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Laurent Marsollier - One of the best experts on this subject based on the ideXlab platform.
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mycolactone as analgesic subcutaneous bioavailability parameters
Frontiers in Pharmacology, 2019Co-Authors: Jérémie Babonneau, Estelle Marion, Marieline Reynaert, Jeanpaul Saint Andre, A Croue, Priscille Brodin, David Guilet, Dimitri Breard, Pascal Richomme, Laurent MarsollierAbstract:Mycobacterium ulcerans is the bacillus responsible for Buruli ulcer, an infectious disease and the third most important mycobacterial disease worldwide, after tuberculosis and leprosy. M. ulcerans infection is a type of panniculitis beginning mostly with a nodule or an edema, which can progress to large ulcerative lesions. The lesions are caused by mycolactone, the polyketide toxin of M. ulcerans. Mycolactone plays a central role for host colonization: it provokes an immunomodulatory effect and an analgesic effect. Mycolactone induces analgesia by targeting type-2 angiotensin II receptors (AT2R), causing cellular hyperpolarization. Moreover, a single subcutaneous injection of mycolactone into the mouse footpad can induce long-lasting Hypoesthesia, with significant effects for one to two days. It has been suggested that the long-lasting Hypoesthesia results from the persistence of a significant amount of mycolactone locally, long after the injection, probably due to its slow elimination from tissues. Based on this hypothesis, for the first time, we investigated the correlation between Hypoesthesia and mycolactone bioavailability in the tissue. Various quantities of mycolactone were injected in mouse tissue and Hypoesthesia was recorded, over a period of 48 h, with nociception assays. The Hypoesthesia effect was maximal 6 hours after the injection of 4 µg mycolactone. The return to the basal state 48 h after injection demonstrates the absence of nerve damage. Surprisingly, we have shown that mycolactone levels decreased strongly during the first hours (70% have been eliminated after 4 h, 90% after 10 h) but the small amount remaining was sufficient to induce Hypoesthesia during 24h. Our results demonstrated that mycolactone is rapidly eliminated but very small amounts of mycolactone were sufficient to induce a local biological effect. These results suggest that mycolactone, bound to AT2R, is protected against elimination. On the other hand, our data showed that systemic diffusion of mycolactone in the context of infection is unlikely. To conclude our study underlines that mycolactone could be considered as promising analgesic.
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Mycolactone as Analgesic: Subcutaneous Bioavailability Parameters
Frontiers Media S.A., 2019Co-Authors: Jérémie Babonneau, Estelle Marion, Marieline Reynaert, Jeanpaul Saint Andre, A Croue, Priscille Brodin, David Guilet, Dimitri Breard, Pascal Richomme, Laurent MarsollierAbstract:Mycobacterium ulcerans is the bacillus responsible for Buruli ulcer, an infectious disease and the third most important mycobacterial disease worldwide, after tuberculosis and leprosy. M. ulcerans infection is a type of panniculitis beginning mostly with a nodule or an oedema, which can progress to large ulcerative lesions. The lesions are caused by mycolactone, the polyketide toxin of M. ulcerans. Mycolactone plays a central role for host colonization as it has immunomodulatory and analgesic effects. On one hand, mycolactone induces analgesia by targeting type-2 angiotensin II receptors (AT2R), causing cellular hyperpolarization and neuron desensitization. Indeed, a single subcutaneous injection of mycolactone into the mouse footpad induces a long-lasting Hypoesthesia up to 48 h. It was suggested that the long-lasting Hypoesthesia may result from the persistence of a significant amount of mycolactone locally following its injection, which could be probably due to its slow elimination from tissues. To verify this hypothesis, we investigated the correlation between Hypoesthesia and mycolactone bioavailability directly at the tissue level. Various quantities of mycolactone were then injected in mouse tissue and Hypoesthesia was recorded with nociception assays over a period of 48 h. The Hypoesthesia was maximal 6 h after the injection of 4 μg mycolactone. The basal state was reached 48 h after injection, which demonstrated the absence of nerve damage. Surprisingly, mycolactone levels decreased strongly during the first hours with a reduction of 70 and 90% after 4 and 10 h, respectively. Also, mycolactone did not diffuse in neighboring skin tissue and only poorly into the bloodstream upon direct injection. Nevertheless, the remaining amount was sufficient to induce Hypoesthesia during 24 h. Our results thus demonstrate that intact mycolactone is rapidly eliminated and that very small amounts of mycolactone are sufficient to induce Hypoesthesia. Taken together, our study points out that mycolactone ought to be considered as a promising analgesic
