Sakavičius, Dalius

Background Trigeminal neuralgia (TNN) is a disabling facial pain disorder marked by sudden unilateral paroxysms, most often in the maxillary or mandibular branches. Prevalence is 4–29 cases per 100,000 persons, with female predominance. Pharmacological therapy is a first-line treatment and microvascular decompression is the surgical standard, but both are limited by resistance, intolerance, or procedural risk. Injectable therapies have recently emerged as minimally invasive alternatives. This review systematically evaluated their efficacy and safety in TNN. Methods A systematic search of PubMed (MEDLINE) and the Cochrane Library was performed for studies published between 2015 and 2025 using the terms “trigeminal neuralgia AND injection.” Eligible studies were randomized trials or cohort studies including ≥20 adults with classical TNN treated by injectable therapies and reporting pain or safety outcomes. From 363 records, 13 studies met inclusion criteria. Results Thirteen studies (seven randomized trials; six cohorts; ~840 patients) were analyzed. Botulinum toxin A (BTX-A) was most studied (n = 27–152), reducing pain by 40–70% and attack frequency by up to 60%, with ≥50% responders in 55–91% and relief lasting 3–6 months. A pilot trial (n = 81) found single-dose BTX-A more durable than repeated dosing. Ozone therapy (n = 103) lowered VAS from 8.1 to 2.9 at 12 months. Calcitonin-enhanced blocks (n = 30, n = 33) prolonged analgesia up to 35 weeks and reduced drug use. Corticosteroid–anesthetic blocks (n = 72), bupivacaine adjuncts (n = 73), and guanfacine–lidocaine (n = 37) also showed significant benefits. Adverse effects were mild and transient. Conclusions Injectable therapies demonstrate consistent efficacy and safety in TNN. BTX-A and calcitonin have the strongest evidence, while other modalities remain promising but less studied. They may represent a minimally invasive option for refractory patients pending validation in larger multicenter trials.

Gydytojai odontologai ir odontologai specialistai privalo suprasti, kad gydo ne tik dantis ir burną, bet gydo pacientą kaip visumą, kuriam dėl šiuolaikinės medicinos pasiekimų vis anksčiau ir tiksliau diagnozuojamos ligos, sėkmingiau taikomi nauji veido ir žandikaulių srities gydymo metodai. Specialistui nepakanka žinoti apie siauros srities ligas ir jų gydymą, gydytojo pareiga į žmogaus organizmą, gretutines ligas, jų gydymą ir procesų bei veiksnių sąveiką žvelgti plačiau. Medicinoje, kaip ir gyvenime, susiduriama su priežasties ir pasekmės santykiu. Bet koks invazyvus gydymas turi pasekmių, kurios gali būti laukiamos, nes gydo ligą, ir, deja, nepageidaujamos, sukeliančios neigiamą poveikį. Kalbėdami apie invazyvų gydymą, omenyje turime ne tik chirurginį, bet ir medikamentinį gydymą. Jau nuo seno laikomasi vieno iš pagrindinių chirurgijos principų – „žeisdamas gydau“. Gydymo sėkmė priklauso nuo tinkamai parinkto gydymo veiksmingumo, trukmės, optimalaus stiprumo ir t. t. Šie principai pritaikomi ir chirurginiams, ir konservatyviems gydymo metodams. Deja, medikamentinis gydymas taip pat gali sukelti šalutinį poveikį. [...].

