Royal Perth Hospital, Perth, Australia.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2013 Jan;115(1):e1-3. doi: 10.1016/j.oooo.2011.08.017. Epub 2012 May 4.
Lingual or inferior alveolar nerve (IAN) injury after dental procedures may result from direct trauma or local anesthetic agent and presents with immediate onset of typically nonprogressive symptoms, including pain and sensory changes. We report a case of delayed-onset pain and progressive sensory symptoms after IAN block for amalgam restoration. A 54-year-old man presented with progressive right-sided facial pain 48 hours after IAN block for amalgam restoration, followed 1 week later by hypoesthesia and allodynia in IAN distribution. The presentation is more consistent with inflammatory neuropathy, as is well recognized in brachial plexopathy. Imaging was used to exclude local and central causes, following which the clinical diagnosis was made. Inflammatory neuropathies may be distinguished from iatrogenic causes on the basis of delayed symptom onset, early severe pain, and progressive sensory symptoms. Awareness of this condition is important, because early steroid therapy followed by medications for neuropathic pain may provide benefit.
牙体牙髓治疗后出现的舌神经或下牙槽神经（IAN）损伤可由直接创伤或局麻药引起，表现为典型的非进行性症状，包括疼痛和感觉改变。我们报告了一例 IAN 阻滞用于银汞合金修复后延迟发作的疼痛和进行性感觉症状。一名 54 岁男性在 IAN 阻滞用于银汞合金修复后 48 小时出现右侧面部进行性疼痛，1 周后出现 IAN 分布区感觉迟钝和痛觉过敏。其表现更符合炎性神经病，臂丛神经病中也可观察到这种情况。影像学检查用于排除局部和中枢原因，然后做出临床诊断。炎性神经病可根据症状延迟发作、早期严重疼痛和进行性感觉症状与医源性损伤区分开来。了解这种情况很重要，因为早期类固醇治疗加用治疗神经病理性疼痛的药物可能有益。