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Image_1_Mycolactone as Analgesic: Subcutaneous Bioavailability Parameters.pdf
2019Co-Authors: Jérémie Babonneau, Estelle Marion, Marieline Reynaert, Jeanpaul Saint Andre, A Croue, Priscille Brodin, David Guilet, Dimitri Breard, Pascal Richomme, Laurent MarsollierAbstract:Mycobacterium ulcerans is the bacillus responsible for Buruli ulcer, an infectious disease and the third most important mycobacterial disease worldwide, after tuberculosis and leprosy. M. ulcerans infection is a type of panniculitis beginning mostly with a nodule or an oedema, which can progress to large ulcerative lesions. The lesions are caused by mycolactone, the polyketide toxin of M. ulcerans. Mycolactone plays a central role for host colonization as it has immunomodulatory and analgesic effects. On one hand, mycolactone induces analgesia by targeting type-2 angiotensin II receptors (AT2R), causing cellular hyperpolarization and neuron desensitization. Indeed, a single subcutaneous injection of mycolactone into the mouse footpad induces a long-lasting Hypoesthesia up to 48 h. It was suggested that the long-lasting Hypoesthesia may result from the persistence of a significant amount of mycolactone locally following its injection, which could be probably due to its slow elimination from tissues. To verify this hypothesis, we investigated the correlation between Hypoesthesia and mycolactone bioavailability directly at the tissue level. Various quantities of mycolactone were then injected in mouse tissue and Hypoesthesia was recorded with nociception assays over a period of 48 h. The Hypoesthesia was maximal 6 h after the injection of 4 μg mycolactone. The basal state was reached 48 h after injection, which demonstrated the absence of nerve damage. Surprisingly, mycolactone levels decreased strongly during the first hours with a reduction of 70 and 90% after 4 and 10 h, respectively. Also, mycolactone did not diffuse in neighboring skin tissue and only poorly into the bloodstream upon direct injection. Nevertheless, the remaining amount was sufficient to induce Hypoesthesia during 24 h. Our results thus demonstrate that intact mycolactone is rapidly eliminated and that very small amounts of mycolactone are sufficient to induce Hypoesthesia. Taken together, our study points out that mycolactone ought to be considered as a promising analgesic.
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Mycolactone as Analgesic: Subcutaneous Bioavailability Parameters
'Frontiers Media SA', 2019Co-Authors: Jérémie Babonneau, Estelle Marion, Marieline Reynaert, A Croue, Priscille Brodin, David Guilet, Dimitri Breard, Pascal Richomme, J.p. Saint-andré, Laurent MarsollierAbstract:is the bacillus responsible for Buruli ulcer, an infectious disease and the third most important mycobacterial disease worldwide, after tuberculosis and leprosy. infection is a type of panniculitis beginning mostly with a nodule or an oedema, which can progress to large ulcerative lesions. The lesions are caused by mycolactone, the polyketide toxin of . Mycolactone plays a central role for host colonization as it has immunomodulatory and analgesic effects. On one hand, mycolactone induces analgesia by targeting type-2 angiotensin II receptors (ATR), causing cellular hyperpolarization and neuron desensitization. Indeed, a single subcutaneous injection of mycolactone into the mouse footpad induces a long-lasting Hypoesthesia up to 48 h. It was suggested that the long-lasting Hypoesthesia may result from the persistence of a significant amount of mycolactone locally following its injection, which could be probably due to its slow elimination from tissues. To verify this hypothesis, we investigated the correlation between Hypoesthesia and mycolactone bioavailability directly at the tissue level. Various quantities of mycolactone were then injected in mouse tissue and Hypoesthesia was recorded with nociception assays over a period of 48 h. The Hypoesthesia was maximal 6 h after the injection of 4 μg mycolactone. The basal state was reached 48 h after injection, which demonstrated the absence of nerve damage. Surprisingly, mycolactone levels decreased strongly during the first hours with a reduction of 70 and 90% after 4 and 10 h, respectively. Also, mycolactone did not diffuse in neighboring skin tissue and only poorly into the bloodstream upon direct injection. Nevertheless, the remaining amount was sufficient to induce Hypoesthesia during 24 h. Our results thus demonstrate that intact mycolactone is rapidly eliminated and that very small amounts of mycolactone are sufficient to induce Hypoesthesia. Taken together, our study points out that mycolactone ought to be considered as a promising analgesic
Etsuhide Yamamoto - One of the best experts on this subject based on the ideXlab platform.
