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Introduction Sialoliths can be removed by sialendoscopy in some cases. But sometimes it fails if the stone is located in the proximal or hilum of Wharton's duct. Aim To evaluate the clinical efficacy of the sialendoscopy-assisted intraoral incision approach to remove large stones located in the proximal or hilum of Wharton's duct, when sialendoscopy alone fails. Material and methods Twenty patients with large stones located in the proximal or hilum of Wharton's duct were included in our study. We used a sialendoscopy-assisted intraoral incision approach to remove large stones located in the proximal or hilum of Wharton's duct when endoscopy failed. The complications and treatment effect were observed. Results The stones were removed successfully in this way in all patients. Two cases had tongue numbness after the operation, and recovered 3 months later without additional intervention. No swelling or pain appeared during the 3-month to 1-year follow-up. Saliva could be observed from the orifice in 15 patients, with little or none in 5 patients. Conclusions The sialendoscopy-assisted intraoral incision approach to remove large stones located in the proximal or hilum of Wharton's duct is effective and safe.

This paper reveals the concepts of taste in the Patani Malay ethnic group. Forty-five Patani Malays living in Pattani province, Yala province, and Narathiwat province participated in this study. The analysis uses the framework of componential analysis in ethnosemantics. The results show that there are ten basic taste terms in the Patani Malay dialect: /masɛ/ ‘sour’, /maseŋ/ ‘salty’, /manih/ ‘sweet’, /paheɁ/ ‘bitter’, /lɨcah/ ‘a little bit spicy and causing tongue pain’, /lɨta/ ‘unpleasant taste, sticking on the tongue and causing tongue numbness’, /khɨlaɁ/ ‘astringent’, /pɨdah/ ‘spicy’, /lɨmɔɁ/ ‘nutty’ and / tawa/ ‘bland’. All of them are distinguished by eight dimensions: taste buds, tongue side, tongue tip, acidity, tongue body, pain, tongue numbness, and nuttiness. Besides using each taste term individually to describe tastes of food, Patani Malays also use them repeatedly, combine each taste term together, and combine them with modifiers. From these ten basic taste terms, there are two taste terms that concern pain in the mouth and on the tongue. These are /lɨcah/ ‘a little bit spicy and causing tongue pain’ and /pɨdah/ ‘spicy’. This reflects the preference for spicy flavours in the Patani Malay ethnic group. It may be due to the influence of using spices and chili in cooking adopted from foreign countries since ancient times. It may also be due to the geographical characteristics of Pattani, Yala, and Narathiwat provinces, which are located along the coast. People, therefore, prefer eating spicy food to keep their body warm and prevent illness.

A 29-year-old male presented to our emergency department with complaints of a left frontal headache, similar to his prior headaches. He also reported about 30 minutes of facial and tongue numbness, left arm weakness, slurred speech and changes in hearing that had resolved prior to his arrival. Despite the short duration of the other neurologic symptoms, he also endorsed persistent “dizziness.” Despite his history of recurrent headaches, he had never had any neuroimaging. This, as well as his reports of new neurological symptoms, prompted his care team to obtain a non-contrast brain computed tomography. The findings were consistent with a mass with mild hydrocephalus. Patient underwent neurosurgical resection of the mass at a tertiary center. He did well after surgery and was discharged on postop day 6 with a diagnosis of colloid cyst.

Objectives To demonstrate different techniques in manipulating the chorda tympani nerve during endoscopic stapedotomy for otosclerotic patients. Materials Twenty patients presented with clinically diagnosed otosclerosis were randomly selected from outpatient ENT clinic in a tertiary referral Hospital over a period of 2 years (2013–2015) for endoscopic stapes surgery. Methods This prospective study demonstrates different management modalities of chorda tympani nerve in endoscopic stapes surgery according to the endoscopic anatomical relationship between the length of the chorda tympani nerve and the degree of scutum overhanging the oval window niche structures (endoscopic scutum- chorda tympani relationship). Results Three management techniques were carried out to deal with chorda tympani based on its endoscopic anatomical relationship with the scutum (no manipulation, upward-displacement, downward-displacement). All patients had significant improvement of postoperative hearing. Only 2 patients were managed by downward displacement technique had postoperative change in taste sensation and tongue numbness that improved over a period of 6 months. Conclusion trans -Canal fully endoscopic stapedotomy provides feasible and safe handling of the chorda tympani nerve with best postoperative taste sensation preservation.

OBJECTIVES: To investigate an unusual outbreak of tetrodotoxin poisoning in Leizhou, southeast China, a case series analysis was conducted to identify the source of illness. METHODS: A total of 22 individuals experienced symptoms of poisoning, including tongue numbness, dizziness, nausea and limb numbness and weakness. Two toxic species, Amoya caninus and Yongeichthys nebulosus, were morphologically identified from the batches of gobies consumed by the patients. Tetrodotoxin levels in the blood and Goby fish samples were detected using liquid chromatography-tandem mass spectrometry. RESULTS: The tetrodotoxin levels in the remaining cooked Goby fish were determined to be 2090.12 µg/kg. For Amoya caninus, the toxicity levels were 1858.29 µg/kg in the muscle and 1997.19 µg/kg in the viscera and for Yongeichthys nebulosus, they were 2783.00 µg/kg in the muscle and 2966.21 µg/kg in the viscera. CONCLUSION: This outbreak demonstrates an underestimation of the risk of Goby fish poisoning. Furthermore, the relationships among the toxic species, climates and marine algae present should be clarified in the future.

