ABSTRACT
AIM: To report a case of mixed neuralgic and dental pain and to discuss the possible pathophysiological background. SUMMARY: A case of coexistent dental and neuralgic pain in the distribution of the trigeminal nerve is presented, and the endodontic and neurological treatments are described. The possible diagnostic and pathophysiological correlations are discussed. KEY LEARNING POINTS: * Pre-trigeminal and atypical neuralgias are amongst the possible differential diagnoses of acute dental pain. * In a patient with nonodontogenic pain, simultaneous dental pain in the same area could be overlooked. * Dentists should consider a nonodontogenic origin as a possible explanation for burning, lancinating or atypical pain. In such cases, an appropriate medical specialist should be consulted.
Subject(s)
Facial Neuralgia/diagnosis , Facial Pain/diagnosis , Periapical Periodontitis/diagnosis , Toothache/pathology , Trigeminal Neuralgia/diagnosis , Acute Disease , Adult , Diagnosis, Differential , Facial Neuralgia/etiology , Facial Neuralgia/therapy , Facial Pain/etiology , Facial Pain/therapy , Functional Laterality , Humans , Male , Nerve Block , Periapical Periodontitis/complications , Periapical Periodontitis/therapy , Root Canal Therapy , Toothache/etiology , Toothache/therapy , Trigeminal Neuralgia/etiology , Trigeminal Neuralgia/therapyABSTRACT
After giving a brief summary describing the development of different methods for stabilisation of traumatic spine fractures the authors discuss their own results on 125 patients, who were treated between January 1st 1983 and September 15th 1988. The different surgical procedures (Harrington-instrumentation, transpedicular osteosynthetic stabilisation, fixateur interne) are compared. In the neurological physical examination 25% of the patients improved at least one degree in the Frankel-scale. In four patients there was worsening of the neurological findings. The radiological postoperative studies analyzed the angles of kyphosis and scoliosis within the traumatized spine segments. In overall-comparison of surgical procedures the fixateur interne showed best results (repositional loss of kyphosis angle 6.8 degrees, no fracture instability). Worse results were found for Harrington-stabilisation (repositional loss 9.1 degrees, fracture instability in three cases) and for transpedicular osteosynthetic stabilisation (repositional loss 12.4 degrees, fracture instability in two cases). In conclusion the authors describe the possible different complications for the three methods of judging from the clinical aspect and propose the following standard way of procedure: Fusion of the vertebral bodies with a stable implant and the possibility for intraoperative repositioning, postero-lateral spongiosa-grafting, fusion of the vertebral arc joints, transpedicular spongiosal filling of the traumatized vertebral body, resection of traumatized tissue from intervertebral discs and intercorporal blocking.
Subject(s)
Bone Plates , Internal Fixators , Orthopedic Fixation Devices , Spinal Fractures/surgery , Thoracic Vertebrae/injuries , Adolescent , Adult , Aged , Female , Follow-Up Studies , Humans , Lumbar Vertebrae/injuries , Lumbar Vertebrae/surgery , Male , Middle Aged , Spinal Fusion/methods , Thoracic Vertebrae/surgeryABSTRACT
Soft tissue defects of the dorsal side of the elbow require a stable soft tissue reconstruction. Therefore, for the treatment of limited, uninfected defects, local or distant skin flaps should be used. For large and infected defects, the use of the proximally pedicled arteria radialis forearm flap is indicated. We used the flap in 14 patients as an alternative to conventional methods. This neurovascular, septocutaneous flap proved safe and versatile, guaranteeing stable soft tissue reconstruction of the dorsal aspect of the elbow. The flap has an orthograde flow and is nourished by the radial artery. With its long, neurovascular pedicle, it can be transposed in a proximal ulnar or radial direction. Four years after operation, all elbow joints showed a complete range of motion. No further soft tissue instabilities were seen.