Tyrimo tikslas. Palyginti dviejų lėtinio apikalinio periodontito gydymo metodų - apikoektomijos su retrogradiniu šaknies viršūnes užpildymu ir endodontinio gydymo, atliekamo prieš šaknies viršūnes rezekciją veiksmingumą. Tyrimo medžiaga ir metodai. Atlikta sisteminė literatūros apžvalga, įtraukiant klinikinius tyrimus su pacientais, kuriems dėl periapikalinio pažeidimo buvo taikyta apikoektomija. Tyrimai atrinkti vadovaujantis PRISMA metodika iš duomenų bazių „PubMed“, „Science Direct' ir „Wiley Online Library". Analizuoti straipsniai, publikuoti 2016-2024 m. anglų kalba. Tyrimų atrankai taikytas PICO modelis. Straipsnių kokybė ir šališkumo rizika vertinta naudojant „RoB 2“ ir „ROBINS-I" įrankius. Rezultatai. Apžvelgti trys tinkami tyrimai parodė, kad apikoektomija su retrogradiniu plombavimu, ypač naudojant mineralinio trioksido agregatą (MTA), užtikrina geresnį apikalinį sandarumą ir ilgesnį dantų funkcionavimo laikotarpį. Vis dėlto kai kuriuose tyrimuose nustatyta, kad apikoektomija be retrogradinio plombavimo taip pat gali būti veiksminga, jei prieš operaciją atliekamas kokybiškas ortogradinis plombavimas. Ilgalaikio sėkmingo gydymo rodiklis, priklausomai nuo metodo, svyravo nuo 55 proc. ir 99,2 proc. Išvados. Apikoektomija su retrogradiniu plombavimu dažnai užtikrina geresnius ilgalaikius rezultatus, tačiau kai kuriais atvejais pakanka tinkamai atlikto ortogradinio plombavimo. Siekiant nustatyti optimalų gydymo metodą, reikalingi papildomi tyrimai su didesnėmis imtimis.

Introduction. This article comprehensively explores Dirofilariasis, focusing on Dirofilaria repens and Dirofilaria immitis as rare zoonotic ailments. Emphasis is placed on their prevalence, life cycle intricacies, and symptoms, particularly the rising incidence of Dirofilaria repens in Europe, notably Lithuania. The report details three cases of oral dirofilariasis, presenting clinical histories, diagnostics, interventions, and species identification. The discussion highlights the rarity of maxillo-mandibular dirofilariasis, addressing diagnostic challenges and diverse treatment options. Objective. The objective is to investigate the emergence, clinical aspects, and management of Dirofilariasis, with a focus on Dirofilaria repens, emphasizing its prevalence in Europe, particularly Lithuania. Materials and methods. The article presents three cases of oral dirofilariasis, providing detailed clinical histories, diagnostic procedures, interventions, and species identification. A thorough examination of Dirofilaria repens prevalence and characteristics in Europe, especially Lithuania, is conducted. Results. The discussion reveals insights into the rarity of maxillo-mandibular dirofilariasis, highlighting diagnostic challenges and diverse treatment options. The cases contribute valuable information on clinical and diagnostic aspects, enhancing the understanding of this unusual condition. Conclusion. The conclusion emphasizes the critical need for heightened awareness and a comprehensive diagnostic approach in managing oral dirofilariasis. It serves as a reminder to healthcare professionals about the importance of increased awareness for effective management in medical practice.

The complete mechanism of Trigeminal neuralgia (TN) development is still not fully understood, knowing that several different factors can cause this disease. Magnetic resonance imaging (MRI) is an auxiliary tool to determine the possible cause. This paper reviews the architecture of the trigeminal nerve that is important to TN, describes the imaging appearance of vascular compression of the trigeminal nerve in TN patients, and discusses the relationship between these findings and the causative TN branch. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria, this systematic review and meta-analysis was carried out. The query set that was utilised was (neurovascular conflict) AND (trigeminal nerve) AND (neuralgia). The databases Google Scholar, ScienceDirect, ResearchGate, and PubMed/MEDLINE were utilised. The primary database search yielded 3886 articles; after applying search criteria, 4 articles were selected for the study. The methodological indicator of non-randomized studies - MINORS was used. The most common branches involved in the TN were a combination of second and third branches (55.6%). The overall difference was statistically insignificant when comparing the second and third trigeminal nerve branches with the most common neurovascular conflict vessels. MRI is the most used diagnostic tool for evaluating NVC in TN. The analyzed studies present the most frequent involvement of vertebral artery or superior cerebellar artery vessels in the NVC. Further large sample size studies are needed to develop a map (algorithm) that can easily identify the contacting vessel in the presence of branch TN.

