Numb chin syndrome in sickle cell disease: a case series of Jamaican patients.

Numb chin syndrome is an uncommon presentation that has been reported as secondary to metastatic disease, trauma, and infections of the maxilla, mandible, or oral cavity. The hypoesthesia, paraesthesia, or pain are a result of injury to the inferior alveolar nerve, which is particularly vulnerable as it exits the mandible through the mandibular foramen as the mental nerve. In persons with sickle cell disease, it has been reported as a manifestation of mandibular vaso-occlusive crisis. This case series presents 13 patients with sickle cell disease who presented with numb chin syndrome, the largest number of cases that has been described in the literature to date. The report illustrates the wide variety of presentations and therefore possible differential diagnoses to consider. In this case series, the symptoms were associated with vaso-occlusive crises, allergic reactions, dental infections, malignancy, rheumatoid arthritis, and pregnancy. Most appeared to be self-limiting; however, one patient was having his second episode, and the numbness has persisted in three patients. The series illustrates that it is important not only to ensure that the source of the local vaso-occlusive crisis is treated, but also to not miss important differentials such as metastatic disease, where this can be the first presentation of malignancy and would represent a very poor prognosis. There is no reported successful treatment for the hypoesthesia in this case series, and this presents an area for further research.

Occurrence and remission of loss of sensitivity of inferior alveolar nerve in mandibular fractures

ABSTRACT Purpose: to evaluate the occurrence of loss of sensitivity of the inferior alveolar nerve, and to monitor the remission of this change in patients with mandibular fractures subjected to surgical treatment. Methods: patients with mandibular fractures, surgically treated within one year, were prospectively evaluated. Data regarding etiology, fracture location, type and displacement, and surgical access, were obtained. The tactile and thermal tests were applied at eighteen points in the mental region, within a period of six months. Statistical tests were applied to compare the categories of variables and the period of observation (p ≤ 0.050). Results: during the study, 37 patients were included. There were 24 bilateral and 13 unilateral fractures. Sensory changes occurred in 56.8% of the patients in the preoperative period, in 83.8% of the patients, in the postoperative period, and 35.1% of the patients presented complete remission during the final period of the study. Conclusion: sensory changes occurred in about half of the patients, due to the fracture, increasing greatly in the postoperative period, with complete remission in about one third of the cases. The fracture type, degree of displacement and surgical access type influenced the occurrence of sensory alterations.

Advance in Functional Restoration of Injured Nerve with Low Level Laser and its Utilization in the Dental and Maxillofacial Region.

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.

TRANSECTION OF INFERIOR ALVEOLAR NERVE IN THE RAT - NEUROANATOMICAL STUDY AND EXPERIMENTAL MODEL.

OBJECTIVE: Experimental lesions in the inferior alveolar nerve (IAN) are used for the study of peripheral and central alterations. The objective of our study was to contribute to a more precise description of the approach to the IAN and creating a lesion. MATERIAL AND METHODS: Twenty-six males of Wistar laboratory rats were used for the study. The animals were divided into three groups: control group (6 rats), experimental group (12 rats - a part of the bone above the mandibular canal was removed under general anaesthesia using extraoral approach, after exposing a part of the IAN, the nerve was excised in a length of 3 mm), and a sham group (8 rats - the nerve was only dissected but not transected). Persisting denervation was verified using surgical revision and histological and immunohistochemical analysis after the observation period (4 weeks). RESULTS: No evidence of re-innervation after 4 weeks. We found no statistically significant differences in mean weight gains between individual groups during the observation period. CONCLUSION: The described technique used in the study is one of the possible ways to create a nerve lesion at the site of the main trunk of the nerve. At the same time, the study provides a more precise description of the anatomical situation and approach to the IAN in the mandibular canal.

Electromyographic evaluation of the facial and motor donor nerves before facial reanimation surgery in Moebius syndrome.

