Secondary surgical decompression of the inferior alveolar nerve after overfilling of endodontic sealer into the mandibular canal: Case report and literature review.

The authors report the case of a 43-year-old woman who underwent endodontic treatment of the right second mandibular molar with substantial extrusion of endodontic material into the mandibular canal. The patient presented at the Department of Oral and Maxillofacial Surgery with a persistent total anaesthesia of the lower lip and chin after two months. 2D panoramic view and 3D CT-scan examination highlighted the overfilling into the mandibular canal with a more than 50% stenosis of the canal and a consequently significant compression of the dental pedicle. A surgical decompression of the inferior alveolar nerve was performed through an inferior vestibular approach, using PiezoSurgery®. The tooth was conserved. After a period of 8days, paraesthesia of the lower lip and chin appeared. Thermoalgic sensitivity was recovered at 1month. At 3months postoperatively, the patient had recovered protopathic and epicritic sensitivity. Dental prosthetic rehabilitation was finally achieved one year postoperatively. The authors discuss the physiopathology of nervous injuries during dental procedures, and further strategies in the case of persistent neurologic disorders.

Central retinal artery occlusion after peribulbar anesthesia: report of 3 cases.

We report 3 cases of central retinal artery occlusion following peribulbar anesthesia. Those patients were scheduled for retinal detachment repair, removal of a pterygium, and cataract surgery, respectively. In patient 1, a peribulbar anesthesia was performed with 17 ml of ropivacaine and a compression with a Honan's balloon was maintained at 30 mmHg for 30 min to reduce intra ocular pressure and facilitate intra ocular surgery. In the second patient, 13 ml of ropivacaine was administered without compression of the ocular globe. Patient 3 received 14 ml of mepivacaine and compression was maintained at 30 mmHg for 10 min. In these 3 cases, the surgeon noticed a whitening of the retina during the postoperative period, corresponding with a typical occlusion of the central artery of the retina. Several mechanisms may be cited in an attempt to explain this retinal ischemia: the high volume injected, the speed of injection, a compression of the ocular globe at high pressures for a prolonged period of time, and/or an intrinsic vasoconstricting effect of local anesthetic agents.

Hypopyon uveitis (without scleritis) a manifestation symptom of relapsing polychondritis.

We report an atypical ocular symptom, hypopyon uveitis without scleritis encountered in relapsing polychondritis. Relapsing polychondritis should be considered in the differential diagnosis of sterile hypopyon uveitis.

Bilateral eye hemorrhage after laparoscopic cholecystectomy.

A case of bilateral eye hemorrhage after laparoscopic cholecystectomy, probably caused by an increase in venous blood pressure due to carbon dioxide insufflation, is reported.

[Per- and postoperative pain]. / Douleur per- et post-opératoire.

We have made a huge amount of progress over the last decade, but we must continue to clear a way through the undergrowth. Per- and postoperative pain is typical of acute pain and is characterized by an excess of nociception due to tissue injury, visceral distention or disease. It contrasts with chronic pain which has been going on for 3 to 6 months. PATHWAYS OF PAIN: We know that the spinothalamic cord is involved in nociceptive activity. Two pathways are of great interest. One ends in a nucleus of the hypothalamus and the second in the amygdala. Both are involved in affective and emotional activity. Treatment of postoperative pain requires first that one be aware that pain is a reality and secondly that it must be assessed with various scales. Only then can the therapeutic strategy set about using the different methods available. Strategy must be continuously assessed to improve its efficacy. Different kinds of treatment can be used during the per- and postoperative period including enteral (paracetamol, nonsteroidal analgesic and antiinflammatory drugs (NSAIDs)) or parenteral (paracetamol, NSAIDs, morphine or similar) analgesic drugs. Local anesthesia seems however to be more effective. Several factors are involved in per- and postoperative pain. Its treatment is based on comprehensive team work in which each person represents a link in the therapeutic chain. For the future, we can expect to see the appearance of new drugs, processes or associations able to prolong postoperative analgesia.

Peribulbar anesthesia and sub-Tenon injection for vitreoretinal surgery: 300 cases.

BACKGROUND AND OBJECTIVES: We carried out a prospective study in order to evaluate the efficacy and safety of peribulbar anaesthesia supplemented by a sub-Tenon injection in case of inadequate analgesia during vitreoretinal surgery. METHODS: We performed 300 consecutive vitreoretinal procedures. Patients received a mean volume of 17+/-4.5 ml of a mixture of etidocaine 1%, bupivacaine 0.50% and hyaluronidase (25 UI/ml). Supplementation was represented by a sub-Tenon infiltration of lidocaine 2% (2 or 3 ml). This volume was not included in the mean volume. RESULTS: Analgesia was adequate throughout surgery without any supplementation in 85% of cases and with a sub-Tenon infiltration in 99%. Akinesia was complete in 82%, mild in 15% and absent in 3% of cases. The sub-Tenon injection was performed immediately before starting the procedure in 58% of cases and during the surgery with a delay of 80+/-21 min in 42%. Eleven patients (3.66%) were agitated during surgery and two of them needed a general anaesthesia to allow for the procedure. Generalised epilepsy was encountered in two patients (0.66%) immediately after the peribulbar injection in one patient and 15 min later in the other. The systolic blood pressure severely decreased between 60 to 70 mm Hg 40 min after the accomplishment of the peribulbar in 2 patients and at 90 min in 2 others. CONCLUSION: Our results demonstrate that peribulbar anaesthesia alone offers excellent analgesia in 85% of patients and supplemented by a sub-Tenon injection in 99%.

