三叉神经分支皮层诱发电位及其与瞬目反射的相关性研究

目的：探讨健康者三叉神经分支刺激诱发皮层电位（TSEP）的关系及特点,比较图形及数据差异,探讨经眶上神经刺激诱发皮层电位与瞬目反射（BR）的相关性。方法：通过电刺激30例健康成人的眶上神经、眶下神经和颏神经,收集刺激对侧的三叉神经皮层诱发电位;电刺激眶上神经,记录瞬目反射R1、R2和R2＇相关数据,应用SPSS统计程序进行独立样本t检验和q检验。结果：眶上神经刺激诱发皮层电位和瞬目反射各波潜伏期相关性不显著,呈低度相关。各分支诱发三叉神经皮层电位P1、N1、P2潜伏期差异具有统计学意义（P〈0.05）,N2、P3、N3、P4、N4、P5、N5各波潜伏期三支差异不明显,眶上神经刺激诱发皮层电位各波较其他两支延迟。结论：TSEP与BR具有不同的传导通路,各波潜伏期无明显相关性。不同分支刺激诱发皮层电位,早期波的潜伏期具有差异,与神经传导通路相适应;后续各波具有一致性。临床应综合分析以判定神经功能状态。     

上颌神经诱发三叉神经皮层电位的研究

目的　探讨三叉神经的分支上颌神经皮层诱发电位的特点及与三叉神经其他分支皮层诱发电位的差异。方法　通过刺激 10名健康成人的眶下神经 ,收集刺激对侧的三叉神经诱发电位 (TSEP)。结果　①刺激发生 2 0ms左右出现P1,其后N1～N5等 9个波峰依次出现 ;②P3、N3、P4潜伏期稳定 ,N3～N4振幅高且图形规律 ;③上颌神经皮层诱发电位与下颌神经皮层诱发电位无明显差异。结论　上颌神经TSEP中高峰电位出现于 110ms的N3P4波 ,波幅 >10 μV ,其潜伏期相对稳定 ,形成上颌神经TSEP的特点 ,早期的P1～N2波幅较低 ,但可以因周围神经的改变而有较大的变化 ;正常上颌神经的TSEP各波潜伏期、图形特点、峰峰电位差与下颌神经TSEP差异不明显。根据图形特点、参数可以作为临床三叉神经上颌支功能状态和病理改变的判定指标     

电刺激颏神经诱发三叉神经皮层电位的研究

目的　以电生理手段客观评价三叉神经的功能状态。方法　通过刺激 18名健康成人颏神经 ,在T3、T4部位收集本侧及对侧的三叉神经诱发电位 (TSEP)。结果　①在刺激发生 16ms左右 ,出现第一个阳性波即P1,依次为N1～N5等 10个波峰 ;②其中P3,N3,P4,N4潜伏期较为稳定 ,N3～P4为一个陡降的高振幅波且图形稳定 ;③对于刺激的反应 ,在同一个体双侧具有同等的程度 ;④波幅随刺激强度的加大明显增高。结论　各波的潜伏期、图形特点、峰峰电位差并结合图形整体形态及参数可以作为临床判定TSEP的指标。     

下颌骨牵引延长后下齿槽神经功能的评价

目的 采用三叉神经体感诱发电位（trigeminal somatosensory evoked potential,TSEP)检查恒河猴下颌骨牵引延长术对下齿槽神经功能的影响。方法 健康青年恒河猴7只，行下颌角部完全骨截开术，右侧或双侧安放牵引器。截骨间隙平均牵引距离为13．5mm。于术前、牵引完成时、牵引完成后4周分别进行下齿槽神经SEP检查。结果 术前下齿槽神经SEP各波的潜伏期测量值，两侧对比检验差异无显著性。牵引术完成时SEP各波的潜伏期较术前均有不同程度延长（P＜0．01，P＜0．001），波幅显著下降（P＜0．001）。术后4周各波潜伏期及波幅均有恢复，但多数差别仍有显著性。结论 TSEP检查提示下颌骨牵引延长术对下齿槽神经功能有一定影响，术后4周其功能有部分恢复。     