BACKGROUND: Moebius syndrome is a clinical entity characterized by bilateral facial and abducens nerve palsies; other cranial nerver might be affected as well. So far, no studies have reported the electromyographic responses of the facial musculature in this group of patients. OBJECTIVE: The objective of our study is to describe the electromyographic responses of the facial muscle and the main donor nerves for facial reanimation in patients with Moebius syndrome. METHOD: We analyzed electromyographies from the facial, hypoglossal, masseterine (trigeminal) and accessory nerves from patients with Moebius syndrome treated between 2010 and 2016. Results are presented as percentages and central tendency measures. RESULTS: 24 patients were included, mean age 11.79 ± 9.39 years. The facial nerve showed complete unilateral recruitment in 4 patients, partial bilaterally in 11, 7 showed no activity bilaterally and two had unilateral inactivity. The masseterine was normal in 14 patients, had partial recruitment bilaterally in 4 and unilaterally in 4 cases. The accessory nerve was normal in 20 patients, showed partial recruitment bilaterally in 3 and unilaterally in 1 patients. The hypoglossal was normal in 22 patients, and altered in 2 cases. CONCLUSION: Patients with Moebius syndrome show several degrees of alteration in electromyographic evaluation of the facial nerve. Electromyography is a useful tool in evaluating potential motor donor nerves for facial reanimation surgery.

ANTECEDENTES: El síndrome de Moebius es una entidad clínica caracterizada por parálisis bilateral congénita del nervio facial y el abducens. Adicionalmente se pueden encontrar afectados otros pares craneales. Actualmente no existen estudios que reporten la respuesta electromiográfica de la musculatura facial en esta población. OBJETIVO: Describir la respuesta electromiográfica de la musculatura facial y de los principales nervios donadores para reconstrucción facial dinámica en pacientes con síndrome de Moebius. MÉTODO: Se analizaron electromiografías de los nervios facial, hipogloso, maseterino (trigémino) y accesorio en pacientes con síndrome de Moebius atendidos entre 2010 y 2016. Los resultados se presentan en porcentajes y medidas de tendencia central y de dispersión. RESULTADOS: Se incluyeron 24 pacientes, con una edad promedio de 11.79 ± 9.39 años. El nervio facial presentó reclutamiento unilateral completo en 4 pacientes, parcial bilateral en 11 pacientes, en 7 pacientes ausencia de reclutamiento bilateral e inactividad unilateral en 2 pacientes. El maseterino tuvo reclutamiento completo en 14 pacientes, parcial bilateral en 4 pacientes y parcial unilateral en 4 pacientes. El nervio accesorio mostró reclutamiento completo en 20 pacientes, parcial bilateral en 3 pacientes y parcial unilateral en 1 paciente. El hipogloso mostró actividad normal en 22 pacientes, parcial bilateral en 1 paciente y parcial unilateral en 1 paciente. CONCLUSIÓN: Los pacientes con síndrome de Moebius presentan alteraciones en los registros electromiográficos del nervio facial. La electromiografía permite identificar los nervios donadores para realizar la reconstrucción dinámica.

Assessment of Mandibular Movement Monitoring With Machine Learning Analysis for the Diagnosis of Obstructive Sleep Apnea.

