLLLT has the potential to improve neurosensory recovery in patients with IAN paresthesia.
Assuntos
Queixo/inervação , Terapia com Luz de Baixa Intensidade/métodos , Nervo Mandibular/efeitos da radiação , Procedimentos Cirúrgicos Bucais/métodos , Recuperação de Função Fisiológica , Sensação/fisiologia , Traumatismos do Nervo Trigêmeo/radioterapia , Adulto , Feminino , Humanos , Masculino , Nervo Mandibular/fisiopatologia , Pessoa de Meia-Idade , Traumatismos do Nervo Trigêmeo/fisiopatologiaRESUMO
PURPOSE: The aim of this study was to evaluate the relative effectiveness of stellate ganglion blockade (SGB) versus xenon light irradiation (XLI) for the treatment of neurosensory deficits resulting from orthognathic surgery as determined by a comparison of prospective measurements of electrical current perception thresholds (CPTs) and ranged CPTs (R-CPTs). MATERIALS AND METHODS: CPT and R-CPT in the mental foramen area were measured during electrical stimulation at 98 different sites on the body in patients who had undergone orthognathic surgery. After surgery, patients were assigned to the SGB group or the XLI group. CPT and R-CPT of the 2 groups were measured at stimulation frequencies of 2,000, 250, and 5 Hz before surgery, 1 week after surgery, and after 10 treatment sessions. Furthermore, the influence of surgical factors, such as genioplasty and a surgically exposed inferior alveolar nerve (IAN), was examined in the 2 groups. RESULTS: Patients' CPT and R-CPT values indicated a considerable amount of sensory disturbance in most cases after surgery. The change in magnitude of all CPT and R-CPT values for the SGB group decreased considerably compared with that for the XLI group after treatment. There was no correlation between CPT or R-CPT values and surgical factors (eg, genioplasty and exposure of the IAN). CONCLUSION: SGB of the IAN could be an effective method for treating neurosensory deficits after orthognathic surgery on the IAN.
Assuntos
Lasers de Gás/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Bloqueio Nervoso/métodos , Procedimentos Cirúrgicos Ortognáticos/efeitos adversos , Complicações Pós-Operatórias/terapia , Distúrbios Somatossensoriais/terapia , Gânglio Estrelado/efeitos dos fármacos , Adolescente , Adulto , Anestésicos Locais/administração & dosagem , Estimulação Elétrica/métodos , Feminino , Seguimentos , Mentoplastia/efeitos adversos , Humanos , Masculino , Nervo Mandibular/efeitos dos fármacos , Nervo Mandibular/fisiopatologia , Nervo Mandibular/efeitos da radiação , Maxila/cirurgia , Mepivacaína/administração & dosagem , Pessoa de Meia-Idade , Fibras Nervosas Mielinizadas/efeitos dos fármacos , Fibras Nervosas Mielinizadas/fisiologia , Fibras Nervosas Mielinizadas/efeitos da radiação , Osteotomia de Le Fort/efeitos adversos , Osteotomia Sagital do Ramo Mandibular/efeitos adversos , Complicações Pós-Operatórias/radioterapia , Estudos Prospectivos , Limiar Sensorial/fisiologia , Distúrbios Somatossensoriais/radioterapia , Adulto JovemRESUMO
Bilateral sagittal split osteotomy (BSSO) is a technique commonly used to correct mandibular disproportion but many patients experience hypoaesthesia of the inferior alveolar nerve (IAN). The purpose of this study was to verify the effectiveness of using a low-level laser therapy protocol after BSSO. The 10 patients in our study, who underwent BSSO with Le Fort I osteotomy and had low-level laser therapy on one side of the jaw, were evaluated over a period of 60 days. The data for the treated and non-treated sides were compared post-operatively. At 15, 30 and 60 days after surgery, when sensitivity was recovered on both sides. On the treated side, recovery was faster and was almost complete at the time of the last evaluation. We suggest that this lower-level laser therapy protocol can improve tissue response and accelerate the recovery of neurosensory disorders following BSSO. (NCT01530100).
