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Sabalys G, Juodzbalys G, Wang HL. Aetiology and pathogenesis of trigeminal neuralgia: a comprehensive review. J Oral Maxillofac Res 2013; 3:e2. [PMID: 24422020 PMCID: PMC3886096 DOI: 10.5037/jomr.2012.3402] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/29/2012] [Indexed: 11/29/2022]
Abstract
Objectives The aim of present paper was to discuss issues related to trigeminal
neuralgia with strong emphasis on the aetiology and pathogenesis of this
problem. Material and Methods An electronic search of 5 databases (1965 - Oct 2012) and a hand search of
peer-reviewed journals for relevant articles were performed. In addition,
experience acquired from treating 3263 patients in the Department of
Maxillofacial Surgery, Lithuanian University of Health Sciences, were also
summarized. Results Generally, aetiological factors can be classified into 3 most popular
theories that were based on: 1) Related to other disease, 2) Direct injury
to the trigeminal nerve, and 3) Propagates the polyetiologic origin of the
disease. In addition, two pathogenesis mechanisms of trigeminal neuralgia
were proposed. First: the peripheral pathogenetic mechanism that is often
induced by progressive dystrophy around the peripheral branches of the
trigeminal nerve. Second, central pathogenetic mechanism which often
triggered by peripheral pathogen that causes long-lasting afferent
impulsation and the formation of a stable pathologic paroxysmal type
irritation focus on the central nerve system (CNS). Conclusions Patients with susceptive trigeminal neuralgia should be examined carefully by
specialists who have expertise in assessing and diagnosing of possible
pathological processes and be able to eliminate the contributing factors so
the trigeminal neuralgia can be properly managed.
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Affiliation(s)
- Gintautas Sabalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences Kaunas Lithuania
| | - Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences Kaunas Lithuania
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan Ann Arbor, Michigan USA
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Juodzbalys G, Wang HL, Sabalys G, Sidlauskas A, Galindo-Moreno P. Inferior alveolar nerve injury associated with implant surgery. Clin Oral Implants Res 2011; 24:183-90. [DOI: 10.1111/j.1600-0501.2011.02314.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2011] [Indexed: 11/27/2022]
Affiliation(s)
- Gintaras Juodzbalys
- Department of Maxillofacial Surgery; Lithuanian University of Health Sciences; Kaunas; Lithuania
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine; School of Dentistry; University of Michigan; Ann Arbor; MI; USA
| | - Gintautas Sabalys
- Department of Maxillofacial Surgery; Lithuanian University of Health Sciences; Kaunas; Lithuania
| | - Antanas Sidlauskas
- Clinic of Orthodontics; Lithuanian University of Health Sciences; Kaunas; Lithuania
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Juodzbalys G, Wang HL, Sabalys G. Injury of the Inferior Alveolar Nerve during Implant Placement: a Literature Review. J Oral Maxillofac Res 2011; 2:e1. [PMID: 24421983 PMCID: PMC3886063 DOI: 10.5037/jomr.2011.2101] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 01/10/2011] [Indexed: 12/25/2022]
Abstract
Objectives The purpose of present article was to review aetiological factors,
mechanism, clinical symptoms, and diagnostic methods as well as to
create treatment guidelines for the management of inferior alveolar
nerve injury during dental implant placement. Material and Methods Literature was selected through a search of PubMed, Embase and Cochrane
electronic databases. The keywords used for search were inferior
alveolar nerve injury, inferior alveolar nerve injuries, inferior
alveolar nerve injury implant, inferior alveolar nerve damage, inferior
alveolar nerve paresthesia and inferior alveolar nerve repair. The
search was restricted to English language articles, published from 1972
to November 2010. Additionally, a manual search in the major anatomy,
dental implant, periodontal and oral surgery journals and books were
performed. The publications there selected by including clinical, human
anatomy and physiology studies. Results In total 136 literature sources were obtained and reviewed. Aetiological
factors of inferior alveolar nerve injury, risk factors, mechanism,
clinical sensory nerve examination methods, clinical symptoms and
treatment were discussed. Guidelines were created to illustrate the
methods used to prevent and manage inferior alveolar nerve injury before
or after dental implant placement. Conclusions The damage of inferior alveolar nerve during the dental implant
placement can be a serious complication. Clinician should recognise and
exclude aetiological factors leading to nerve injury. Proper presurgery
planning, timely diagnosis and treatment are the key to avoid nerve
sensory disturbances management.