Importance: Given the high prevalence of obstructive sleep apnea (OSA), there is a need for simpler and automated diagnostic approaches. Objective: To evaluate whether mandibular movement (MM) monitoring during sleep coupled with an automated analysis by machine learning is appropriate for OSA diagnosis. Design, Setting, and Participants: Diagnostic study of adults undergoing overnight in-laboratory polysomnography (PSG) as the reference method compared with simultaneous MM monitoring at a sleep clinic in an academic institution (Sleep Laboratory, Centre Hospitalier Universitaire Université Catholique de Louvain Namur Site Sainte-Elisabeth, Namur, Belgium). Patients with suspected OSA were enrolled from July 5, 2017, to October 31, 2018. Main Outcomes and Measures: Obstructive sleep apnea diagnosis required either evoking signs or symptoms or related medical or psychiatric comorbidities coupled with a PSG-derived respiratory disturbance index (PSG-RDI) of at least 5 events/h. A PSG-RDI of at least 15 events/h satisfied the diagnosis criteria even in the absence of associated symptoms or comorbidities. Patients who did not meet these criteria were classified as not having OSA. Agreement analysis and diagnostic performance were assessed by Bland-Altman plot comparing PSG-RDI and the Sunrise system RDI (Sr-RDI) with diagnosis threshold optimization via receiver operating characteristic curves, allowing for evaluation of the device sensitivity and specificity in detecting OSA at 5 events/h and 15 events/h. Results: Among 376 consecutive adults with suspected OSA, the mean (SD) age was 49.7 (13.2) years, the mean (SD) body mass index was 31.0 (7.1), and 207 (55.1%) were men. Reliable agreement was found between PSG-RDI and Sr-RDI in patients without OSA (n = 46; mean difference, 1.31; 95% CI, -1.05 to 3.66 events/h) and in patients with OSA with a PSG-RDI of at least 5 events/h with symptoms (n = 107; mean difference, -0.69; 95% CI, -3.77 to 2.38 events/h). An Sr-RDI underestimation of -11.74 (95% CI, -20.83 to -2.67) events/h in patients with OSA with a PSG-RDI of at least 15 events/h was detected and corrected by optimization of the Sunrise system diagnostic threshold. The Sr-RDI showed diagnostic capability, with areas under the receiver operating characteristic curve of 0.95 (95% CI, 0.92-0.96) and 0.93 (95% CI, 0.90-0.93) for corresponding PSG-RDIs of 5 events/h and 15 events/h, respectively. At the 2 optimal cutoffs of 7.63 events/h and 12.65 events/h, Sr-RDI had accuracy of 0.92 (95% CI, 0.90-0.94) and 0.88 (95% CI, 0.86-0.90) as well as posttest probabilities of 0.99 (95% CI, 0.99-0.99) and 0.89 (95% CI, 0.88-0.91) at PSG-RDIs of at least 5 events/h and at least 15 events/h, respectively, corresponding to positive likelihood ratios of 14.86 (95% CI, 9.86-30.12) and 5.63 (95% CI, 4.92-7.27), respectively. Conclusions and Relevance: Automatic analysis of MM patterns provided reliable performance in RDI calculation. The use of this index in OSA diagnosis appears to be promising.

Effects of inferior alveolar nerve rupture on bone remodeling of the mandible: A preliminary study.

Although various animal studies have indicated that sensory nerves played an important role in bone metabolism and nerve injury could impair the process of bone remodeling, the actual effect of sensory nerve rupture on human bones remains unclear. The aim of this preliminary study was to investigate the effect of inferior alveolar nerve (IAN) rupture on mandibular bone remodeling of patients underwent bilateral sagittal split ramus osteotomy (BSSRO).Ten patients with unilateral IAN rupture during BSSRO were involved in this study. Neurosensory examinations were employed to assess the sensory function of bilateral IAN. The remodeling process of the post-operational mandible was evaluated by panoramic radiographs and computed tomography (CT) scans.Neurosensory examinations indicated that nerve rupture resulted in significant hypoesthesia at the IAN-rupture side. Assessment of panoramic radiographs showed no evident alterations of bone structure at the IAN-rupture side of mandible. Evaluation of CT images also indicated no statistical difference in bone density and thickness between IAN-rupture side and contralateral side.Accordingly, our study indicated that IAN rupture may not significantly impair the short-term bone remodeling process of human mandible.

Heteronymous H reflex in temporal muscle as sign of hyperexcitability in ALS patients.