Assuntos
Hipestesia/prevenção & controle , Terapia com Luz de Baixa Intensidade/métodos , Nervo Mandibular/efeitos da radiação , Osteotomia Sagital do Ramo Mandibular/métodos , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Adulto , Placas Ósseas , Queixo/inervação , Estudos Cross-Over , Deformidades Dentofaciais/cirurgia , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Lasers Semicondutores/uso terapêutico , Pessoa de Meia-Idade , Osteotomia de Le Fort/métodos , Osteotomia Sagital do Ramo Mandibular/instrumentação , Recuperação de Função Fisiológica/efeitos da radiação , Sensação/efeitos da radiação , Contenções , Tato/efeitos da radiação , Adulto JovemRESUMO
Of the different physiotherapy techniques used in the nervous process repair, the use of Low level laser therapy (LLLT) has generated results, due to the biostimulant effects that generates laser irradiation while interacting with tissues and cells. This study seeks to identify changes or morphological microscopic alterations of inferior alveolar nerve in healthy rats. We used 16 Sprague Dawley rats, which were exposed to Low level Laser in the side area of the mandibule. The left side was taken as a control on the right side was applied low-level laser so transcutaneous for 1 minute with a power density of 5 Joules/cm2, 3 sessions per week, a total of 3 weeks. The sample unit and the histological analyses were obtained from the inferior alveolar nerve section and its surrounding tissue. The results show that there is a noticeable difference in the thickness of perineural tissue in irradiated side compared to the control side, the average thickness was 21.125 mm in irradiated group and 27.575 mm for the control group showing a statistically difference significant between them. In conclusion, the application of low-power laser at low dose produces a variation in the nervous morphology, increasing the density of its components.
De las diferentes técnicas fisioterapéuticas utilizadas en el proceso de reparación nerviosa, la utilización de terapia con Láser de Baja Potencia (LLLT) ha generado resultados, debido a los efectos bioestimulantes que la irradiación láser genera al interactuar con los tejidos y células. Este estudio pretende determinar los cambios o alteraciones morfológicas microscópicas del nervio alveolar inferior sano en ratas. Se utilizaron 16 ratas Sprague Dawley, a las cuales se les aplicó Laser de Baja Potencia en la zona lateral de la mandíbula. El lado izquierdo se tomó como control; al lado derecho se le aplicó láser de baja potencia de manera transcutánea durante 1 minuto con una densidad de energía de 5 Joules /cm2 , 3 sesiones por semana, en un total de 3 semanas. La unidad de muestra y análisis fueron los cortes histológicos obtenidos de la sección del nervio alveolar inferior y su tejido circundante. Los resultados muestran que existe una notable diferencia en el espesor de los tejidos perineurales del lado irradiado en comparación con el lado control, el promedio de grosor fue de 21,125 mm en irradiados y 27,575 mm para el control, mostrando una diferencia estadísticamente significativa entre ellos. En conclusión la aplicación de láser de baja potencia en dosis baja produce una variación en la morfología nerviosa, aumentando la densidad de sus componentes.
Assuntos
Animais , Feminino , Ratos , Nervo Mandibular/efeitos da radiação , Terapia com Luz de Baixa Intensidade , Ratos Sprague-DawleyRESUMO
PURPOSE: The purpose of this investigation was to determine the effects of low-level laser (LLL) irradiation on neural regeneration in surgically created defects in the rabbit inferior alveolar nerve. STUDY DESIGN: Five adult female New Zealand White rabbits underwent bilateral exposure of the inferior alveolar nerve. A 6-mm segment of nerve was resected, and the nerve gap was repaired via entubulation by using a Gore-Tex conduit. The experimental side received 10 postoperative LLL treatments with a 70-mW gallium-aluminum-arsenide diode at 4 sites per treatment. At 15 weeks after surgery, the nerve segments were harvested bilaterally and prepared for light microscopy. Basic fuchsin and toluidine blue were used to highlight myelinated axons. The segments were examined histomorphometrically by using computer analysis to determine mean axonal diameter, total fascicular surface area, and axonal density along the repair sites. RESULTS: Gross examination of all nerves showed intact neural bundles with variable degrees of osseous remodeling. Light microscopic evaluation revealed organized regenerated neural tissue in both groups with more intrafascicular perineural tissue in the control group. Histomorphometric evaluation revealed increased axonal density in the laser treated group as compared with the control. CONCLUSIONS: LLL irradiation may be a useful noninvasive adjunct to promote neuronal wound healing in surgically created defects repaired with expanded polytetrafluoroethylene entubulation.