Inflammation of the jaw joint: symptoms and treatment

What is mandibular nerve injury?

By this concept, dentists mean injury to one of the nerves:

• chin;
• lingual;
• alveolar.

Types of injuries include sprain, compression, crushing and rupture - partial or complete. The cause of the stretching is the long-term retraction of the mucoperiosteal flap, which is created by an implant of greater length than necessary. Crush injuries and compression are caused by needle injuries during the administration of anesthesia. Rupture occurs in two cases: when cutting the mucosa or during preparation of the hole for the implant.

How is the disease diagnosed?

The diagnosis of a neurological disorder is carried out by a specialist - a neurologist. To exclude dental pathologies, an initial consultation and examination by a dentist will be required. The primary examination is carried out by palpation. The doctor determines the pain of the main points located on the tongue and in the sublingual area. Unpleasant sensations occur when pressure is applied to the skin located in the lower part of the jaw on the side in which the disorder develops. In this case, there is no change in taste sensations. Degenerative changes in the mucosa, ulcerative lesions, and deformation of the lingual papillae can be visually determined.

To clarify the diagnostic assumption, the described nerve processes are blocked. Common anesthetics are used for this: lidocaine, novocaine. Confirmation of the suspected disease occurs if the pain disappears as a result of the administration of local anesthesia. At the same time, the neurologist tries to exclude anomalies with similar symptoms: tumors, cystic processes, damage to the trigeminal nerve, etc.

Causes and prevention of mandibular nerve injuries

The only cause of such damage is considered to be medical errors. Since in preparation for implantation, X-rays of the jaw are taken, which the doctor must carefully study so that when choosing an implant and a place for it, he does not injure the nerve, the injuries are caused by his unprofessionalism or negligence.

Damage to the mandibular nerve most often occurs when:

• improper administration of anesthesia - needle injury;
• choosing an implant that is too long;
• damage by an instrument - when preparing the site for the implant.

The only way to avoid such an injury is for a doctor to responsibly approach the stage of preparation for surgery, carefully studying the condition and structure of his patient’s jaw. The only way of prevention for the patient is to choose a trusted clinic and a highly qualified doctor. Specialists at the Implantmaster clinic have been able to reduce the number of injuries of this kind to 2%, since they carefully study three-dimensional photographs of a person’s jaw before implantation, and can correctly assess the condition of the bone tissue, the location of nerves and blood vessels, and select the optimal size of the implant.

Description of the pathological condition

The disease of the nerve branches located in the tongue and lower jaw is accompanied by pain and salivation disorders. Nerve clusters (nodes) located in this area belong to the peripheral parts of the NS. Despite the fact that neurologists anatomically separate the sublingual and submandibular nodes, degenerative processes occur in them simultaneously. This is due to the fact that numerous neural connections are distributed between the channels. This allows the pathology to be classified as one disease.

Our team of doctors

Maxillofacial surgeon, Implantologist

Bocharov Maxim Viktorovich

Experience: 11 years

Dental surgeon, Implantologist

Chernov Dmitry Anatolievich

Experience: 29 years

Orthopedist, Neuromuscular dentist

Stepanov Andrey Vasilievich

Experience: 22 years

Endodontist, Therapist

Skalet Yana Alexandrovna

Experience: 22 years

Orthopedic dentist

Tsoi Sergey Konstantinovich

Experience: 19 years

Dentist-orthodontist

Enikeeva Anna Stanislavovna

Experience: 3 years

How to deal with pathology?

Therapeutic methods for getting rid of the disorder are complex. The main task is to get rid of the source of neuralgia. Depending on the pathogen causing the disease, antimicrobial, antiviral drugs, antibiotics, antihistamines are used to rid the body of toxic substances. At the initial stage, treatment of inflammatory foci, relief from chronic ailments, and restoration of endocrine functionality are carried out. If the anomaly is caused by alcohol addiction, comprehensive treatment is required. At this stage, you will need the help of highly specialized specialists who are competent in treating the affected area or organ.

If the cause of inflammation of the nerve fibers is tumor, adhesive, or cystic objects, surgical intervention and removal of the pathogenic formation are indicated. To reduce and get rid of pain, local neuronal blockers and analgesics are prescribed. If the restoration measures taken are ineffective, a decision is made to completely block the affected nodes with special medications.

As supportive, accompanying therapy, medications are prescribed aimed at restoring the functionality of the vascular system. On the eighth day of treatment, metabolic agents (vitamin-containing complexes) are introduced into the treatment course. To relieve symptoms, it is recommended to take antidepressants, mild sedatives, and non-narcotic tranquilizers. It is possible to use laser physiotherapy and acupuncture. These types of treatment become the main ones when it is impossible (contraindications) to use medications.

