Gary Heir - Academia.edu (original) (raw)

Papers by Gary Heir

Research paper thumbnail of Bilateral glossopharyngeal neuropathy following chemo and radiation therapy for a primitive neuroectodermal tumour

Journal of Oral Rehabilitation, Nov 14, 2015

This case describes a young adult male patient diagnosed and treated for a primitive neuroectoder... more This case describes a young adult male patient diagnosed and treated for a primitive neuroectodermal tumour (PNET) at 3 years of age. Chemotherapy and radiation therapy used following surgical treatment of this tumour have known neurotoxic complications, some of which have delayed onset. In this case, the patient exhibited sudden onset, persistent bilateral and deep ear pain that was consistent with a neuropathy of the glossopharyngeal nerve occurring 17 years after the completion of therapy for PNET. Treatment with pregabalin was successful with near-complete resolution of the complaint. The diagnostic certainty in this case is discussed in relation to the current diagnostic criteria for neuropathic pain.

Research paper thumbnail of Use of compounded topical medications for treatment of orofacial pain: a narrative review

Background and Objectives: Orofacial pain is a frequent form of pain perceived in the face and/or... more Background and Objectives: Orofacial pain is a frequent form of pain perceived in the face and/or oral cavity. It may be caused by diseases or disorders of regional structures, dysfunction of the nervous system, or through referral from distant sources. The objective of the narrative review is to describe the classifications of orofacial pain, potential targets for pharmacotherapeutic treatment and discusses the novel topical administration of already approved medications for management. Actual cases will be presented illustrating administration and efficacy. Methods: Electronic databases (PubMed, Embase, Ovid Medline, Google scholar, Scopus, Cochrane library) were searched using keywords "Topical medications" and "Orofacial Pain" from 1 st January 1974 to 30 th November 2021. A total of 280 articles were identified and relevant 105 articles were included in the review.

Research paper thumbnail of Hemicrania continua secondary to neurogenic paravertebral tumor- a case report

Scandinavian Journal of Pain, Aug 24, 2021

Objectives: Hemicrania continua (HC) is one of the trigeminal autonomic cephalalgias (TAC), where... more Objectives: Hemicrania continua (HC) is one of the trigeminal autonomic cephalalgias (TAC), where sympathetic dysfunction and autonomic dysfunction resulting in parasympathetic over activation with some evidence of sympathetic inhibition have been suggested as probable causes. However, cases of hemicrania continua secondary to sympathetic dysfunction due to neurogenic paravertebral tumor impinging on the sympathetic chain has not been previously reported. In this case, the probability of the sympathetic dysfunction was more likely based on the clinical features and management. Case presentation: A 23-year-old female presented with a chief complaint of right unilateral pain in the retro-bulbar, head and facial region for the past three years. An initial MRI of the brain was negative, whereas an MRI of the spine was advised to rule out a cervicogenic origin of the pain. The MRI revealed a well-defined mass lesion within right paravertebral region at T3 indicative of a neurogenic tumor. The patient was diagnosed with probable hemicrania continua secondary to neurogenic tumor impinging on adjacent sympathetic chain. A trial of indomethacin 75 mg/day was advised, which provided complete relief of the headache. The patient was referred to a neurologist for management of the neurogenic tumor. Conclusions: Headache disorders may be secondary to pathologies and comprehensive evaluation and accurate diagnosis are essential. Knowledge of neuroanatomy is paramount to understand and explain underlying pathophysiological mechanisms. Multidisciplinary management is essential in complex orofacial cases.

Research paper thumbnail of Minimally Invasive Trigeminal Ablation: Long Buccal Nerve

Journal of oral and facial pain and headache, Jul 1, 2019

To describe a technique of minimally invasive trigeminal nerve ablation of the long buccal nerve ... more To describe a technique of minimally invasive trigeminal nerve ablation of the long buccal nerve that was performed at a tertiary care academic medical center. Methods: This case describes a 44-year-old woman with refractory left long buccal nerve neuropathy following a dental procedure. After failing medical management, she was taken for nerve exploration, which revealed no nerve discontinuity or neuroma formation. She was therefore counseled regarding the risks and possible benefits of a novel minimally invasive trigeminal nerve thermoablation of the long buccal nerve technique. Results: Postoperatively, the patient experienced mild anesthesia along the long buccal nerve division and no longer experiences any allodynia or hypersensitivity. Additionally, she no longer requires any additional medical therapy or interventions. Conclusion: Minimally invasive trigeminal nerve ablation of the long buccal nerve may be effective surgical intervention in treating refractory neuropathic pain in cases of no structural nerve defects. However, long-term well-designed studies are required to fully define its role.