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Relationship between recovery period of lower lip Hypoesthesia and sagittal split area or plate screw position after sagittal split ramus osteotomy.
Oral surgery oral medicine oral pathology oral radiology and endodontics, 2007Co-Authors: Yukari Hashiba, Koichiro Ueki, Kohei Marukawa, Kiyomasa Nakagawa, Etsuhide Yamamoto, Kosuke MatsubaraAbstract:Objective The purpose of this study was to objectively evaluate the relationship between recovery of Hypoesthesia of the lower lip after sagittal split ramus osteotomy (SSRO) with trigeminal somatosensory evoked potential (TSEP) and sagittal split area or plate screw position, using postoperative computerized tomography (CT). Study design The subjects consisted of 58 patients (116 sides) with mandibular prognathism who underwent SSRO. The patients were divided into 2 groups. The Ob group, consisting of 62 sides, underwent the Obwegeser method. The OD group, consisting of 54 sides, underwent the Obwegeser–Dal Pont method. Trigeminal nerve Hypoesthesia at the region of the lower lip was assessed bilaterally by the TSEP method. An electroencephalograph recording system (Neuropack Sigma; Nihon Koden, Tokyo, Japan) was used to analyze the potentials. Each patient was evaluated preoperatively and then postoperatively at 1 week, 2 weeks, 1 month, 3 months, 6 months and 1 year. Postoperative CT was performed in all cases to measure the sagittal split area (SSA) as well as the distance between the plate (the most medial point of screw) and the mental foramen (PM). Then comparisons between the 2 groups in recovery period of the lower lip, SSA, and PM were performed. Furthermore, the relationships between recovery period of Hypoesthesia of the lower lip and SSA or PM were evaluated statistically. Results The average measurable period and standard deviation of TSEP of the lower lip was 3.4 ± 5.5 weeks in the Ob group and 11.3 ± 13.7 weeks in the OD group. There were significant differences between the Ob group and the OD group (P Conclusion This study suggested that recovery period of Hypoesthesia of the lower lip after SSRO was strongly associated with SSA and PM.
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a comparison of postoperative Hypoesthesia between two types of sagittal split ramus osteotomy and intraoral vertical ramus osteotomy using the trigeminal somatosensory evoked potential method
International Journal of Oral and Maxillofacial Surgery, 2007Co-Authors: Daisuke Takazakura, Mayumi Shimada, A Shamiul, Koichiro Ueki, Kohei Marukawa, Kiyomasa Nakagawa, Etsuhide YamamotoAbstract:Abstract The purpose of this study was to evaluate Hypoesthesia of the lower lip using trigeminal somatosensory-evoked potential following 2 types of sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO). There were 30 patients with mandibular prognathism, with and without asymmetry, who were divided into three groups: the Obwegeser method (Ob) group, the Obwegeser–Dal Pont method (ODP) group and the intraoral vertical ramus osteotomy (IVRO) group. The trigeminal somatosensory-evoked potential was recorded in the region of the lower lip and evaluated preoperatively and postoperatively. The average recovery periods from lower lip Hypoesthesia in the IVRO and the Ob group were significantly shorter than in the ODP group ( P
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Evaluation of upper lip Hypoesthesia with a trigeminal somatosensory-evoked potential following Le Fort I osteotomy in combination with mandibular osteotomy.