OBJECTIVE: The stimulation of the masseteric nerve elicits a homonymous and a heteronymous H reflex in the masseter muscle and in the temporalis one. The presence of the H reflex may be considered a sign of upper motor neuron (UMN) involvement in amyotrophic lateral sclerosis (ALS) patients. The aim of this study was to evaluate the presence of the heteronymous H reflex in patients with ALS and compare it with normal subjects. METHODS: We enrolled 36 ALS patients and 52 healthy subjects. We stimulated the masseteric nerve in the infratemporal fossa and recorded the muscle responses ipsilaterally to the stimulation. RESULTS: The heteronymous temporalis H reflex was elicitable in 88.9% of ALS patients and in none of the controls. CONCLUSION: The heteronymous H reflex does not disappear when the stimulation intensity is increased. It can be used as sign of UMN involvement and may prove useful in patients with suspected MND/ALS with purely lower motor neurons (LMN) signs and no signs of UMN involvement. SIGNIFICANCE: The heteronymous H reflex is present far more often in ALS patients than in healthy people. It is a simple test that may be used to detect UMN involvement in patients in whom the only evident signs are LMN impairment, improving diagnosis of ALS.

Effect of Premedication on the Success of Inferior Alveolar Nerve Block in Patients with Irreversible Pulpitis: A Systematic Review of the Literature.

BACKGROUND: Failure in the provision of inferior alveolar nerve block anesthesia (IANB) is a significant problem during endodontic treatment of irreversible pulpitis. Various methodologies have been advocated one of which is administration of premedication prior to anesthesia. Despite the considerable number of reports, the topic yet deserves more clarification. This systematic review was conducted to provide an oversight on the effectiveness of premedication prior to IANB in mandibular teeth. METHODS: A PubMed and Cochrane Database search was conducted by using MeSH terms inferior alveolar nerve block + pulpitis and mandibular anesthesia+pulpitis. Two reviewers independently performed the screening, selection of papers, and data extraction. Papers in English language that included randomized clinical studies on the impact of different medications on the success of inferior alveolar block anesthesia in irreversible pulpitis were included. Additionally, relevant supporting literature was also used where necessary. RESULTS: Initially, 118 papers were selected from PubMed and 68 were selected from Cochrane. Five additional articles were retrieved from Google Search. Following the elimination of duplicates and irrelevant articles, 35 studies were selected meeting the criteria. It was observed that there was moderate evidence to suggest that some premedications were partially effective for the enhancement of mandibular anesthetic effect in irreversible pulpitis. CONCLUSION: Though some medications appear to be promising, further supporting research will help highlight this significant topic which requires further clarification.

Auriculotemporal Nerve Involvement in Parotid Bed Malignancy.

OBJECTIVE: To identify and evaluate patients with parotid bed malignancy demonstrating radiographic findings of auriculotemporal (AT) nerve involvement. METHODS: A retrospective review of patients with parotid bed malignancy was performed to identify patients with imaging findings of AT nerve involvement and record associated clinical findings, symptoms, and pathology information. Independent, blinded review of radiographic images by a senior neuroradiologist was performed to identify imaging characteristics and categorize patients into highly likely or possible involvement groups. RESULTS: Of 547 patients identified with parotid bed malignancy, 23 patients exhibited radiographic findings suggestive of AT nerve involvement. Thirteen patients met criteria for highly likely involvement, and 10 patients met criteria for possible involvement. Cutaneous malignancy with metastasis to the parotid bed accounted for 11 of 23 patients, and the most common histology was squamous cell carcinoma (9 patients). Primary parotid malignancy accounted for 12 of 23 patients, and the most common histology was salivary ductal carcinoma (3 patients). All 13 highly likely patients reported periauricular pain, and 11 of 13 demonstrated facial weakness. Features suggesting advanced disease included radiographic findings of intracranial involvement (10/23 patients), nonsurgical primary treatment (13/23 patients), and positive margins on pathology report (7/10 patients). CONCLUSION: AT nerve involvement is an uncommon but important phenomenon that often occurs in the setting of advanced disease and is commonly associated with periauricular pain and coexisting facial weakness. Awareness of the associated clinical features and imaging patterns can allow for appropriate identification of this pattern of spread and help to optimize treatment planning.

Validation of diagnostic methods for traumatic sensory neuropathy and neuropathic pain.

