Search

This manuscript is a systematic, narrative review that compiles and describes all data available from 2019 related to epidemiologic, diagnostic, and therapeutic advances in diabetic neuropathy (DN). Epidemiology of DN is discussed. Diagnostic modalities include predictive models, electrodiagnostics, imaging, and biomarkers. A majority of studies on the treatment of diabetic peripheral neuropathy (DPN) involve pharmacotherapy, but complementary and alternative medicine, exercise, modalities, psychological, interventional, and surgical options are also explored. DN is a highly prevalent and debilitating consequence of diabetes that can present challenges to the clinician as the assessment is largely subjective with different phenotypic presentations among patients. Treatment of DN is largely symptomatic as the pathogenesis of DN is not fully understood and is likely multifactorial. It is evident from the broad range of treatments that too often provide unsatisfactory relief that there is no consensus about a single most effective treatment for DN, and monotherapy rarely proves to be successful.

Background and objectivesMandibular nerve blocks are indicated for atypical face pain and trigeminal neuralgia. We hypothesized that a modified lateral approach, which entailed a combination of lateral and anterior approach techniques to the mandibular nerve block would lead to similar efficacy and improved safety profile rather than the typical lateral or anterior techniques.MethodsThis alternative approach was derived from anatomical investigation using the Radiology Anatomy Atlas Viewer and reconstructed axial cadaveric slices. We used axial slices at the level of the lateral pterygoid plate, and at the level of the temporomandibular joint to devise a needle path appropriate for this block.ResultsThe modified lateral approach to the mandibular nerve block was verified theoretically through cadaveric reconstructed slices and has been successfully performed in our practice. Precise needle trajectory could avoid both periosteal contact and gross redirection, as well as other procedural complications.ConclusionThe modified lateral approach to a mandibular nerve block avoids the respective risks associated with either the lateral and anterior approach. Facial intervention techniques typically pose increased safety challenges, however through cadaveric anatomic reconstruction, we have developed a safer approach for mandibular nerve blockade.