ABSTRACT
OBJECTIVES: The aim of this work is to introduce a new condition within temporomandibular disorders, temporomandibular joint compromise (TMJC), a mandibular movement limiting disorder of extra-articular traumatic cause, and evaluate the response rate and safety of treatment. The limiting cause of mandibular movement is the lack of space between the mandibular ramus and maxilla. The main symptoms of TMJC include headache, dizziness, and tinnitus. In many cases, the headache is previously diagnosed as a migraine. METHODS: Data were collected from 54 patients aged between 6 and 59 years that had a confirmed diagnosis of migraine according to the 3rd Edition of the International Headache Classification of the International Headache Society of 2018, and were treated for TMJC in a dental clinic. They also presented with other otolaryngological symptoms. A retrospective quasi-experimental study without a control group was carried out due to ethical considerations related to the harmless nature of the treatment. RESULTS: After treatment of TMJC, migraine symptoms disappeared in 52 patients (96.3%, P<.001), and persisted, although with clinical improvement, in 2 (3.7%). There was also an improvement in the other associated symptoms: dizziness disappeared in 23 out of 27 affected patients (85.21%, P<.001), and tinnitus disappeared in the 31 affected patients (100%, P<.001). No significant treatment-related side effects were observed. CONCLUSIONS: This study shows the high rate of response and safety of the treatment of TMJC.
Subject(s)
Headache Disorders , Headache/etiology , Temporomandibular Joint Disorders , Adolescent , Adult , Child , Humans , Middle Aged , Retrospective Studies , Temporomandibular Joint , Temporomandibular Joint Disorders/complications , Young AdultABSTRACT
Procedural sedation and analgesia (PSA) is a widely used strategy in various fields to carry out numerous diagnostic and therapeutic procedures. However, there is limited information on its efficacy and safety during enzymatic debridement of burn patients with Nexobrid®. The aim of our study was to describe the U-type PSA procedure in a series of patients requiring enzymatic debridement. We carried out a retrospective, descriptive study involving 28 patients requiring enzymatic debridement of a limb, trunk or multiple locations, who had been admitted to the Burn Unit of the University Hospital Complex of A Coruña (Spain). Of these, 17 patients (not requiring invasive mechanical ventilation [IMV]) received intravenous PSA and two received local/regional anesthesia. Among those patients who received PSA, the most frequently used sedative during the application and removal of Nexobrid® was ketamine following premedication with midazolam (median Ramsay sedation score = 3; range = 2-4). The most common type of analgesics prescribed for the debridement procedure was opioids. Three patients required rescue analgesia because of the intensity of their pain (Visual Analogue Scale [VAS] ≥ 4). The patients did not experience any of the complications analyzed. In our case series, U-type PSA proved to be a satisfactory and safe support strategy for enzymatic debridement of burn patients not requiring IMV due to another cause.
L'analgésie-sédation (AS) est largement utilisée au cours d'actes diagnostiques et thérapeutiques. Cependant, nous ne disposons que de peu de données concernant son efficacité et son innocuité et son efficacité durant le débridement enzymatique par Nexobrid® chez les brûlés. Nous décrivons ici une série rétrospective de 28 patients hospitalisés dans le CTB de La Corogne (Espagne) ayant bénéficié d'un débridement enzymatique du tronc, des membres ou de localisations multiples sous analgo-analgésie séquentielle avec rétrocontrôle. Parmi ces patients, 17 n'étaient pas ventilés et ont reçu une AS intraveineuse, 2 ont bénéficié d'anesthésie locale ou locorégionale. L'agent hypnotique le plus utilisé lors de la mise en place et du retrait de Nexobrid® était la kétamine (après prémédication par midazolam). Le score de sédation (Ramsay) médian était de 3 (interquartiles 2 et 4). Les opiacés étaient les analgésiques les plus fréquents. Trois patients ont eu besoin d'analgésie supplémentaire, indiquée par une EVA ≥ 4. Aucune complication n'a été retrouvée. Dans cette série, l'analgoanalgésie séquentielle avec rétrocontrôle apparaît comme un moyen efficace et sûr d'assurer l'analgésie pendant un débridement enzymatique chez des brûlés en ventilation spontanée.