Research paper thumbnail of Symposium 2 Temporomandibular Disorder and Anti-inflammation Treatment

Research paper thumbnail of Diagnosis and Management of TMJ Involvement in Ankylosing Spondylitis

The Journal of cranio-mandibular practice, Mar 1, 1983

A patient with facial pain and a limited range of mandibular movement underwent an extensive dent... more A patient with facial pain and a limited range of mandibular movement underwent an extensive dental/craniomandibular examination. In addition, he had a medical and rheumatological evaluation. A diagnosis of ankylosing spondylitis with secondary involvement of the temporomandibular joints was made. This was clearly differentiated from rheumatoid arthritis. A multidisciplinary approach to treatment was established with excellent cooperation between physicians and dentist. The management of this patient is described.

Research paper thumbnail of Temporomandibular joint craniomandibular disorders. An overview

Research paper thumbnail of If only I knew...!

Research paper thumbnail of Introduction to orofacial pain

Research paper thumbnail of Doctor, why wasn't I told this before?

Research paper thumbnail of Peripheral and Central Pain of Temporomandibular Disorders

Research paper thumbnail of Application of psychometric testing for validation in the field of orofacial pain

Research paper thumbnail of History Taking of the Facial Pain Patient with the Assistance of a Comprehensive Questionnaire

Cranio-the Journal of Craniomandibular Practice, 1993

Research paper thumbnail of Pain and dysfunction of the temporomandibular joint

Research paper thumbnail of Combined Palliative and Anti-Inflammatory Medications as Treatment of Temporomandibular Joint Disc Displacement Without Reduction: A Systematic Review

Cranio-the Journal of Craniomandibular Practice, Jul 1, 2013

The aim of this study was to evaluate the efficacy of self-care combined with anti-inflammatory m... more The aim of this study was to evaluate the efficacy of self-care combined with anti-inflammatory medications in the treatment of temporomandibular joint (TMJ) pain associated with disc displacement without reduction (DDWOR). A systematic review of randomized clinical trials was done by the authors. The databases searched were Medline (1966 to July 2012); EMBASE (1980 to July 2012); and LILACS (from 1982 to July 2012). The review authors independently assessed trials for eligibility and methodological quality and also extracted all data. The data was double-checked for accuracy. There was no language restriction in the searches of EMBASE, PubMed, and LILACS databases, or in the manual search. The risk of bias and the heterogeneity of the studies taken into consideration were assessed. Two studies, randomizing 175 patients, were included in this review. The first study (n = 106) compared the following interventions: medical treatment, rehabilitation, arthroscopic surgery with postoperative rehabilitation, or arthroplastic surgery with post-operative rehabilitation. The second study (n = 69) compared the use of nonsteroidal anti-inflammatory medications and self-care instructions, nonsteroidal anti-inflammatory medications, occlusal splint, and mobilization therapy. The third group received no treatment; patients were only informed of their prognosis. There is no sufficient evidence regarding efficacy and safety of the palliative treatments associated with anti-inflammatory versus other treatments, or absence of treatment on pain reduction in patients with TMJ DDWOR.

Research paper thumbnail of Differentiation of Orofacial Pain Related to Lyme Disease from Other Dental and Facial Pain Disorders

Dental Clinics of North America, Apr 1, 1997

The diagnostic process for the orofacial pain patient is often perplexing. Compounding the proces... more The diagnostic process for the orofacial pain patient is often perplexing. Compounding the process of solving a diagnostic mystery is the multiplicity of etiologic factors. The propensity for Lyme disease to present with symptoms mimicking dental and temporomandibular disorders makes the task even more complex. It is hoped that the reader is cognizant of the fact that a pathologic process of dental structures--the teeth and their attachments to the mandible and maxilla, the temporomandibular joints, masticatory musculature, and vascular supply and sensory innervation of the oromandibular anatomy--may also be the source of facial pain. Although unique, similar complaints may also be manifestations of other causes, including pain associated with Lyme disease. The informed and fastidious clinician does not overlook these possibilities when evaluating the headache and facial pain patient. The clinician should be equipped with the knowledge and minimal armamentarium to evaluate the patient appropriately. To paraphrase from Sherlock Holmes, we must first eliminate the impossible, whatever is left is the truth, no matter how unlikely. A differential diagnosis must be achieved based on clinical experience, unbiased observations, and probability.