INTRODUCTION: We evaluated diagnostic value of sensory tests during recovery from iatrogenic sensory neuropathy using intraoperatively verified nerve injury with subjective symptoms as gold standard. METHODS: Inferior alveolar nerves were monitored neurophysiologically throughout mandibular osteotomy in 19 patients. Sensory disturbance was registered and sensation tested using clinical and quantitative sensory (QST) and neurophysiologic tests postoperatively at 1, 3, 6, and 12 months. Sensitivity, specificity, and predictive values were calculated for all tests. RESULTS: The sensitivity of clinical tests was at best 37%, with 100% specificity, but they lost diagnostic value at chronic stages. Best diagnostic accuracy (highest combination of sensitivity and specificity) at different time points was achieved by combining neurophysiologic and thermal QST or tactile and thermal QST. The single most accurate test was sensory neurography. CONCLUSIONS: Neurography or combinations of neurophysiologic and quantitative tests enables most reliable early and late diagnosis. Clinical sensory examination is inadequate for accurate diagnosis. Muscle Nerve 59:342-347, 2019.

Ethanol-Induced Cervical Sympathetic Ganglion Block Applications for Promoting Canine Inferior Alveolar Nerve Regeneration Using an Artificial Nerve.

Polyglycolic acid collagen (PGA-C) tubes are bio-absorbable nerve tubes filled with collagen of multi-chamber structure, which consist of thin collagen films. Favorable clinical outcomes have been achieved when using these tubes for the treatment of damaged inferior alveolar nerve (IAN). A critical factor for the successful nerve regeneration using PGA-C tubes is blood supply to the surrounding tissue. Cervical sympathetic ganglion block (CSGB) creates a sympathetic blockade in the head and neck region thus increasing blood flow in the area. To ensure an adequate effect, the blockade must be administered with local anesthetics one to two times a day for several consecutive weeks; this poses a challenge when creating animal models for investigating this technique. To address this limitation, we developed an ethanol-induced CSGB in a canine model of long-term increase in blood flow in the orofacial region. We examined whether IAN regeneration via PGA-C tube implantation can be enhanced by this model. Fourteen Beagles were each implanted with a PGA-C tube across a 10-mm gap in the left IAN. The IAN is located within the mandibular canal surrounded by bone, therefore we chose piezoelectric surgery, consisting of ultrasonic waves, for bone processing, in order to minimize the risk of nerve and vessel injury. A good surgical outcome was obtained with this approach. A week after surgery, seven of these dogs were subjected to left CSGB by injection of ethanol. Ethanol-induced CSGB resulted in improved nerve regeneration, suggesting that the increased blood flow effectively promotes nerve regeneration in IAN defects. This canine model can contribute to further research on the long-term effects of CSGB.

Wide Intraoral Surgical Access to the Inferior Alveolar Nerve During Cryotherapy at the Infratemporal Fossa: Technical Modification.

Trigeminal neuralgia is characterized by unilateral pain in the region supplied by the sensory distribution of the fifth cranial nerve. Pharmacologic therapy is an adequate initial treatment option in 75% of patients. When the Jannetta surgical operation is not available or not indicated and when conservative treatment fails to relieve the pain or the medication has to be discontinued because of side effects, one of the remaining surgical options is cryosurgery in the peripherally distributed nerves that emanate from the trigeminal nerve. This technical note describes a perioperative method for exposing and mobilizing the inferior alveolar nerve (IAN) from its bony canal. This approach provided easy access to infratemporal fossa structures during cryotherapy. This technique represented a further development of the technique previously described by the authors. This method ensured direct visualization of the IAN and wide access to theinfratemporal fossa during IAN cryotherapy.

Experimental Study on Involvement of the Central Nervous System in Inferior Alveolar Nerve Damage-Associated Hyperalgesia of the Mental Region.