慢性咀嚼肌疼痛患者面部和手指电刺激痛阈的初步观察

目的 通过测定和对比慢性咀嚼肌痛(masticatory muscle pain,MMP)患者及健康对照组双侧咬肌区、双侧颞肌区及左手中指的电刺激感觉阈和痛阈,初步探讨慢性MMP患者的三叉神经感觉功能是否出现变化.方法 收集慢性MMP患者12例(慢性MMP患者组),以及年龄、性别与慢性MMP患者组相似的健康对照者12名(健康对照组),分别行咬肌区、颞肌区疼痛的视觉模拟量表(visual analogy scale,VAS)评分;对两组双侧咬肌区、双侧颞肌区和左手中指的电刺激感觉阈和痛阈进行榆查.对两组5个部位的电刺激感觉阈和痛阈进行分析对比.结果 与健康对照组相比,慢性MMP患者组左侧咬肌、右侧咬肌、左侧颞肌、右侧颞肌和左手中指的电刺激痛阈均明显降低[分别为(5.9±1.1)、(5.7±1.0)、(5.3±1.4)、(5.5±1.7)和(5.2±1.0)mA],差异均有统计学意义(F=24.433,P＜0.001);而两组电刺激感觉阈的差异无统计学意义(F=0.341,P=0.959).慢性MMP患者组VAS得分与咀嚼肌电刺激感觉阈和痛阈之间未发现相关关系.结论 相比健康对照组,慢性MMP患者的咬肌、颞肌及手指的电刺激痛阈均显著降低,提示患者三叉神经感觉功能出现变化,其机制可能涉及高级神经中枢.     

经颅磁刺激对夜磨牙患者咬肌运动诱发电位的研究

目的：比较夜磨牙患者与正常对照组经颅磁刺激（TMS）下产生的咬肌运动诱发电位（MEP）的异同。方法：纳入30名夜磨牙患者及30名健康志愿者,单脉冲TMS大脑皮层面部运动区域,记录咬肌MEP,分析比较2组MEP的各项参数。试验均在白天受试者清醒的状态下进行。结果：夜磨牙组咬肌MEP的激发阈值（130％AMT）为53％,对侧MEP（c-MEP）的潜伏期为（6．7±1．3）ms、波幅为0．19（0．15,0．29）mV,三叉神经根MEP（r-MEP）的潜伏期为（2．3±0．4）ms,中枢传导时间（CCT）为4．4（3．3,5．2）ms;正常对照组AMT为52（52,55）％,c-MEP的潜伏期为（6．4±0．7）ms、波幅为0．23（0．17,0．28） mV,r-MEP的潜伏期为（2．4±0．4）ms,CCT为4．0（3．4,4．4）ms,2组咬肌运动诱发电位各项参数均无统计学差别。结论：与正常人相比较,夜磨牙患者大脑皮层运动系统兴奋性未见明显改变。     

正常人瞬目反射检测方法的研究

目的:探讨电刺激所诱发的瞬目反射(BR)的不同检测方法和波形特征,进行定量分析,建立其实验室参考值.方法:采用神经肌电图仪对30 例(60 侧)健康年轻志愿者进行眶上神经及颏神经刺激,分别于眼轮匝肌及提上唇肌处记录瞬目反射波形,统计4 组瞬目反射的R1、R2、R2'的潜伏期及波幅,并做出统计学处理.结果:眶上神经刺激眼轮匝肌记录方法,即常规瞬目反射测试方法所得结果与既往国内外文献报道基本一致,眶上神经刺激提上唇肌记录方法可引出与前法类似波形,且图形稳定,重复性好.颏神经刺激眼轮匝肌及提上唇肌记录方法引出之波形中,R1欠稳定,但双侧R2稳定.结论:采用眶上神经刺激提上唇肌记录方法可作为瞬目反射的检测方法之一.颏神经刺激眼轮匝肌及提上唇肌记录方法,与眶上神经刺激眼轮匝肌或提上唇肌记录方法相结合可作为瞬目反射的辅助检测.     