Nacionalinės valdžios institucijos turi nustatyti sveikatos tyrimų prioritetus ir priimti sprendimus dėl investicijų į sveikatos sistemas ir sveikatos priežiūros priemones. Visuomenės sveikatos intervencijomis siekiama sumažinti gyventojų ligų naštą ir pagerinti gyvenimo kokybę. DALY yra priemonė kiekybiškai įvertinti ligų naštą, išreikštą populiacijoje prarastų metų dėl ankstyvos mirties ar negalios, skaičiumi. Darbo tikslas − teoriškai pagrįsti DALY indeksą, jį interpretuoti ir pateikti apskaičiavimo bei praktinio panaudojimo pavyzdžių. Mokslinių straipsnių, publikuotų 1997–2021 m. laikotarpiu, ieškota MEDLINE, Google Scholar ir ScienceDirect mokslinių duomenų bazėse. Paieškoje naudotos raktažodžių kombinacijos anglų kalba: DALY index, disability-adjusted life year, life expectancy, quality of life. Literatūros šaltiniai atrinkti remiantis šiais kriterijais: straipsniai, kuriuose aprašomas DALY indeksas; straipsniai, pateikiantys DALY indekso pritaikymo būdus; straipsniai, kuriuose apskaičiuojami DALY indeksas. Rezultatai parodė daugybę skirtumų tarp intervencijos kainos ir sveikatos pagerėjimo. Nustatytas silpnas ryšys tarp intervencijos didesnės kainos ir patikimesnio sveikatos pagerėjimo, tačiau nerasta įrodymų, kad brangesnė intervencija sveikatą pagerintų labiau. Daromos išvados, jog DALY skaičiavimui reikalinga daugybė duomenų, kurie ne visada prieinami, o skaičiavimas sudėtingas ir brangus. Be to, DALY nevertina ligonio galimybių gyventi su negalia ir daugelio kitų veiksnių, turinčių įtakos sveikatos politikos klausimų sprendimui.

Aim. Purpose of these case report is to highlight the precision and accuracy obtained with patientspecific implants for orbital reconstruction designed on the basis of 3d analysis of orbital computed tomographic scan (CT) using virtual planning, computerised designing, 3d printed stereolithographic models and 3d printed titanium orbita implants to correct late post traumatic orbital deformities which causes enophthalmos, diplopia and facial deformity. Material and methods. These 2 cases report describes a patients who came to our clinic for correction of enophthalmos, persistent diplopia in upward gaze and facial deformities, more than twelve months post trauma. Three dimensional (3D) virtual treatment planning was carried out by using the 3D CT data. The unaffected orbit of the contralateral side was superimposed on the deformed orbit to highlight the defect and a customized implant was designed in the desired size and shape on 3d planning program and they were printed with 3d printer for precise anatomic orbital reconstruction. Results. There was a marked improvement in the diplopia, in upward gaze, enophthalmos and facial deformities post surgery when the individual orbital implants printed with 3d technology was used. Conclusion. The concept of 3D virtual treatment planning, 3D stereolithographic models, individual printed with 3d printer titanium mesh implants, greatly improves the correction of extremely difficult late post- traumatic orbital deformities.