Oral surgery oral medicine oral pathology oral radiology and endodontics, 2006Co-Authors: Koichiro Ueki, Mayumi Shimada, Yukari Hashiba, Chika Shimizu, Kan Yoshida, Kohei Marukawa, Kiyomasa Nakagawa, Etsuhide YamamotoAbstract:Purpose The purpose of this study was to objectively evaluate Hypoesthesia of the upper lip following Le Fort I osteotomy in combination with mandibular osteotomy with trigeminal somatosensory evoked potential (TSEP). Subjects and methods The subjects consisted of 25 patients with mandibular prognathism with maxillary retrognathism mandibular prognathism with or without asymmetry, who underwent Le Fort I osteotomy in combination with sagittal split ramus osteotomy (SSRO) or intraoral vertical ramus osteotomy (IVRO).Trigeminal nerve Hypoesthesia at the region of the upper lip was assessed bilaterally by the TSEP method. The electrodes were placed exactly above the highest point of the vermilion border and on the mucosa of the upper lip. An electroencephalograph recording system (Neuropack Sigma; Nihon Koden Corp., Tokyo, Japan) was used to analyze the potentials. Each patient was evaluated preoperatively and then postoperatively at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year. Results The average measurable period and standard deviation of TSEP of the upper lip was 7.8 ± 10.7 weeks following Le Fort I osteotomy, TSEP of the lower lip was 4.6 ± 9.2 weeks in the patients who underwent SSRO with Le Fort I osteotomy, and 1.2 ± 0.4 weeks in the patients who underwent IVRO with Le Fort I osteotomy. Conclusion This study objectively proved that Hypoesthesia could appear in the upper lips following Le Fort I osteotomy with TSEP. The measurable period for the upper lip following Le Fort I osteotomy tended to be longer than that for the lower lip in the patients who underwent SSRO and IVRO with Le Fort I osteotomy.
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somatosensory evoked potential to evaluate the trigeminal nerve after sagittal split osteotomy
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, 2001Co-Authors: Kiyomasa Nakagawa, Daisuke Takazakura, Shigeyuki Takatsuka, Koichiro Ueki, Etsuhide YamamotoAbstract:Abstract Objective: The purpose of this study was to assess the onset period of trigeminal nerve Hypoesthesia during bilateral sagittal split osteotomy, with the use of the trigeminal somatosensory-evoked potential (TSEP). Study Design: Subjects were 10 patients with mandibular prognathism who underwent setback surgery. Intraoperative TSEP was measured 4 times: just before the commencement of the surgery, immediately after the induction of general anesthesia; after the medial periosteal dissection of the alveolar neurovascular bundle; after the sagittal split of bone; and after semirigid fixation with a titanium miniplate with the use of a monocortical screw. Postoperative TSEP was measured after the start of postoperative weeks 2, 4, 12, and 24. Normal records of the TSEP wave comprised peak (13 ms), trough (16 ms), peak (22.7 ms), and trough (36 ms) (N1, P1, N2, P2, respectively). Trigeminal Hypoesthesia was assessed by the latency of P1 and N2, because they indicated the most reproducible waveforms. Results: The change in shape of the spectra indicated that prolonged latency was initiated on medial periosteal dissection and was extended further after the sagittal bone split and fixation. However, latency recovery was observed relatively quickly after the start of postoperative weeks 2 and 4. Conclusions: Trigeminal Hypoesthesia appeared to be induced by direct injury to the alveolar nerve during the bone split or by compression injury after fixation. Accordingly, the occurrence of a long-lasting postoperative trigeminal sensory Hypoesthesia seemed to depend on nervous involvement of the split surface, the manner of fixation, or the intraoperative care. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:146-52)
Jean Régis - One of the best experts on this subject based on the ideXlab platform.
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Decreased Probability of Initial Pain Cessation in Classic Trigeminal Neuralgia Treated With Gamma Knife Surgery in Case of Previous Microvascular Decompression: A Prospective Series of 45 Patients With >1 Year of Follow-up.