咬肌神经封闭治疗咬肌疼痛——临床记录

文章描述了对支配咬肌的咬肌神经局部注射麻醉剂的技术。在三叉神经第三支下颌神经通过卵圆孔后．下颌神经的前支与咬肌神经相伴行穿过颞下窝,最终咬肌神经穿过下颌切迹支配咬肌。在尸体解剖的帮助下,设计出对咬肌的局部封闭技术。咬肌神经的局部封闭是获得整个咬肌麻醉的有效方法。这种外周神经封闭对治疗急慢性咬肌疼痛提供了另一种治疗选择。该方法也可用来诊断鉴别疼痛来源。     

颞下颌关节紊乱病患者与健康人群颌面部机械疼痛敏感性的比较

目的 利用定量触诊仪对受试者双侧咬肌区及关节区进行触诊,比较和分析疼痛性颞下颌关节紊乱病（TMD）患者与健康人群口颌面部机械疼痛敏感性的差异。 方法 选取患有单侧咬肌区或关节区疼痛的TMD患者各40例作为试验患者组,40例健康人作为对照组。利用定量触诊仪在受试者双侧咬肌区或关节区进行触诊,通过口述疼痛模拟评分法（NRS）获得受试者不同检测位点的机械疼痛感觉,绘制机械疼痛敏感性地图,并计算熵值和重心坐标。利用两因素方差分析法分析性别和检查侧（患者组：健患侧;对照组：左右侧）对各组熵值和重心坐标的影响;利用三因素方差分析法分析性别、检查侧和检测位点对各组NRS评分的影响。 结果 TMD患者咬肌区及关节区健患侧熵值均有统计学差异（咬肌：P＜0.001,关节：P=0.006）,且患侧NRS指数显著高于健侧（咬肌：P＜0.001,关节：P＜0.001）;但对照组咬肌区及关节区双侧熵值及NRS指数无明显统计学差异（P≥0.071）。 结论 机械疼痛敏感性地图技术在提供标准化触诊的基础上可以作为区分疼痛性TMD患者及正常人的有效辅助工具,并为该技术应用于TMD患者治疗效果评估的可行性提供了依据。     

下颌骨颏部骨折小型接骨板固定的应变分析

目的探讨下颌骨颏部正中骨折内固定后功能状态下接骨板的应变情况。方法使用聚氨酯合成的下颌骨,建立由咬肌、颞肌、翼内肌、翼外肌和二腹肌5组肌肉共同加载的下颌骨机械力学模型。采用电阻应变片法分析前牙咬合（INC）,左侧磨牙咬合（L-MOL）,双侧后牙咬合（ICP）3种咬合状态下接骨板的应变。结果3种咬合状态下接骨板的外表面均表现为受压,且上缘接骨板的应变小于下缘接骨板。另外,加载时舌侧骨折线出现裂隙。结论下颌骨在功能状态下,颏部上下缘均受到张应力。颏部正中骨折,应该按照Champy的张力带理论固定2个接骨板。     

Somatosensory-evoked potential to evaluate the trigeminal nerve after sagittal split osteotomy

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.     

