Decompression of inferior alveolar nerve: case report comment

Ngeow, Dr. W.C. (2011) Decompression of inferior alveolar nerve: case report comment. [Journal (Paginated)]

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Paresthesia as a result of mechanical trauma is one of the most frequent sensory disturbances of the inferior alveolar nerve. This case report describes surgical treatment for paresthesia caused by a compressive phenomenon within the mandibular canal. The cause of the compression, a broken instrument left in the patient's mouth during previous endodontic therapy, was identified during routine radiography and computed tomography. Once the foreign object was removed by surgery, the paresthesia resolved quickly. This case highlights the potential for an iatrogenic mechanical cause of paresthesia. Comment : The article by Marques and Gomes (J Can Dent Assoc 2011;77:b34) caught my attention. For your information, there is almost an almost similar case reported recently, but with dysesthesia.1 It is fortunate that the patient in the current case has less severe symptoms (occasional numbness of her left lip and a small part of her chin, and a tingling sensation in the vestibular gingival). What I can deduce from the radiographs shown is that the file was actually lodged onto the wall of the periapical defect and the mandibular canal, and because of this the inferior alveolar nerve (IAN) was spared direct injury. Ikeda et al.2 had shown that there is room between the IAN and the canal. However, as reported by the Marques and Gomes, her symptoms were more aggravated in the morning and during stressful situations. This may be a result of fluid accumulation in the morning, or during any sympathetic (stressful) event, that may result in vasodilatation, and hence compression within the narrow mandibular canal that usually average 3.4 + 0.5 mm in diameter. 2,3 I hope this opinion is of help. Thank you.

Item Type:Journal (Paginated)
Additional Information:Times Cited: 0 Ngeow, W. C.
Keywords:A proposal for the mechanism of compression in the mandibular canal by separated endodontic file
JOURNALS > Online Journal of Health and Allied Sciences
ID Code:8171
Deposited By: Ngeow, A.P. Dr. Wei Cheong
Deposited On:25 Apr 2012 13:00
Last Modified:25 Apr 2012 13:00

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1. Nayak RN, Hiremath S, Shaikh S, Nayak AR. Dysesthesia with pain due to a broken endodontic instrument lodged in the mandibular canal—a simple deroofing technique for its retrieval: case report. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;111(2):e48-51.

2. Ikeda K, Ho KC, Nowicki BH, Haughton VM. Multiplanar MR and anatomic study of the mandibular canal. AJNR Am J Neuroradiol 1996;17:579-84.

3. Juodzbalys G, Wang HL, Sabalys G. Anatomy of Mandibular Vital Structures. Part I: Mandibular Canal and Inferior Alveolar Neurovascular Bundle in relation with Dental Implantology. J Oral Maxillofac Res 2010;1(1):e2


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