Auxiliary but effective techniques include the use of estuary mud, the introduction of aloe extract, and attending physiotherapeutic sessions (electrophoresis, galvanization, inductothermy, etc.).

Symptoms and stages of damage

The symptoms by which this complication can be recognized are as follows:

• numbness of parts of the head - tongue, lips, chin, cheeks, etc.;
• biting lips and tongue;
• choking while eating or drinking;
• profuse salivation.

All this creates a number of inconveniences for the patient: it makes it difficult to eat and talk, disrupts facial expressions, and also prevents men from shaving and women from applying makeup. The severity of this injury is determined by its degree: a minor one goes away on its own or with the help of drug treatment, a severe one leads to irreversible processes of nerve degeneration and is not curable. Damage to the mandibular nerve, the symptoms of which the patient observes, requires immediate consultation with a doctor - only a specialist will be able to determine its extent and provide timely assistance.

Dentists distinguish the following stages of this implantation complication:

• minor - neuropraxia;
• more severe, but partial damage - axonotmesis;
• a serious injury that leads to complete loss of sensitivity - neurotmesis.

Causes of neuralgic anomaly

Factors in the development of neurological disorders in the jaw area are both internal and external primary sources. Internal reasons include:

• frequent hypothermia;
• systematic damage to oral tissues by inflammatory processes;
• complications after medical and dental procedures;
• infections of the mouth and throat, sore throats, inflammation of lymphatic deposits;
• chronic diseases of the peritoneum, gastrointestinal tract, pelvis, sternum.

External provocateurs of the disease are:

• severe intoxication or chronic poisoning with industrial poisons;
• constant interaction with household chemical compounds;
• consumption of alcoholic beverages;
• accumulation of slag, intoxicating substances that are not excreted by the liver;
• metabolic disorders as a result of diabetic syndrome;
• damage to the endocrine system.

A variety of allergic conditions, vegetative-vascular dystonia, chronic blood pressure disorders, hypotension, and hypovitaminosis can aggravate the situation.

Recovery and treatment

In the first case, self-recovery takes approximately 1 month; the help of doctors is not needed, since there is no anatomical damage. Symptoms of the second appear after a while - usually 6-8 weeks, so recovery can be painful and incomplete: it will take more than 2 months. In the third stage of damage to the mandibular nerve, treatment gives results only at the beginning and is performed surgically, since we are talking about degeneration with a violation of integrity. Loss of sensitivity, which is observed in a patient for more than 3 months, indicates a high probability of losing it forever. Damage to the mandibular nerve, the consequences of which is the lack of sensitivity of the nerve for a year, leads to irreversible changes. Only the professionalism and responsibility of the doctor, which is guaranteed by the specialists of our Implantmaster clinic, can protect the patient from such unpleasant injuries.

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Facial neuritis - symptoms and treatment

Neuritis (neuropathy) is a disease of the nervous system, manifested in dysfunction of a nerve or a certain group of nerves.

In recent years, the Greek word “pathos”, which means “suffering”, has been used to denote syndromes of damage to the peripheral nervous system, and previously used terms, for example, “neuritis”, have been replaced by “neuropathy”, “sciatica” by “radiculopathy”, etc. d. If several nerves are inflamed, then it is polyneuropathy, if one nerve is inflamed, then it is mononeuritis. When the cause of inflammation of the nerves is, for example, diabetes, we talk about diabetic polyneuropathy, [1] and if there is an infection, then about infectious polyneuropathy (for example, herpes, diphtheria, etc.); [2] if the factor is hereditary, then it is hereditary polyneuropathy; if associated with a nutritional disorder, for example, alcohol abuse, then alcoholic polyneuropathy; if polyneuropathy appears against the background of reduced immunity, then it is idiopathic polyneuropathy, etc. [3]

Many types of peripheral neuropathy are often caused by exposure to toxic chemicals, malnutrition, injury and nerve compression, and also occur as a result of certain medications, such as those used to treat cancer and HIV/AIDS. [4]

As an example, consider such a common type of neuritis as neuritis of the facial nerve, also called Bell's palsy, the incidence of which is 23 people per 100 thousand, in all age groups, regardless of gender. The average age of patients is 40 years.