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Affiliation(s)
- Gintaras Juodzbalys
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas Lithuania
| | - Hom-Lay Wang
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas Lithuania
| | - Gintautas Sabalys
- Department of Oral and Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas Lithuania
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Lukošiūnas A, Kubilius R, Sabalys G, Keizeris T, Sakavičius D. An analysis of etiological factors for traumatic mandibular osteomyelitis. Medicina (Kaunas) 2011; 47:380-385. [PMID: 22112987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the factors that were associated with the development of osteomyelitis during the treatment of mandibular fractures. MATERIAL AND METHODS The data of 3188 patients with mandibular fractures treated during 2002-2009 were analyzed. Traumatic osteomyelitis of the mandible was diagnosed in 207 patients. The background factors of complications were studied and compared with the control group (100 patients) not having complications after treatment of mandibular fractures. The data of clinical, roentgenologic, microbiological, and immunological investigations were analyzed. A logistic regression model was developed to identify the factors for osteomyelitis development. RESULTS The treatment in 6.5% of patients was complicated with osteomyelitis; 88.5% of these patients were men, and more than 80% of patients were younger than 50 years. In 86.8% of cases, Staphylococcus species were isolated, with Staphylococcus aureus accounting for 69.1% of cases. The following factors were found to be associated with osteomyelitis development: immunity dysfunction, caries-affected teeth at the fracture line, mobile fractured bones, bone fixation after more than 7 days following trauma, healthy teeth at the fracture line, insufficient bone reposition, and bone fixation after 3-7 days following trauma. CONCLUSION Comparative analysis of factors influencing the treatment results revealed a great importance of immunological and dental status and microflora at the affected site. Insufficient or late reposition and fixation of fractured bone fragments play a significant role in the healing process.
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Affiliation(s)
- Algirdas Lukošiūnas
- Department of Maxillofacial Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Guobis Ž, Kareivienė V, Basevičienė N, Paipalienė P, Niedzelskienė I, Sabalys G, Kubilius R, Gervickas A. Microflora of the oral cavity in patients with xerostomia. Medicina (Kaunas) 2011; 47:646-651. [PMID: 22370462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the dependence of the condition of the microflora of the oral cavity on the etiology of xerostomia, patients' sex, age, degree of hyposalivation, and duration of the sense of dryness. MATERIAL AND METHODS A total of 64 patients with complaints of oral dryness referred to the Clinic of Oral and Dental Diseases, Hospital of Lithuanian University of Health Sciences, for consultation during the period from 2003 to 2005 were selected for the study. The etiological factors of xerostomia were as follows: radiotherapy (PRT) to the maxillofacial area, Sjögren's syndrome (SS), and xerogenic medications, tricyclic antidepressants (TCAs). RESULTS There were 50 women and 14 men. Their mean age was 60.5 ± 1.6 years. All the patients in the PRT group had high counts of Candida spp. as compared with percentages of patients in the TCA and SS groups (100% vs. 66.7% and 56.2%, P<0.05). Patients' age and sex in different etiology groups had no significant impact on the condition of their oral microflora. There were equal percentages of patients with deficient and normal salivation in the TCA group (44% in both the groups; P<0.01). All the patients in the PRT group had pronounced hyposalivation (P<0.002). A significantly greater percentage of patients with severely reduced salivation had high counts of Lactobacillus spp. (P<0.01). Significantly greater percentages of patients with the clinical duration of xerostomia of up to 6 months had high counts of Lactobacillus spp. and Candida spp. colonies. CONCLUSIONS In patients with xerostomia, the condition of the microflora of the oral cavity and impairment of major salivary gland function varied according to the etiology of the disease. The level of hyposalivation and the duration of xerostomia were found to have a significant impact on the microflora of the oral cavity.
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Affiliation(s)
- Žygimantas Guobis
- Department of Dental and Oral Pathology, Medical Academy, Lithuanian University of Health Sciences, Eivenių 2, 50028 Kaunas, Lithuania.