Neurosurgery, 2015Co-Authors: Constantin Tuleasca, Romain Carron, Noémie Resseguier, Anne Donnet, Jean Gaudart, Marc Levivier, P Roussel, Jean RégisAbstract:BACKGROUND: Microvascular decompression (MVD) is the reference technique for pharmacoresistant trigeminal neuralgia (TN). OBJECTIVE: To establish whether the safety and efficacy of Gamma Knife surgery for recurrent TN are influenced by prior MVD. METHODS: Between July 1992 and November 2010, 54 of 737 patients (45 of 497 with >1 year of follow-up) had a history of MVD (approximately half also with previous ablative procedure) and were operated on with Gamma Knife surgery for TN in the Timone University Hospital. A single 4-mm isocenter was positioned in the cisternal portion of the trigeminal nerve at a median distance of 7.6 mm (range, 3.9-11.9 mm) anterior to the emergence of the nerve. A median maximum dose of 85 Gy (range, 70-90 Gy) was delivered. RESULTS: The median follow-up time was 39.5 months (range, 14.1-144.6 months). Thirty-five patients (77.8%) were initially pain free in a median time of 14 days (range, 0-180 days), much lower compared with our global population of classic TN (P = .01). Their actuarial probabilities of remaining pain-free without medication at 3, 5, 7, and 10 years were 66.5%, 59.1%, 59.1%, and 44.3%. The Hypoesthesia actuarial rate at 1 year was 9.1% and remained stable until 12 years (median, 8 months). CONCLUSION: Patients with previous MVD showed a significantly lower probability of initial pain cessation compared with our global population with classic TN (P = .01). The toxicity was low (only 9.1% Hypoesthesia); furthermore, no patient reported bothersome Hypoesthesia. However, the probability of maintaining pain relief without medication was 44.3% at 10 years, similar to our global series of classic TN (P = .85).
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Multiple Sclerosis-Related Trigeminal Neuralgia: A Prospective Series of 43 Patients Treated with Gamma Knife Surgery with More than One Year of Follow-Up
Stereotactic and Functional Neurosurgery, 2014Co-Authors: Constantin Tuleasca, Romain Carron, Noémie Resseguier, Anne Donnet, Philippe Roussel, Jean Gaudart, Marc Levivier, Jean RégisAbstract:tively, and remained stable till 12 years. The Hypoesthesia actuarial rate at 6 months, 1 and 2 years was 11.5, 11.5 and 16%, and remained stable till 12 years. Conclusions: GKS proved safe and effective in this special group of patients.
John A Branda - One of the best experts on this subject based on the ideXlab platform.
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case 34 2018 a 58 year old woman with paresthesia and weakness of the left foot and abdominal wall
The New England Journal of Medicine, 2018Co-Authors: Haatem Reda, Benjamin H Harvey, Nagagopal Venna, John A BrandaAbstract:A Woman with Paresthesia and Weakness of the Foot and Abdominal Wall A 58-year-old woman from New England presented to the outpatient neurology clinic in early autumn with Hypoesthesia of the trunk...
Kiyomasa Nakagawa - One of the best experts on this subject based on the ideXlab platform.
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Relationship between recovery period of lower lip Hypoesthesia and sagittal split area or plate screw position after sagittal split ramus osteotomy.
Oral surgery oral medicine oral pathology oral radiology and endodontics, 2007Co-Authors: Yukari Hashiba, Koichiro Ueki, Kohei Marukawa, Kiyomasa Nakagawa, Etsuhide Yamamoto, Kosuke MatsubaraAbstract:Objective The purpose of this study was to objectively evaluate the relationship between recovery of Hypoesthesia of the lower lip after sagittal split ramus osteotomy (SSRO) with trigeminal somatosensory evoked potential (TSEP) and sagittal split area or plate screw position, using postoperative computerized tomography (CT). Study design The subjects consisted of 58 patients (116 sides) with mandibular prognathism who underwent SSRO. The patients were divided into 2 groups. The Ob group, consisting of 62 sides, underwent the Obwegeser method. The OD group, consisting of 54 sides, underwent the Obwegeser–Dal Pont method. Trigeminal nerve Hypoesthesia at the region of the lower lip was assessed bilaterally by the TSEP method. An electroencephalograph recording system (Neuropack Sigma; Nihon Koden, Tokyo, Japan) was used to analyze the potentials. Each patient was evaluated preoperatively and then postoperatively at 1 week, 2 weeks, 1 month, 3 months, 6 months and 1 year. Postoperative CT was performed in all cases to measure the sagittal split area (SSA) as well as the distance between the plate (the most medial point of screw) and the mental foramen (PM). Then comparisons between the 2 groups in recovery period of the lower lip, SSA, and PM were performed. Furthermore, the relationships between recovery period of Hypoesthesia of the lower lip and SSA or PM were evaluated statistically. Results The average measurable period and standard deviation of TSEP of the lower lip was 3.4 ± 5.5 weeks in the Ob group and 11.3 ± 13.7 weeks in the OD group. There were significant differences between the Ob group and the OD group (P Conclusion This study suggested that recovery period of Hypoesthesia of the lower lip after SSRO was strongly associated with SSA and PM.