Most often, facial paralysis occurs as a result of local hypothermia. The source of infection is often chronic processes in the mouth, throat, and ear. In acute otitis media, nerve damage is caused by perineural edema of vascular origin. But more often, facial paralysis is caused by the herpes zoster virus in the area of ​​the external auditory canal and eardrum. [5]

Facial neuritis develops as a result of:

• tumor processes in the cerebellopontine angle and posterior cranial fossa, temporal bone, parotid gland;
• traumatic brain injuries;
• acute, chronic otitis, mastoiditis;
• infections - syphilis, tuberculosis, Lyme disease, HIV infections, malaria, diphtheria, typhus, etc.;
• sarcoidosis, collagenosis, amyloidosis;
• Guillain–Barré syndrome;
• multiple sclerosis and many other diseases.
• Sometimes the development of neuropathy of the facial nerve is observed during pregnancy against the background of nephropathy.[6]

First symptoms

Clinical signs of damage to the mandibular nerve are expressed in discomfort in the area of ​​innervation: the area of ​​the mental foramen, the lower lip, the membrane of the gums and cheeks to the borders of the second molar.

Pathology is expressed:

• Paresthesia – change in sensitivity (no painful sensations during injection, etc.).
• Dysesthesia is a change in sensitivity that brings discomfort (pain, “pins and needles”).
• Anesthesia – complete loss of sensitivity.

When extracting wisdom teeth, the lingual nerve is most often damaged (up to 2.1%). During implantation, damage to this nerve is less common and manifests itself with the following symptoms:

• increased salivation;
• speech defects;
• involuntary tongue biting;
• problems with swallowing;
• loss or change in taste;
• burning sensation of the tongue;
• numbness of the mucous membrane of the tongue and gums.

Up to 90% of lingual nerve injuries heal on their own within 7-10 weeks of onset.

Classification of manifestations

According to Seddon's classification, injuries to the trigeminal nerve are of several types:

• Neuropraxia. The damage is reversible. The sheath of the nerve fibers is not affected. There is no degeneration. Sensitivity returns a few weeks after treatment.
• Axonotmesis. Requires long-term therapy for up to six months. Fiber damage occurs and degeneration develops. The damage is reversible.
• Neurotmesis. Nerve structures, fibers and connective membranes are affected. Scars form. The pathological process is irreversible. Surgery is required.

According to the WHO classification, there are five categories of NAS lesions:

• compression or traumatic injury;
• edema;
• gap;
• final break;
• post-traumatic fibrosis.

Assessing the complexity of a clinical situation

To diagnose neurological pathologies, two research methods are used:

1. Mechanoceptive. The tissue response to mechanical action and stimulation is recorded.

• Two-point irritation.
• Brush test.

1. Nociceptive. Determine the perception of pain.

• Using a pin.
• Temperature test.

You can determine a taste deficiency by using a cotton pad with sugar or salt.

Research is carried out simultaneously on the affected and healthy sides of the maxillofacial apparatus.

Symptoms are documented. Areas of neurosensory deficit are measured with an accuracy of 1 mm.

Therapy concept

Medical tactics for pain and discomfort:

• Monitoring the patient and tracking the dynamics of the condition over a certain period of time.
• Drug therapy. The use of painkillers, hydrogen pump blockers, glucocorticosteroids and other drugs.
• Removing or unscrewing the rod several turns. It is carried out within 24 hours after implantation. The critical period of treatment is three months. It is during this period that improvement should occur.
• Carrying out a microsurgical operation.

There are no strict treatment protocols. The doctor selects the best option based on practical experience and knowledge.

It is generally accepted that the clinical result of the operation is achieved only if it is performed within a year after implantation.

Surgery

Indications for the operation:

• Confirmed nerve damage.
• Persistent sensory impairment for three months.
• Pain due to a pinched nerve.

The result of surgery depends on certain factors:

• Time elapsed from injury to surgery.
• Type and severity of manifestations.
• Features of blood supply in the pathological zone.
• Proper selection and preparation of the rod.
• The general health of the patient.
• Age.
• Presence of tension zones.
• Experience and practical skills of the surgeon.

Speed ​​of diagnosis is key. Especially with minor damage. Late diagnosis threatens the formation of carpal tunnel syndrome.

Causes

The main causes of damage to the NAS are:

• implantation (doctor’s errors, lack of a full preliminary examination);
• removal of dystopic “eights” on the lower jaw;
• errors when performing conduction anesthesia;
• exit of the filling material beyond the root apex into the nerve canal;
• infectious lesion of the periapical region of the lower row.

But the most common reason is the first reason - damage as a result of implant installation, usually in the chewing area.