PURPOSE: Involvement of the central nervous system in sensory disturbances of the mental region occurring after inferior alveolar nerve damage was investigated using a rat model of inferior alveolar nerve damage. PATIENTS AND METHODS: The rat inferior alveolar nerve was damaged by ligation with thread, and the course of behavioral changes after surgery was observed for 42 days. In addition, activation of microglia and astroglia in the trigeminal spinal subnucleus caudalis (Vc) was analyzed using immunohistochemistry. c-Fos-positive cells were quantitatively evaluated to analyze the state of neuron excitement. RESULTS: The withdrawal threshold was significantly decreased 5 days after surgery in the inferior alveolar nerve-ligated (IANL) group compared with that in the sham group and subsequently recovered over time. In addition, microglia and astroglia were activated in the Vc region 5 days after surgery in the model group, and c-fos-positive cells were also significantly more frequent in the IANL group. However, no significant difference in the withdrawal threshold was seen between the IANL and sham groups on day 42, nor were any significant differences seen in the amounts of microglia, astroglia, or c-fos-positive cells. CONCLUSIONS: Interactions among microglia, astroglia, and neurons in the central nervous system might be involved in the progression of inferior alveolar nerve damage-associated mental hyperalgesia to a chronic state.

Stylohyoid Muscle Transfer in Marginal Mandibular Nerve Palsy.

Isolated paralysis of the marginal mandibular nerve results in an asymmetrical lip appearance with aesthetic and functional losses. Until today treatment options include mainly muscle transfers, and botulinium toxin injections for temporary issues. Since it was first reported by Edgerton, the technique of anterior belly of digastric transfer has been one of the most preferred. Alternatives for this technique still remain limited. In this clinical report, a new alternative technique was defined, stylohyoid muscle transfer, for the situations that digastric muscle is absent. The technique was compared with other conventional treatment methods and the outcomes were discussed.

Effects of Inferior Alveolar Nerve Neurosensory Deficits on Quality of Life.

OBJECTIVE: The purpose of this study was to investigate the effect of temporary or persistent neurosensory disturbance of the inferior alveolar nerve (IAN) on the quality of life using Oral Health Impact Profile (OHIP-14) questionnaire. METHODS: The patients with the neurosensory deficit of the IAN that was confirmed by subjective and objective neurosensory tests formed the study group. The patients who had dental or oral and maxillofacial surgery procedures in the same unit and did not present neurosensory deficit were matched with the study group according to their gender and age and were presented as the control group. Both groups filled OHIP-14 questionnaire. RESULTS: This study included 200 patients (122 female and 78 male), aged between 18 and 75 years. Kolmogrov-Smirnov, Levene, Mann-Whitney U, and Kruskal Wallis tests were used for statistical analysis. In study group, the average OHIP-14 scores were higher in women than in men in physical pain and handicap subgroups. There were significant differences between study and control groups in functional limitation, psychological discomfort, psychological disability, and handicap subgroups. The OHIP-14 scores were higher in study group compared with the control group. CONCLUSION: It was concluded that the patients with the neurosensory deficit of the IAN have a poorer quality of life than those without neurosensory deficits.

Laser Biophotomodulation in Patients with Neurosensory Disturbance of the Inferior Alveolar Nerve After Sagittal Split Ramus Osteotomy: A 2-Year Follow-Up Study.

OBJECTIVE: To evaluate the effect of the application of photobiomodulation in a 2-year follow-up period in patients who have been intervened with a sagittal ramus split osteotomy and present neurosensory disturbance of the inferior alveolar nerve. BACKGROUND: Photobiomodulation is a common clinical tool in dentistry, for its beneficial effects have been shown in surgical and periodontal wound healing, reducing of swelling and pain, neurosensory recovery, and treatment of temporomandibular joint disorders. METHODS: This is a 2-year follow-up study with an experimental (Laser) group (n = 33) that received photobiomodulation, and a control (Sham) group (n = 9), placebo. All patients from the Laser group received laser applications (continuous wave of 0.353 W/cm2, 27 J in 270 sec per session) on days 1, 2, 3, 5, 10, 14, 21, and 28 after surgery. Neurosensory disturbance was evaluated with five tests: Visual Analog Scale (VAS) for pain and sensitivity, sensitivity threshold test, two-point discrimination, and thermal discrimination. All tests were performed before (24 h before surgery) and after surgery (24 h, 28 days, 60 days, 6 months, 1 year, 2 years, more than 2 years). Participants and evaluator were blinded to intervention. Variables were described with absolute frequencies, percentages, and medians. Ordinal and dichotomous variables were compared with Mann-Whitney's and Fisher's tests, respectively. RESULTS: Clinical improvement was observed during the follow-up period for the Laser group; general VAS for sensitivity was normal in 11 participants from the Laser group at 2 years postsurgery (40.74%), while no participants from the Sham group achieved this (p = 0.0341). Twenty-three participants recovered initial values for two-point discrimination (69.7%) after 2 years of follow-up (p = 0.0025) as well as sensitivity threshold test. General VAS for pain was normal in 31 patients from the Laser group after 2 years of follow-up (93.94%, p = 0.0254). CONCLUSIONS: Photobiomodulation was effective for neurosensory recovery on sample studied.