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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:e2. [PMID: 24421958 PMCID: PMC3886040 DOI: 10.5037/jomr.2010.1102] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Accepted: 12/31/2009] [Indexed: 11/27/2022]
Abstract
Objectives It is critical to determine the location and configuration of the mandibular canal and related vital structures during the implant treatment. The purpose of the present study was to review the literature concerning the mandibular canal and inferior alveolar neurovascular bundle anatomical variations related to the implant surgery. Material and Methods Literature was selected through the search of PubMed, Embase and Cochrane electronic databases. The keywords used for search were mandibular canal, inferior alveolar nerve, and inferior alveolar neurovascular bundle. The search was restricted to English language articles, published from 1973 to November 2009. Additionally, a manual search in the major anatomy, dental implant, prosthetic and periodontal journals and books were performed. Results In total, 46 literature sources were obtained and morphological aspects and variations of the anatomy related to implant treatment in posterior mandible were presented as two entities: intraosseous mandibular canal and associated inferior alveolar neurovascular bundle. Conclusions A review of morphological aspects and variations of the anatomy related to mandibular canal and mandibular vital structures are very important especially in implant therapy since inferior alveolar neurovascular bundle exists in different locations and possesses many variations. Individual, gender, age, race, assessing technique used and degree of edentulous alveolar bone atrophy largely influence these variations. It suggests that osteotomies in implant dentistry should not be developed in the posterior mandible until the position of the mandibular canal is established.
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Affiliation(s)
- Gintaras Juodzbalys
- Department of Oral and Maxillofacial Surgery, Kaunas University of Medicine Lithuania
| | - Hom-Lay Wang
- Department of Oral and Maxillofacial Surgery, Kaunas University of Medicine Lithuania
| | - Gintautas Sabalys
- Department of Oral and Maxillofacial Surgery, Kaunas University of Medicine Lithuania
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Juodzbalys G, Wang HL, Sabalys G. Anatomy of Mandibular Vital Structures. Part II: Mandibular Incisive Canal, Mental Foramen and Associated Neurovascular Bundles in Relation with Dental Implantology. J Oral Maxillofac Res 2010; 1:e3. [PMID: 24421959 PMCID: PMC3886037 DOI: 10.5037/jomr.2010.1103] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 12/22/2009] [Indexed: 11/16/2022]
Abstract
Objectives The purpose of the present study was to review the literature of
how to identify the mental foramen, mandibular incisive canal and
associated neurovascular bundles during implant surgery and how
to detect and avoid the damage of these vital structures during
implant therapy. Material and Methods Literature was
selected through a search of PubMed, Embase and Cochrane electronic
databases. The keywords used for search were mandibular incisive
canal, mental foramen, mental nerve, anterior mental loop. The search
was restricted to English language articles, published from 1979
to November 2009. Additionally, a manual search in the major anatomy,
dental implant, and periodontal journals and books was performed. Results In total, 47 literature
sources were obtained and reviewed. The morphology and variations
of the mandibular incisive canal, mental foramen and associated
neurovascular bundles were presented as two entities. It suggested
that clinicians should carefully assess these vital structures to
avoid nerve/artery damage. Conclusions The mandibular incisive canal, mental foramen and associated neurovascular
bundles exist in different locations and possess many variations.
Individual, gender, age, race, assessing technique used and degree
of edentulous alveolar bone atrophy largely influence these variations.
It suggests that the clinicians should carefully identify these
anatomical landmarks, by analyzing all influencing factors, prior
to their implant surgical operation.
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Affiliation(s)
- Gintaras Juodzbalys
- Department of Oral and Maxillofacial Surgery, Kaunas University of Medicine Lithuania
| | - Hom-Lay Wang
- Department of Oral and Maxillofacial Surgery, Kaunas University of Medicine Lithuania
| | - Gintautas Sabalys
- Department of Oral and Maxillofacial Surgery, Kaunas University of Medicine Lithuania
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Guobis Z, Baseviciene N, Paipaliene P, Sabalys G, Kubilius R. [Xerostomia: clinic, etiology, diagnosis and treatment]. Medicina (Kaunas) 2006; 42:171-9. [PMID: 16528134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
The aim of this article is to review the problem of xerostomia considering its clinical, etiological, diagnostic and treatment features, basing on the today's tutorials and scientific articles found in databases on the Internet. Recent epidemiologic data on the prevalence of xerostomia in different countries are introduced. There are analyzed the main aspects of clinical manifestations of xerostomia, according to the different etiology analyzed. The most common etiological factors causing xerostomia, especially the main three of them: radiation therapy, Sjögren's syndrome, and drugs, are pointed out. The most popular and accepted clinical and laboratory assays for measuring and evaluating the function of salivary glands are represented. Attention is paid to xerostomia as substantiation of the separate diagnosis and its role in diagnosing other diseases. The concept of possible treatment modalities and prognosis are discussed. The main and most common problems concerning xerostomia are revealed.