灼口综合征三叉神经诱发电位的初步研究

目的 通过电生理学手段检测BMS患者痛阈值,记录三叉神经诱发电位变化,以期推测神经传导过程中的病理状态,进一步探讨其发病机制。方法 以神经肌电图仪刺激患者舌背,共记录38个样本（灼痛者22,麻胀者10,对照组6）感知最小刺激量为痛阈,3倍阈值刺激舌神经,记录诱发电位中N3、N4的潜伏期及高峰电位的出现时间。结果 灼痛组痛阈值降低,N3、N4潜伏期缩短,高峰电位出现明显提前,与其他两组比较具有显著性差异（P＜0.01）,麻胀组则呈相反趋势,与对照组比较无显著差异（P＞0.05）。结论 BMS灼痛者神经兴性提高,对外界刺激易感;麻胀组则可能存在神经部分或安全传导阻滞。说明BMS灼痛报告真实可信,同时反映出神经传导过程中病理状态存在的可能性,显示出BMS可能存在的发病机制。     

Trigeminal nerve hypesthesia after sagittal split osteotomy in setback cases: correlation of postoperative computed tomography and long-term trigeminal somatosensory evoked potentials.

PURPOSE: We sought to assess the relationship of the inferior alveolar nerve to the osteotomy site after bilateral sagittal split osteotomy (BSSO) and to correlate the nerve osteotomy relationship as the cause of long-term postoperative hypesthesia. Patients and Methods: The subjects consisted of 28 patients with mandibular prognathism who underwent BSSO setback surgery. The distance between the ostectomized surface of the mandibular ramus and mandibular canal was measured and scored on a computed tomograph (CT). The relationship between this distance and the presence and degree or absence of trigeminal nerve hypesthesia was objectively evaluated by latency delay of the trigeminal somatosensory evoked potential (TSEP) records. RESULTS: Five of the 56 sides (8.9%) showed latency delays more than 1 year after the operations. Scored CT points between the canal and the split surface strongly correlated with TSEP latency recovery (Y = 1.716X + 41.2). CONCLUSIONS: This relationship between the canal and the osteotomy site is related to long-term hypesthesia in BSSO postoperatively.     

Somatosensory evoked potentials of inferior alveolar nerve.

PURPOSE: The use of inferior alveolar nerve somatosensory evoked potentials may represent an objective means of evaluating sensory nerve function in the maxillofacial region. The aim of this work was to confirm the existence of a standard sequence of prominent events in the trigeminal somatosensory evoked potentials (TSEPs) of inferior alveolar nerve (IAN) waveform, examine those components and their normal variability by statistical analysis, and discuss TSEPs' nervous origin and some patterns of TSEPs' abnormalities due to dysfunctional nerves. MATERIALS AND METHODS: TSEPs were obtained following electrical stimulation (square wave pulses 0.2 millisecond [ms] in duration, 4 to 6.5 mA, 0.7/second repetition rate, 200 averages) of the gum at the mental foramen level via intraoral surface electrodes and recorded from the contralateral central scalp sites. RESULTS: We successfully recognized steady waveforms of sufficient quality and consistently recorded a "W"-shaped response: latency onset and peak of the initial deflection of positive polarity were approximately 12 ms and 20 ms, respectively. Negative and positive deflections followed with respective peak latencies at around 26 ms and 36 ms. One side of the lower lip can be compared with the contralateral side and patients may serve as their own control in cases of unilateral nerve injury. The anaesthetic block showed the total abolition of responses. Reproducible TSEP waveform was only obtained during nerve stimulation and not during masseter muscle stimulation. CONCLUSIONS: TSEPs, obtained with the present technique, may represent an objective, low-invasive, and reliable way of testing sensory nerve function in the maxillofacial region.     

Evaluation of Systemic Levels of Neutrophilic Enzymes in Patients With Hypertension and Chronic Periodontitis