Research paper thumbnail of The role of sensory input of the chorda tympani nerve and the number of fungiform papillae in burning mouth syndrome

Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Jul 1, 2011

Research paper thumbnail of Use of a Hybrid Training Program to Teach Nutrition Focused Physical Examination to Dietetic Educators and Dietitians in Malaysia

Journal of the Academy of Nutrition and Dietetics, Sep 1, 2020

Learning Outcome: Describe the relationships between body composition and clinical outcomes in pe... more Learning Outcome: Describe the relationships between body composition and clinical outcomes in pediatric Cystic Fibrosis. Background: Cystic Fibrosis (CF) alters the body's sodium-chloride transport mechanisms and leads to mucus accumulation throughout the lungs, pancreas, and intestines, leading to malabsorption. This can cause normal weight adiposity (NWA), lean mass deficits (LMD) and alterations in fat and lean mass indexes (FMI, LMI). Pro-inflammatory cytokines secreted by adipose tissue can contribute to systemic inflammation, leading to declines in clinical outcomes. Methods: This chart review was conducted at Nationwide Children's Hospital (NCH) for patients with CF, aged 8-18 years (n¼114). Frequency/descriptive statistics, t-tests, and Pearson correlations were used to determine relationships between NWA, FMI/LMI percentiles, LMD and FEV1%, lumbar spine bone mineral density (LS BMD), and frequency of hospital admissions. Results: Means for the NWA group show declines in clinical outcomes. Weak, positive relationships between FMI and LMI percentiles were observed for FEV1%

Research paper thumbnail of Letter to the Editor regarding “The Alliance of TMD Organizations: A Call to Action” from CRANIO®

Cranio-the Journal of Craniomandibular Practice, Nov 2, 2017

Research paper thumbnail of The relation of temporomandibular disorders and dental occlusion: a narrative review

PubMed, Apr 5, 2022

Objective: The term temporomandibular disorders (TMDs) encompasses a variety of disorders of the ... more Objective: The term temporomandibular disorders (TMDs) encompasses a variety of disorders of the temporomandibular joint (TMJD) and the associated musculature (MMD). Occlusion and its role in the genesis of TMDs is one of the most controversial topics in this arena. The objective of the narrative review was to summarize the implications of TMDs and its relationship to dental occlusion in two scenarios: 1) TMD as an etiologic factor in dental occlusal changes; 2) The role of dental occlusion as a causative factor in the genesis of TMDs. Data sources: Indexed databases were searched from January 1951 to August 2021 using the terms TMJ, TMD, temporomandibular disorders, temporomandibular joint, and dental occlusion . Conclusion: There is lack of good primary research evaluating true association and showing the cause-and-effect relationship between dental occlusion and TMD. Systematic reviews suggest that the role of occlusion as a primary factor in the genesis of TMDs is low to very low. However, a variety of TMDs can lead to secondary changes in dental occlusion. Distinction between the two is paramount for successful management.

Research paper thumbnail of Bilateral glossopharyngeal neuropathy following chemo and radiation therapy for a primitive neuroectodermal tumour

Journal of Oral Rehabilitation, Nov 14, 2015

This case describes a young adult male patient diagnosed and treated for a primitive neuroectoder... more This case describes a young adult male patient diagnosed and treated for a primitive neuroectodermal tumour (PNET) at 3 years of age. Chemotherapy and radiation therapy used following surgical treatment of this tumour have known neurotoxic complications, some of which have delayed onset. In this case, the patient exhibited sudden onset, persistent bilateral and deep ear pain that was consistent with a neuropathy of the glossopharyngeal nerve occurring 17 years after the completion of therapy for PNET. Treatment with pregabalin was successful with near-complete resolution of the complaint. The diagnostic certainty in this case is discussed in relation to the current diagnostic criteria for neuropathic pain.