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a comparison of lower lip Hypoesthesia measured by trigeminal somatosensory evoked potential between different types of mandibular osteotomies and fixation
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, 2007Co-Authors: Yukari Hashiba, Mayumi Shimada, Chika Shimizu, Shamiul Alam, Kan Yoshida, Koichiro Ueki, Kohei Marukawa, Kiyomasa NakagawaAbstract:Purpose The purpose of this study was to compare objectively, the recovery of hypoestheia of the lower lip following orthognathic surgery using different procedures (sagittal split ramus osteotomy [SSRO]) and intra-oral vertical ramus osteotomy (IVRO)) and fixation methods (monocortical plate fixation and bi-cortical plate fixation). Hypoesthesia was evaluated using the trigeminal somatosensory-evoked potential (TSEP). Patients and Methods The subjects consisted of 174 patients (348 sides) with mandibular prognathism with or without asymmetry, who underwent mandibular ramus osteotomies using different fixation types. The patients were divided into 4 groups. The OAM group consisted of 128 sides who had SSRO using the Obwegeser method with mono-cortical absorbable plate fixation, the ODTM group consisted of 84 sides who had the Obwegeser-Dal Pont method with mono-cortical titanium plate fixation, the OTB group consisted of 32 sides who had the Obwegeser method with bi-cortical titanium plate fixation and the VO group consisted of 104 sides who underwent IVRO according to the Bell method without fixation. Trigeminal nerve hypoestheia at the region of the lower lip was assessed bilaterally by the TSEP method. An electroencephalograph recording system (Neuropack Sigma; Nion Koden Corp., Tokyo, Japan) was used to analyze the potentials. Each patient was evaluated pre-operatively and then post-operatively at 1 and 2 weeks, 1, 3, and 6 months, and 1 year. Results The mean measurable period and standard deviation of TSEP of the lower lip in the OAM group was 5.2 ± 9.9 weeks, 10.9 ± 13.1 weeks in the ODTM group, 7.8 ± 4.5 weeks in the OTB group, and 2.5 ± 6.3 weeks in the VO group. There were significant differences between the OAM and ODTM groups (P Conclusion This study proved using objective measurements that the recovery period from Hypoesthesia of the lower lip following orthognathic surgery was dependent on the surgical procedure. Recovery in lower lip Hypoesthesia after IVRO was significantly earlier than SSRO.
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a comparison of postoperative Hypoesthesia between two types of sagittal split ramus osteotomy and intraoral vertical ramus osteotomy using the trigeminal somatosensory evoked potential method
International Journal of Oral and Maxillofacial Surgery, 2007Co-Authors: Daisuke Takazakura, Mayumi Shimada, A Shamiul, Koichiro Ueki, Kohei Marukawa, Kiyomasa Nakagawa, Etsuhide YamamotoAbstract:Abstract The purpose of this study was to evaluate Hypoesthesia of the lower lip using trigeminal somatosensory-evoked potential following 2 types of sagittal split ramus osteotomy (SSRO) and intraoral vertical ramus osteotomy (IVRO). There were 30 patients with mandibular prognathism, with and without asymmetry, who were divided into three groups: the Obwegeser method (Ob) group, the Obwegeser–Dal Pont method (ODP) group and the intraoral vertical ramus osteotomy (IVRO) group. The trigeminal somatosensory-evoked potential was recorded in the region of the lower lip and evaluated preoperatively and postoperatively. The average recovery periods from lower lip Hypoesthesia in the IVRO and the Ob group were significantly shorter than in the ODP group ( P
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Evaluation of upper lip Hypoesthesia with a trigeminal somatosensory-evoked potential following Le Fort I osteotomy in combination with mandibular osteotomy.