Siblings of sudden infant death syndrome and near miss in about 30 families: is there a genetic factor?

The purposes of this study were: (1) to compare our data with those reported in the general population; (2) to find a factor implicated in repetitive accidents; (3) to look for a possible genetic factor; and (4) to evaluate whether or not the risk of recurrence was the same in a family with two or more infants having died of sudden intant death syndrome (SIDS) as in the general population. We study retrospectively 77 files which constitute a group of 30 families which was analysed with reference to a list of data laid out in the shape of genealogical trees. Our study shows that risk factors are similar to those described previously and repetitive among siblings or cousins. The rate of recurrence is not available for the general population. On studying some family trees, we can speculate on the existence of an autosomal dominant gene with incomplete penetrance.

[Peribulbar anesthesia for peroperative and postoperative pain control in eye enucleation or evisceration: 31 cases]. / L'anesthésie péribulbaire pour le contrôle de la douleur per et postopératoire au cours des énucléations ou éviscérations. Trente et un cas.

OBJECTIVES: The aim of this prospective study was to assess peroperative and postoperative analgesia in eye enucleation or evisceration performed under peribulbar anesthesia. PATIENTS AND METHODS: We report 31 patients undergoing an eye enucleation (17 cases) or evisceration (14 cases). The surgical procedure was performed under local anesthesia alone in 22 patients. General anesthesia was associated with local anesthesia in 9 patients. Peribulbar block was achieved with the first insertion of the needle parallel to the inferior orbital floor and the second at level of supraorbital notch. A mixed anesthetic solution of equal quantity of lidocaine 2% with epinephrine (0.25 mg/20 ml) and bupivacaine 0.50% with epinephrine (0.10 mg/20 ml) was injected (total quantity 16.8 +/- 4.3 ml). RESULTS: To assess the peroperative pain we considered the patients with local anesthesia only (22 patients). One of these 22 patients needed one injection (0.50 mg/kg) of propofol for cutting the optic nerve. Surgery was ended without any other drug but that case was considered as a failure. Peroperative analgesia was obtained in 21 of 22 patients (95.4%). To assess analgesia in the postoperative period we included 31 patients. Analgesia was complete from the accomplishment of the peribulbar block to the 4th hour in all patients (efficacy 100%). From the 4th to the 24th hour, pain remained absent in 11 (enucleation 10 cases and evisceration 1 case) of the 31 patients and no drug was used. In 20 patients (enucleation 7 cases and evisceration 13 cases), pain appeared between the 4th and the 10th hour and patients were relieved by paracetamol alone in 14 cases (enucleation 6 cases and evisceration 8 cases) or by its association with nalbuphine in 5 cases (enucleation 1 case and evisceration 4 cases). In one patient (evisceration) the association of the drugs was uneffective. CONCLUSION: Peribulbar anesthesia is safe and generates major postoperative analgesia so we suggest to offer that technique to patients undergoing evisceration or enucleation.

Peribulbar anaesthesia during keratoplasty: a prospective study of 100 cases.

AIMS: A prospective study was carried out in order to evaluate the efficacy and safety of peribulbar anaesthesia during keratoplasty and to describe surgical conditions. METHODS: Of 137 consecutive keratoplasties, 100 (73%) were performed under peribulbar anaesthesia. Patients received a mean volume of 16.5 (SD 4) ml (range 9-22 ml) of a mixture of etidocaine, bupivacaine, and hyaluronidase. Ocular compression duration was at least 20 minutes and intraocular pressure (IOP) was measured with a Tonopen after injection, compression, and before trephination. Degree of akinesia, pain scoring, complications, and surgical conditions were studied. RESULTS: Before trephination, IOP was 5.73 mm Hg below the preinjection value and was never above 21 mm Hg. Akinesia was complete in 80% of cases and 94% of patients found that surgery was painless. Two patients (2%) were very agitated during surgery. The last patient presented with an acute intraoperative suprachoroidal haemorrhage that did not result in a true expulsive haemorrhage despite an "open sky" situation. Surgical conditions were judged to be optimal by the patients in 92% of cases and by the surgeon in 98% of cases. CONCLUSION: These results demonstrate that peribulbar anaesthesia offers excellent anaesthesia and akinesia during keratoplasty and may be recommended for this type of surgery.