Cryoneurolysis of alveolar nerves for chronic dental pain: A new technique and a case series.

BACKGROUND: Chronic neuropathic dental pain has a poor prognosis with a low chance of significant spontaneous improvement. Local or oral therapies may be efficient, however short in terms of duration with potential side effects. Cryoneurolysis has been described to prevent acute postoperative pain or to treat some chronic pain conditions; however, application to dental orofacial pain has not been reported so far. CASE SERIES: Following a positive diagnostic block on the corresponding alveolar nerve, neuroablation was performed using a cryoprobe on three patients suffering from persistent pain after a dental extraction and 1 after multiple tooth surgeries. The effect of treatment was assessed using a Pain Numeric Rating Scale (NRS) and determined by changes in medication dosage and quality of life at day 7 and 3 months. Two patients experienced more than 50% of pain relief at 3 months, 2 by 50%. One patient was able to wean off pregabalin medication, one decreased amitriptyline by 50%, and one decreased tapentadol by 50%. No direct complications were reported. All of them mentioned improvement in sleep and quality of life. CONCLUSION: Cryoneurolysis on alveolar nerves is a safe and easy-to-use technique allowing prolonged neuropathic pain relief after dental surgery.

[New therapy for sleep apnea at CHUV: hypoglossal nerve stimulation]. / Nouvelle thérapie de l'apnée du sommeil au CHUV: le neurostimulateur du nerf hypoglosse.

Neurostimulation of the hypoglossal nerve is a new alternative treatment to CPAP (Continuous Positive Airway Pressure) for patients with moderate-to-severe OSAS (Obstructive Sleep Apnea Syndrome) with anteroposterior pharyngeal obstruction visualized during a Drug Induced Sleep Endoscopy (DISE). Implantation and follow-up are performed at the CHUV with the collaboration between the SAOS-ronchopathie unit, the maxillofacial and dental surgery division and the center for investigation and research on sleep (CIRS). In this article, we present the technique, its indication and the outcomes through a recent review of the literature. This new device has been used for five years, mainly in the United States and Europe.

La neurostimulation du nerf hypoglosse est un nouveau traitement alternatif à la CPAP (Continuous Positive Airway Pressure: ventilation en pression positive continue) pour les patients présentant un SAOS (syndrome d'apnées obstructives du sommeil) de stade modéré à sévère avec une obstruction pharyngée antéro-postérieure, objectivée lors d'un examen endoscopique en sommeil induit (DISE). L'implantation du dispositif et le suivi sont réalisés au CHUV grâce à une étroite collaboration entre l'Unité SAOS-ronchopathie, la division de chirurgie maxillo-faciale et dentaire et le Centre d'investigation et de recherche sur le sommeil (CIRS). Dans cet article, nous présentons la technique, ses indications ainsi que les résultats à travers une revue de la littérature récente sur cette technologie qui est pratiquée depuis maintenant cinq ans, principalement aux Etats-Unis et en Europe.

[Sleep apnea : diagnostic and therapeutic modalities in case of failure of the CPAP]. / Apnées du sommeil : modalités diagnostiques et thérapeutiques en cas d'échec de la CPAP.

Obstructive sleep apnea (OSA) is a sleep disorder that affects 49 % of men and 23% of women over 40 years old. CPAP is currently the treatment of choice for severe OSAS, but there are mild to moderate cases of OSAS with poor compliance or intolerance to CPAP, for which alternative treatments should be considered. In this article, we present a tool for evaluation of the upper airways, the DISE (Drug-induced sleep endoscopy), the OAM (mandibular advancement device), the bimaxillary advancement osteotomy, the hypoglossal nerve stimulation and the positional treatment.

Le syndrome d'apnées obstructives du sommeil (SAOS) est un trouble du sommeil qui affecte 49 % des hommes et 23 % des femmes de plus de 40 ans. La CPAP est actuellement le traitement de choix pour les SAOS sévères, mais il existe des cas de SAOS de degré léger à modéré qui présentent une mauvaise compliance, voire une intolérance à la CPAP, pour lesquels il faut envisager des traitements alternatifs. Dans cet article, nous vous présentons un outil d'évaluation des voies aériennes supérieures, le DISE (Drug-induced sleep endoscopy), l'OAM (orthèse d'avancement mandibulaire), l'ostéotomie d'avancement bimaxillaire, la pose d'un stimulateur du nerf hypoglosse et le traitement positionnel.

[When should a patient with malaise be referred to the emergency ward?]. / Quand référer aux urgences un patient présentant un malaise?

General physicians (GPs) and emergency doctors are regularly called upon to deal with cases of "malaise" or sudden unforeseen feelings of debility. As highly disparaged as this designation may be, it remains commonly used in everyday life, enabling patients to express a general sensation of ill-being, accompanied by various non-specific symptoms. The lack of a preliminary case history and clinical analysis makes difficult to swiftly determine the severity of the situation, let alone its etiology. GPs are expected to rapidly detect any possibly serious risk factors; the decision to either hospitalize the patient or allow him to return home, is in their hands. The following article sets forth algorithms to assist with the diagnostic process and general handling of such cases.