Effects of trauma to the mandibular nerve on human perioral directional sensitivity.

The capacity of 4 patients who had previously experienced trauma to their mandibular nerves to distinguish opposing directions of tactile motion over the distribution of the mental nerve was compared to that of 8 neurologically normal adults. Brushing stimuli were delivered to the perioral region and were precisely controlled for their velocity, the length of skin traversed, the width of skin contacted, and the orientation and direction of motion. A temporal, 2-alternative, forced choice method was used to obtain estimates of directional sensitivity, d'. It was discovered that impairment in cutaneous directional sensitivity could be readily detected within areas of hypaesthesia. Although directional sensitivity was found to increase linearly with the length of skin traversed for both the patients and the neurologically normal adults, the slope and the x-intercept of the linear relationship differed between the two groups. The difference in the slope suggests that direction discrimination within the hypaesthetic areas is relatively insensitive to changes in the length of skin traversed. The difference in the x-intercept suggests that a greater length of skin must be traversed before any information about direction is made available at the hypaesthetic sites. The dependency of the capacity of neurologically normal and impaired individuals to process information about direction of tactile motion on the length of skin traversed and the velocity of stimulation suggests that a high degree of stimulus control is required for the detection and quantification of subtle neurosensory deficits.