Risk of inferior alveolar nerve injury with coronectomy vs surgical extraction of mandibular third molars-A comparison of two techniques and review of the literature.

The removal of mandibular third molar teeth is one of the most common oral surgical procedures. In a significant number of patients, it carries a degree of associated morbidity, including damage to the inferior alveolar nerve (IAN). For this reason, practitioners desire the most up-to-date guidance on the most appropriate technique, informed by the best available evidence that will produce the lowest incidence of iatrogenic complications. The aim of this study was to perform a systematic review comparing the effect of coronectomy vs complete surgical extraction of mandibular third molar teeth on the risk of IAN injury and other complications in adults. Studies were identified through Embase (1980-2016) and Ovid MEDLINE (1946-2016) database searches. Search terms included coronectomy, partial root removal, deliberate vital root retention, odontectomy, surgical removal, surgical extraction, complete tooth extraction and extract. Limits of the study included humans, English language and randomised controlled trials (RCTs). Only RCTs comparing IAN damage associated with surgical extraction of mandibular third molars vs coronectomy were included. From our database searches, we identified two unique RCTs matching the inclusion criteria. Both evaluated patients who had specific radiographic signs of intimate relationships with the IAN. Upon detailed analysis, the studies were noted to exhibit a high risk of bias in many categories, thereby rendering their results inconclusive. Although evidence from two RCTs suggests that coronectomy can reduce the risk of IAN injury compared to surgical removal of high-risk mandibular third molars, the quality of evidence is insufficient to provide definitive conclusions regarding the preferred technique.

Relapse of B-cell acute lymphoblastic leukaemia presenting as right aural polyp with facial and mandibular nerves palsy.

A patient presenting with an ear polyp is a common finding in otorhinolaryngology practice. The common causes include chronic otitis media and cholesteatoma. We report an adult female patient with a history of acute leukaemia presenting with chronic otitis media symptoms and right ear polyp. She was subsequently diagnosed as relapse of B-cell acute lymphoblastic leukaemia based on histopathological examination. The presentation may be similar to an inflammatory pathology of the middle ear, making it misleading.

[Protecting the inferior alveolar nerve: coronectomy of lower third molars. Review]. / A nervus alveolaris inferior védelmében: alsó bölcsességfogak coronectomiája. Irodalmi áttekintés.

Coronectomy of lower impacted wisdom teeth is the partial removal of third molars, aiming to avoid inferior alveolar nerve injuries. The coronectomy procedure has several crucial points, such as the pulpal, periapical preoperative conditions of the tooth, the way of crown sectioning and decoronation, the wound closure and the length of patients' follow up. In addition it is important to identify and manage possible intraoperative or postoperative complications correctly. According to the literature, the complication rate of coronectomy is usually lower, than that of total teeth removal, furthermore considering inferior alveolar nerve injuries, coronectomy is significantly the safer procedure. The aim of the authors was to review the relevant literature, defining the indications, contraindications and the correct implementation of the coronectomy and to demonstrate the causes and incidences of failures and complications. Further aim was to promote the domestic acceptance of this procedure. Orv Hetil. 2017; 158(45): 1787-1793.