NEUROSTOMATOLOGICAL DISEASES AS A RESULT OF ERRORS AND COMPLICATIONS IN DENTAL PRACTICE

В настоящей работе приведены результаты анализа 118 амбулаторных карт пациентов с нейростоматологическими заболеваниями (исключая идиопатическую невралгию тройничного нерва), которые в 77 (65,2%) случаях были обусловлены врачебными ошибками и осложнениями стоматологических вмешательств. This paper presents the results of an analysis of 118 outpatient records of patients with neurostomatological diseases (excluding idiopathic trigeminal neuralgia), which in 77 (65,2%) cases were due to medical errors and complications of dental interventions.

Comparison of Effectiveness and Safety between Intraoperative 3D-CT-Guided and C-Arm-Guided Percutaneous Balloon Compression for Idiopathic Trigeminal Neuralgia: A Multi-Center Retrospective Study

Objectives. To compare 3D-CT-guided and C-arm-guided percutaneous balloon compression (PBC) in terms of effectiveness and safety. Methods. The medical records and follow-up data of patients with idiopathic trigeminal neuralgia who underwent 3D-CT-guided or C-arm-guided PBCs in Beijing Tiantan Hospital and the Characteristic Medical Center of the Chinese People’s Armed Police Force between February 2018 and March 2020 were retrospectively reviewed and analysed. Results. A total of 291 patients were included. Among them, 212 patients underwent PBC treatment with 3D-CT and others with C-arm. One (0.5%) patient in 3D-CT group and 4 (5.1%) patients in C-arm group failed to receive PBC treatment because of failure of foramen ovale (FO) puncture ( P = 0.020 ). Among patients with successful attempts, 5 (2.4%) patients in the 3D-CT group and 11 (14.7%) patients in the C-arm group received more than one needle pass during the procedure ( P < 0.001 ). The 3D-CT group required less time than the C-arm group for puncture ( P < 0.001 ) and for the whole operation ( P < 0.001 ). The groups shared similar initial relief rates ( P = 0.749 ) and similar recurrence-free survival during follow-ups for a median of 22 months ( P = 0.839 ). No puncture-related complications occurred in either group and the two groups had similar incidences of compression-related complications. Conclusion. 3D-CT facilitated FO puncture and improved success rate of PBC. The overall time efficiency of PBC was also increased with 3D-CT. Thus, 3D-CT is a potentially useful image guidance technology for treating idiopathic trigeminal neuralgia by PBC.

The comparison of efficacy and complications of coblation and radiofrequency thermocoagulation for V2/V3 idiopathic trigeminal neuralgia: a retrospective cohort study of 292 cases

Background Coblation is a novel technique in respect of treating idiopathic trigeminal neuralgia. We aimed to identify the efficacy and complications between radiofrequency thermocoagulation (RFT) and coblation for V2/V3 idiopathic trigeminal neuralgia (ITN) and investigate the risk factors associated with postoperative facial numbness. Methods: We retrospectively reviewed our cohort of 292 patients who had undergone RFT or coblation for V2/V3 ITN. The characteristics of the baseline were collected before surgery. Pain scores, the degree of facial numbness and other complications were evaluated at discharge and 1 month, 3 months, 6 months and 12 months after surgery. Results Postoperative pain intensity was apparently alleviated in both groups. The initial and 12-months remission rates were 94.0 and 75.3% in coblation group compared with 96.9 and 78.4% in RFT group (P = 0.462, P = 0.585). The degree of postoperative facial numbness tended to be more severe in RFT group at discharge, 1 month, 6 months and 12 months (P = 0.006, P = 0.026, P = 0.004, P = 0.003). Factors significantly associated with more severe facial numbness were procedure of RFT (OR = 0.46, 95%CI: 0.28–0.76, P = 0.002), history of previous RFT at the affected side (OR = 2.33, 95%CI: 1.21–4.48, P = 0.011), and ITN with concomitant continuous pain (OR = 0.36, 95%CI: 0.18–0.71, P = 0.004). Conclusion Coblation could reduce the degree of postoperative facial numbness for ITN, and the efficacy was no less effective than RFT. History of previous RFT at the affected side, procedure of RFT, ITN with concomitant continuous pain was identified as significant factors of the development of postoperative facial numbness.