Background: Inflammation stimulates neutrophils to release their enzymes into the extracellular matrix. The aim of the present study is to investigate the serum levels of matrix metalloproteinase (MMP)‐8, MMP‐9, tissue inhibitor of MMP (TIMP)‐1, myeloperoxidase (MPO), and neutrophil elastase (NE) in patients with hypertension and chronic periodontitis (CP). Methods: A total of 95 patients were included in the study. Patients were categorized into three groups: healthy control (n = 29), hypertensive control (n = 32), and hypertensive CP (n = 34). Periodontal parameters were recorded, and serum samples were collected from each participant. Serum MMP‐8, MMP‐9, TIMP‐1, MPO, and NE levels in circulation were assessed by enzyme‐linked immunosorbent assay. Results: The hypertensive CP group had significantly higher serum MMP‐8, MMP‐9, and NE levels than the healthy control group (P <0.05). All study groups had similar serum TIMP‐1 levels (P >0.05). Significantly higher serum MPO levels were detected in patients with hypertension and CP than healthy controls and hypertensive controls (P <0.05); however, the difference in serum MPO levels was not significant between the healthy controls and hypertensive controls (P >0.05). There was no significant difference in MMP‐8/TIMP‐1 ratio among the study groups (P >0.05). MMP‐9/TIMP‐1 ratio was significantly higher in patients with hypertension and CP than healthy controls (P <0.05). Conclusions: The presence of hypertension along with CP has a considerable effect on serum neutrophilic enzyme levels, except TIMP‐1. However, the levels of these enzymes do not seem to be affected by the presence of hypertension only. Further studies including patients who have only CP might help illuminate the effect of CP on these enzymes in patients with hypertension.     

Role of lipocalin 2 and its complex with matrix metalloproteinase-9 in oral cancer

Oral Diseases (2012) 18 , 734–740 Objectives: Recent evidence demonstrated that lipocalin (LCN)2 is induced in many types of human cancer, while the detection of its complex with matrix metalloproteinase (MMP)‐9 is correlated with the cancer disease status. We attempted to evaluate plasma expressions of LCN2, MMP‐9, and their complex (LCN2/MMP‐9) during the diagnostic work‐up of patients with oral squamous cell carcinoma (OSCC) and investigated their correlations with disease progression. Methods: In total, 195 patients with OSCC and 81 healthy controls were recruited. Expression levels of LCN2, MMP‐9, and LCN2/MMP‐9 were determined with immunoenzymatic assays. Results: Patients with OSCC exhibited significantly higher levels of LCN2, MMP‐9, and LCN2/MMP‐9 compared with healthy controls (LCN2: P < 0.001; MMP‐9: P < 0.001; LCN2/MMP‐9: P < 0.01). Plasma levels of LCN2, MMP‐9, and LCN2/MMP‐9 in patients with OSCC were significantly correlated with each other and were associated with more‐advanced clinical stages (P < 0.05) and/or a larger tumor size (P < 0.05), but were not associated with positive lymph‐node metastasis or distal metastasis. Conclusion: Our results suggest that plasma levels of LCN2 and the LCN2/MMP‐9 complex may be useful in non‐invasively monitoring OSCC progression, while supporting their potential role as biomarkers of oral cancer disease status.     

脂质体阿霉素对大鼠三叉神经形态与功能影响的实验研究

目的 :观察脂质体阿霉素对大鼠三叉神经形态与功能的影响。方法 :3 3g/L脂质体阿霉素直接注射于大鼠一侧眶下神经束 ,对侧以生理盐水对照。神经电生理检查给药后大鼠的二腹肌肌电的变化 ,光镜下观察实验侧三叉神经节细胞的形态学变化 ,透射电镜观察三叉神经节细胞的超微形态结构变化。结果 :神经电生理结果显示动物对针刺反应不敏感 ,并显示不同时间左右两侧潜伏期 (ms)及痛阈 (mA)的变化都有显著性差异 (P <0 .0 5 ) ;实验侧光镜下可见大量细胞皱缩 ,形态不规则 ,细胞周围出现空隙 ;电镜下可见胞质中出现不规则的电子致密物质 ,线粒体、高尔基体、粗面内质网、核膜、有髓神经纤维髓鞘和无髓神经纤维病理性改变。结论 :脂质体阿霉素注入神经干后 ,可以选择性破坏相应的节细胞 ,引起神经功能上的变化。