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Affiliation(s)
- Zygimantas Guobis
- Clinic of Dental and Oral Diseases, Kaunas University of Medicine, Kaunas, Lithuania.
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Razukevicius D, Sabalys G, Kubilius R. Comparative analysis of the effectiveness of the mandibular angle fracture treatment methods. Stomatologija 2005; 7:35-9. [PMID: 16254463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
425 patients with mandibular angle fractures were treated at the Hospital of Kaunas University of Medicine (HKUM) Clinic of Maxillo-Facial Surgery. Treatment included the application of closed fracture fragments fixation methods (wire splint fixation, and Kirschner wire osteosynthesis), and methods of open fixation--osteosynthesis using the supra-periosteal miniplate, and osteosynthesis using supra-osseous Zes Pol plate (the latter method was modified by the authors). Relative computerized densitometry showed that closed fixation methods result in a faster healing of fractures. The findings of the pain threshold testing showed that open fixation methods more severely damage the function of the lower alveolar nerve. Using closed fixation methods, osteomyelitis occurred in 5.3% of cases, while using open fixation methods--in 15.3% of cases. Thus, the authors of the article maintain that when mandibular angle fractures, in the presence of suitable conditions, closed fracture fragments fixation methods should be given a priority.
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Affiliation(s)
- Dainius Razukevicius
- Department of Maxillofacial Surgery, Kaunas Medical University, Eiveniu 2, Kaunas, Lithuania
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Kubilius R, Sabalys G, Guzeviciene V. [Acute and chronic facial pain due to injured neural plexus of the upper teeth]. Medicina (Kaunas) 2003; 38:272-6. [PMID: 12474698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The general causes of upper dental plexus injury are tooth disturbances and the periodontal tissues diseases, the pathology of maxillary sinus, various traumatically manipulations in the area of tooth and maxilla as well. The main symptom of upper tooth neural plexus injury is acute and chronic pain in the alveolar sprout of maxilla, gums or in the area of singly tooth, which rarely spreads into neighboring maxillofacial areas. The authors recommend that the acute pain syndrome would be called the inflammation of upper tooth plexus, and the chronic pain syndrome--plexopathia of upper tooth. Study presents the differential diagnosis according to character of facial pain syndrome and the data of sensority disorders research and investigation of pain thresholds as well. The recommendations for treatment tactic and methods of analyzed indispositions are suggested.
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Affiliation(s)
- Ricardas Kubilius
- Kauno medicinos universiteto Veido ir zandikauliu chirurgijos klinika, Eiveniu 2, 3007 Kaunas.
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Sakavicius D, Kubilius R, Sabalys G. [Post-traumatic infraorbital nerve neuropathy]. Medicina (Kaunas) 2002; 38:47-51. [PMID: 12474717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The authors have investigated functional state of infraorbital nerve of 479 patients with zygomatic fractures. The degree of nerve damage was evaluated according to changes of pain threshold during damaged nerve stimulation. It was estimated that in 64.3% of zygomatic fractures the infraorbital nerve was affected. The nerve damage degree could be mild, moderate and severe. In 43.18% of moderate and severe nerve damage cases the neuropathy develops. The symptoms, signs and treatment of neuropathy have been described. The neuropathy with clinical symptoms as permanent soreness and paresthesias (itch, "running ant", fibrillations of cheek tissues etc.) in the infraorbital nerve innervation zone occur to 43.18% of the patients after moderate and severe damage of the nerve. The treatment of neuropathy was analysed. In cases of moderate and severe nerve damages, authors recommend to perform decompression of the nerve, because if not applied, the function of nerve does not recover.
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Affiliation(s)
- Dalius Sakavicius
- Kauno medicinos universiteto Veido ir zandikauliu chirurgijos klinika, Eiveniu 2, 3007 Kaunas
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Kubilius R, Sabalys G, Tercijonas P. The experience of treatment of mandibular fractures. Int J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0901-5027(97)81050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tercijonas P, Sabalys G, Kubilius R. The surgical treatment of facial skeleton deformations. Int J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0901-5027(97)81035-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sakavicius D, Sabalys G, Lukosiunas A. A retrospective study of zygomatic fractures. Int J Oral Maxillofac Surg 1997. [DOI: 10.1016/s0901-5027(97)81540-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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