Introduction: Iatrogenic chorda tympani nerve (CTN) injury during middle ear surgery is quite common. The objective of ours study is to observe frequency & types of CTN injury during middle ear surgery and assess types of post-operative taste disturbances and their functional recovery. Methods: Patients who underwent middle ear surgery from 1st October 2005 to 1st January 2007 in Tribhuvan University Teaching Hospital were divided into 6 groups according to intraoperative CTN manipulation as; seen but not handled, handled but not stretched, stretched but intact, cut while stretching, cut while using burr and clean cut with scissors. Subjective assessment of taste disturbance was done after 2 days & 2, 4 & 6 months post-operatively and categorized as altered taste sensation/metallic taste, tongue numbness and dry mouth. Results: Amongst 260 patients, CTN was seen but not handled in 52/260 (20%), handled but not stretched in 54/260 (20.75%), stretched but intact in 66/260 (25.38%), cut while stretching in 17/260 (6.5%), cut while using burr in 29/260 (11.15%) and clean cut with scissors in 42/260 (16.15%) patients. Eleven out of 260 patients (4.2%) symptomatic amongst which 6/11 (54.5%) had altered taste sensation, 4/11 (36.3%) had tongue numbness and 1/11 (9%) had dry mouth. Complete recovery occurred in 9/ 11 (81.8%) patients by 6 months. Conclusion Though iatrogenic CTN injury was common during middle ear surgery, frequency of taste disturbance was comparatively less, commonest type of CTN injury being stretched but intact. The most common post-operative taste disturbance was altered taste sensation/metallic taste. Most patients recovered completely by 6 months. Functional recovery was earlier when CTN was preserved than when sectioned. Keywords: CTN; middle ear surgery; taste disturbance DOI: http://dx.doi.org/10.3126/joim.v32i3.4955 Journal of Institute of Medicine, December, 2010; 32:3 18-23

OBJECTIVE: To report a case of a paresthesia-type reaction due to the use of rofecoxib in standard doses for the treatment of osteoarthritis. CASE SUMMARY: A 55-year-old white woman was receiving rofecoxib for treatment of osteoarthritis. The patient began to have tongue numbness and hand tingling and numbness shortly after starting therapy with rofecoxib. The occurrence and resolution of her symptoms correlated with the start and end of the therapy. DISCUSSION: An adverse reaction with rofecoxib is a likely explanation for the patient's symptoms. Paresthesias have been reported in 0.1–1.9% of patients who took rofecoxib during premarketing studies, but no causality has been established. One case report of paresthesias occurring in a 59-year-old white man who took one 20-mg dose of piroxicam is available. Information on when the reaction occurred in relation to the dose and resolution of the reaction was not recorded in this study. Our patient's reaction is best classified as idiopathic. CONCLUSIONS: We report the first case of a paresthesia-type reaction to rofecoxib in a patient receiving the drug in standard doses for treatment of osteoarthritis. Although the reaction is rare, clinicians should be aware of its potential.

This video demonstrates a very useful trajectory to a pontine lesion. A 68-year-old man presented with tongue numbness and weakness. The approach used was a transtemporal presigmoid retrolabyrinthine approach to enable an orthogonal trajectory to the lateral pons. Following the transtemporal opening, the root entry zone of the trigeminal nerve and the root exit zone of the facial nerve are identified. The lateral pons is incised to access the tumor, which upon histological analysis was found to be a metastasis. Excellent visualization of the lateral pons is achieved. The opening, relevant anatomy, and closure are illustrated.The video can be found here: http://youtu.be/vS5fCOY6vp8.

A 20-year-old woman presented with a report of tongue numbness. The patient had a long-standing history of Raynaud's phenomenon and had received a diagnosis of mixed connective-tissue disease; testing was positive for antinuclear and anti-ribonucleoprotein antibodies. She was receiving prostacyclin for Raynaud's phenomenon. Two years before presentation, she had begun having intermittent attacks of tongue numbness with concomitant dysarthria. These attacks did not seem to coincide with digital vasospasm and usually resolved within 15 minutes. Because the attacks never occurred during a medical visit, she used her mobile-phone camera to take a picture of her tongue during an attack. The . . .

A comparative study was made of the Gow-Gatestechnique and the standard inferior alveolar nerve block. Forty subjects received both injections and various tests were performed 10 min after injection. The results demonstrated no significant differences between the two injection techniques, except in response to the question concerning subjective tongue numbness. Both techniques achieved a high rate of subjective numbness in the subjects' perception of overall numbness and lip numbness. Objective testing showed that only 38% of the subjects receiving the standard injection and 35% of the subjects receiving the Gow-Gates technique gave no response to the electric pulp tester at the maximum output (80/80).

In recent years, adult tonsillectomies have tended to increase, and with more adult patients there has been increased bleeding during the operation, as well as a tendency for postoperative taste disorders and numbness of the tongue, presumably because the operative field is fixed with a Davis mouth-opening device in pediatric tonsillectomies, and unnecessary compression is applied to the tongue.The authors have devised the Kinki mouth-opening device which combines the advantages of the Whitehead and Davis devices. AA comparison between the Kinki and Davis devices showed that the mouth opening angle and the space between the teeth and the root of the tongue were all greater with the Kinki device than with the Davis device, indicating that the mouth was opened wider with the Kinki device. The postoperative changes in taste were measured with an electric gustometer, and the Davis device caused more loss of taste than the Kinki device. The incidence of tongue numbness was also greater with the Davis device than with the Kinki device. The Kinki mouth-opening device appears to be ideal for adult tonsillectomies.