The Comparison of Efficacy and Complications of Coblation and Radiofrequency Thermocoagulation for V2/V3 Idiopathic Trigeminal Neuralgia: A Retrospective Cohort Study of 292 Cases

Background: Coblation is a novel technique in respect of treating idiopathic trigeminal neuralgia. We aimed to identify the efficacy and complications between radiofrequency thermocoagulation (RFT) and coblation for V2/V3 idiopathic trigeminal neuralgia (ITN) and investigate the risk factors associated with postoperative facial numbness.Methods: We retrospectively reviewed our cohort of 292 patients who had undergone RFT or coblation for V2/V3 ITN. The characteristics of the baseline were collected before surgery. Pain scores, the degree of facial numbness and other complications were evaluated at discharge and 1month, 3 months, 6 months and 12 months after surgery.Results: Postoperative pain intensity was apparently alleviated in both groups. The initial and 12-months remission rates were 94.0% and 75.3% in coblation group compared with 96.9% and 78.4% in RFT group (P=0.462, P=0.585). The degree of postoperative facial numbness tended to be more severe in RFT group at discharge, 1 month, 6 months and 12 months (P=0.006, P=0.026, P=0.004, P=0.003). Factors significantly associated with more severe facial numbness were procedure of RFT (OR=0.46, 95%CI: 0.28-0.76, P=0.002), history of previous RFT at the affected side (OR=2.33, 95%CI: 1.21-4.48, P=0.011), and ITN with concomitant continuous pain (OR=0.36, 95%CI: 0.18-0.71, P=0.004).Conclusion: Coblation could reduce the degree of postoperative facial numbness for ITN, and the efficacy was no less effective than RFT. History of previous RFT at the affected side, procedure of RFT, ITN with concomitant continuous pain was identified as significant factors of the development of postoperative facial numbness.

Novel fluoroscopic landmark to significantly facilitate the visualization of foramen ovale in treating idiopathic trigeminal neuralgia

Background and objectivesAccess through the foramen ovale (FO) is essential in performing trigeminal ganglion injection, glycerol rhizolysis, balloon compression, and radiofrequency thermocoagulation (RFT) to treat idiopathic trigeminal neuralgia (ITN). However, identification of the FO under fluoroscopy can be difficult and time-consuming, and thus exposes patients to increased radiation and procedure risks. Here we present the ‘H-figure’ as a novel fluoroscopic landmark to quickly visualize the FO.MethodsThe H-figure landmark can be recognized as the medial border of the mandible and the lateral edge of the maxilla as the two vertical lines, and the superior line of petrous ridge of temporal bone (S-P-T line) as the horizontal line, and the FO fluoroscopic view is then optimized at the center of the H-figure immediately above the S-P-T line. We applied this landmark in a clinical cohort of 136 patients with ITN who underwent fluoroscopy-guided RFT of the trigeminal ganglion. We also compared the H-figure method with the traditional method. The primary outcome was the total number of fluoroscopic images required to visualize the FO (as a proxy of radiation exposure). Secondary measures included the procedure time required to finalize the FO view and the sensory testing voltage for paresthesia.ResultsWith the H-figure approach we were able to view the FO with an average of 4.2 fluoroscopic shots at an average time of 6.8 min. When compared with the non-H-figure traditional technique, the H-figure method required almost half the fluoroscopic shots in nearly half the procedure duration time, and paresthesia was evoked with half of the voltage.ConclusionThe H-figure is an easy fluoroscopic landmark that can help to view the FO with less radiation and procedure time, and the needles placed with this approach can be closer to the target for the RFT treatment of patients with ITN.

Novel theory about radiosurgery’s action mechanisms on trigeminal ganglion for idiopathic trigeminal neuralgia: Role of the satellite glial cells

Background: There are many theories about the cause of trigeminal neuralgia (TN). None of them satisfactorily explains how demyelination alone through the ephaptic mechanism can contribute to the development of the TN crisis. The main characteristic of TN pain is its dynamic nature, which is difficult to explain based only on anatomical findings. With these antecedents, the exact mechanism by which radiosurgery produces pain relief in TN is unknown. Methods: It is based on the trigeminal ganglion (TG) cytoarchitecture and the pathophysiological findings observed after an injury to a trigeminal branch. TG seems to have a predominant role given its cellular structure. The neuronal component in sensory ganglia is generally surrounded by a single layer of satellite glial cells (SGC), which forms a sheath around each body cell. There is increasing evidence that SGCs play a key role in nociception. This depends on their ability to influence the neuronal excitability that occurs in conditions of neuropathic and inflammatory pain; contributing to both the generation and maintenance of pain. Results: We have already published the beneficial effects of radiosurgery on the TG for the treatment of idiopathic TN and secondary to vertebrobasilar ectasia. Now, we are investigating the functioning of the TG and how radiosurgery could act on the SGC, deactivating them, and contributing to the decrease or disappearance of the painful condition. Conclusion: We are postulating a theory on how radiosurgery in TG produces changes in the SGC, with implications in the pathological mechanisms initiated by the alteration caused in the neuron after a nerve injury.