Oral surgery oral medicine oral pathology oral radiology and endodontics, 2006Co-Authors: Koichiro Ueki, Mayumi Shimada, Yukari Hashiba, Chika Shimizu, Kan Yoshida, Kohei Marukawa, Kiyomasa Nakagawa, Etsuhide YamamotoAbstract:Purpose The purpose of this study was to objectively evaluate Hypoesthesia of the upper lip following Le Fort I osteotomy in combination with mandibular osteotomy with trigeminal somatosensory evoked potential (TSEP). Subjects and methods The subjects consisted of 25 patients with mandibular prognathism with maxillary retrognathism mandibular prognathism with or without asymmetry, who underwent Le Fort I osteotomy in combination with sagittal split ramus osteotomy (SSRO) or intraoral vertical ramus osteotomy (IVRO).Trigeminal nerve Hypoesthesia at the region of the upper lip was assessed bilaterally by the TSEP method. The electrodes were placed exactly above the highest point of the vermilion border and on the mucosa of the upper lip. An electroencephalograph recording system (Neuropack Sigma; Nihon Koden Corp., Tokyo, Japan) was used to analyze the potentials. Each patient was evaluated preoperatively and then postoperatively at 1 week, 2 weeks, 1 month, 3 months, 6 months, and 1 year. Results The average measurable period and standard deviation of TSEP of the upper lip was 7.8 ± 10.7 weeks following Le Fort I osteotomy, TSEP of the lower lip was 4.6 ± 9.2 weeks in the patients who underwent SSRO with Le Fort I osteotomy, and 1.2 ± 0.4 weeks in the patients who underwent IVRO with Le Fort I osteotomy. Conclusion This study objectively proved that Hypoesthesia could appear in the upper lips following Le Fort I osteotomy with TSEP. The measurable period for the upper lip following Le Fort I osteotomy tended to be longer than that for the lower lip in the patients who underwent SSRO and IVRO with Le Fort I osteotomy.
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somatosensory evoked potential to evaluate the trigeminal nerve after sagittal split osteotomy
Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, 2001Co-Authors: Kiyomasa Nakagawa, Daisuke Takazakura, Shigeyuki Takatsuka, Koichiro Ueki, Etsuhide YamamotoAbstract:Abstract Objective: The purpose of this study was to assess the onset period of trigeminal nerve Hypoesthesia during bilateral sagittal split osteotomy, with the use of the trigeminal somatosensory-evoked potential (TSEP). Study Design: Subjects were 10 patients with mandibular prognathism who underwent setback surgery. Intraoperative TSEP was measured 4 times: just before the commencement of the surgery, immediately after the induction of general anesthesia; after the medial periosteal dissection of the alveolar neurovascular bundle; after the sagittal split of bone; and after semirigid fixation with a titanium miniplate with the use of a monocortical screw. Postoperative TSEP was measured after the start of postoperative weeks 2, 4, 12, and 24. Normal records of the TSEP wave comprised peak (13 ms), trough (16 ms), peak (22.7 ms), and trough (36 ms) (N1, P1, N2, P2, respectively). Trigeminal Hypoesthesia was assessed by the latency of P1 and N2, because they indicated the most reproducible waveforms. Results: The change in shape of the spectra indicated that prolonged latency was initiated on medial periosteal dissection and was extended further after the sagittal bone split and fixation. However, latency recovery was observed relatively quickly after the start of postoperative weeks 2 and 4. Conclusions: Trigeminal Hypoesthesia appeared to be induced by direct injury to the alveolar nerve during the bone split or by compression injury after fixation. Accordingly, the occurrence of a long-lasting postoperative trigeminal sensory Hypoesthesia seemed to depend on nervous involvement of the split surface, the manner of fixation, or the intraoperative care. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:146-52)