Ligos istorija yra dokumentas, kuriame įrašoma paciento ligos atsiradimo, plitimo, baigties ir veiksmingo gydymo informacija. Šiame dokumente saugoma ne tik medicininė informacija, bet ir asmens duomenys. Mokomoji ligos istorija yra tinkamiausia gydytojo praktikos simuliacija, padedanti įsigilinti į ligą, tiesiogiai bendraujant ir stebint paciento gydymą ir ligos eigą. Ligos istorijos rašymas yra savarankiškas studento darbas. Šia metodine priemone siekiama išlavinti analitinį ir kritinį studento mąstymą, suteikti žinių apie ligų diagnostiką, gydymo planavimą bei leisti studentui pademonstruoti gebėjimą savarankiškai taikyti teorines žinias praktikoje. Studentas privalo savarankiškai surinkti duomenis rašomai ligos istorijai: anamnezę, tyrimų rezultatus, gydymo planą, komplikacijų profilaktikos priemones ir nustatyti gydymo veiksmingumo prognozę. Vertinant šį darbą, bus atsižvelgiama į individualų studento indėlį analizuojant patologiją, jos tyrimą, ligos nustatymo pagrindimą bei gydymo metodų parinkimą. Šiam tikslui pasiekti, studentas turi panaudoti ne tik studijų metu įgytas pamatines žinias, bet ir pademonstruoti gebėjimą surinkti naujausią informaciją iš šiuolaikinių mokslo literatūros duomenų bazių.

Objectives: The review aims to study dental implant placement purposefulness for patients who have been treated or are on treatment with bisphosphonate medication. Material and Methods: Structured search strategy was applied on electronic databases: MEDLINE, PubMed, PubMed Central and ResearchGate. Scientific publications in English between 2006 and 2017 were identified in accordance with inclusion, exclusion criteria. Publication screening, data extraction, and quality assessment were performed. Outcome measures included implant failure or implant-related osteonecrosis of the jaw. Results: In total, 32 literature sources were reviewed, and 9 of the most relevant articles that are suitable to the criteria were selected. Heterogeneity between the studies was found and no meta-analysis could be done. Five studies analysed intraoral bisphosphonate medication in relation with implant placement, three studies investigated intravenous bisphosphonate medication in relation with implant placement and one study evaluated both types of medication given in relation with implant placement. Patients with intraoral therapy appeared to have a better implant survival (5 implants failed out of 423) rate at 98.8% vs. patients treated intravenously (6 implants failed out of 68) at 91%; the control group compared with intraoral bisphosphonate group appeared with 97% success implant survival rate (27 implants failed out of 842), showing no significant difference in terms of success in implant placement. Conclusions: Patients treated with intravenous bisphosphonates seemed to have a higher chance of developing implantrelated osteonecrosis of the jaw. The intraorally treated patient group appeared to have more successful results. Implant placement in patients treated intraorally could be considered safe with precautions.

OBJECTIVES: The purpose of this study was to evaluate the influence of leukocyte- and platelet-rich fibrin (L-PRF) on impacted mandibular third molar (IMTM) extraction wound healing, patient postoperative discomfort, and incidence of alveolar osteitis. METHOD AND MATERIALS: Thirty-four patients (20 female, 14 male) who met the inclusion criteria for this split-mouth randomized clinical trial were enrolled and 30 patients completed the study. Patients were randomized and underwent bilateral IMTM surgical extractions. Following extraction, one socket randomly received L-PRF, and the other socket served as a regular blood clot control. Postoperatively, the soft tissue healing index (HI), pain according to visual analog scale (VAS), facial swelling using a horizontal and vertical guide, and incidence of alveolar osteitis were evaluated 1, 3, 7, and 14 days after surgery. RESULTS: Sites treated with L-PRF resulted in improved HI (P = .001) and lower pain VAS scores (P = .001) in the first postoperative week. Significant reduction of facial swelling was recorded on first (P = .035) and third (P = .023) postoperative days in L-PRF sites versus controls, ceasing to nonsignificant difference at day 7 (P = .224). None of the L-PRF sites and four control sites were affected by alveolar osteitis (P = .001). CONCLUSION: Within the limitations of this split-mouth study, L-PRF improved soft tissue healing and reduced postoperative pain, swelling, and incidence of alveolar osteitis after IMTM surgical extractions.