Research paper thumbnail of Use of compounded topical medications for treatment of orofacial pain: a narrative review

Background and Objectives: Orofacial pain is a frequent form of pain perceived in the face and/or... more Background and Objectives: Orofacial pain is a frequent form of pain perceived in the face and/or oral cavity. It may be caused by diseases or disorders of regional structures, dysfunction of the nervous system, or through referral from distant sources. The objective of the narrative review is to describe the classifications of orofacial pain, potential targets for pharmacotherapeutic treatment and discusses the novel topical administration of already approved medications for management. Actual cases will be presented illustrating administration and efficacy. Methods: Electronic databases (PubMed, Embase, Ovid Medline, Google scholar, Scopus, Cochrane library) were searched using keywords "Topical medications" and "Orofacial Pain" from 1 st January 1974 to 30 th November 2021. A total of 280 articles were identified and relevant 105 articles were included in the review.

Research paper thumbnail of Hemicrania continua secondary to neurogenic paravertebral tumor- a case report

Scandinavian Journal of Pain, Aug 24, 2021

Objectives: Hemicrania continua (HC) is one of the trigeminal autonomic cephalalgias (TAC), where... more Objectives: Hemicrania continua (HC) is one of the trigeminal autonomic cephalalgias (TAC), where sympathetic dysfunction and autonomic dysfunction resulting in parasympathetic over activation with some evidence of sympathetic inhibition have been suggested as probable causes. However, cases of hemicrania continua secondary to sympathetic dysfunction due to neurogenic paravertebral tumor impinging on the sympathetic chain has not been previously reported. In this case, the probability of the sympathetic dysfunction was more likely based on the clinical features and management. Case presentation: A 23-year-old female presented with a chief complaint of right unilateral pain in the retro-bulbar, head and facial region for the past three years. An initial MRI of the brain was negative, whereas an MRI of the spine was advised to rule out a cervicogenic origin of the pain. The MRI revealed a well-defined mass lesion within right paravertebral region at T3 indicative of a neurogenic tumor. The patient was diagnosed with probable hemicrania continua secondary to neurogenic tumor impinging on adjacent sympathetic chain. A trial of indomethacin 75 mg/day was advised, which provided complete relief of the headache. The patient was referred to a neurologist for management of the neurogenic tumor. Conclusions: Headache disorders may be secondary to pathologies and comprehensive evaluation and accurate diagnosis are essential. Knowledge of neuroanatomy is paramount to understand and explain underlying pathophysiological mechanisms. Multidisciplinary management is essential in complex orofacial cases.

Research paper thumbnail of Minimally Invasive Trigeminal Ablation: Long Buccal Nerve

Journal of oral and facial pain and headache, Jul 1, 2019

To describe a technique of minimally invasive trigeminal nerve ablation of the long buccal nerve ... more To describe a technique of minimally invasive trigeminal nerve ablation of the long buccal nerve that was performed at a tertiary care academic medical center. Methods: This case describes a 44-year-old woman with refractory left long buccal nerve neuropathy following a dental procedure. After failing medical management, she was taken for nerve exploration, which revealed no nerve discontinuity or neuroma formation. She was therefore counseled regarding the risks and possible benefits of a novel minimally invasive trigeminal nerve thermoablation of the long buccal nerve technique. Results: Postoperatively, the patient experienced mild anesthesia along the long buccal nerve division and no longer experiences any allodynia or hypersensitivity. Additionally, she no longer requires any additional medical therapy or interventions. Conclusion: Minimally invasive trigeminal nerve ablation of the long buccal nerve may be effective surgical intervention in treating refractory neuropathic pain in cases of no structural nerve defects. However, long-term well-designed studies are required to fully define its role.

Research paper thumbnail of Symposium 2 Temporomandibular Disorder and Anti-inflammation Treatment

Research paper thumbnail of Diagnosis and Management of TMJ Involvement in Ankylosing Spondylitis

The Journal of cranio-mandibular practice, Mar 1, 1983

A patient with facial pain and a limited range of mandibular movement underwent an extensive dent... more A patient with facial pain and a limited range of mandibular movement underwent an extensive dental/craniomandibular examination. In addition, he had a medical and rheumatological evaluation. A diagnosis of ankylosing spondylitis with secondary involvement of the temporomandibular joints was made. This was clearly differentiated from rheumatoid arthritis. A multidisciplinary approach to treatment was established with excellent cooperation between physicians and dentist. The management of this patient is described.

Research paper thumbnail of Temporomandibular joint craniomandibular disorders. An overview

Research paper thumbnail of If only I knew...!

Research paper thumbnail of Introduction to orofacial pain

Research paper thumbnail of Doctor, why wasn't I told this before?

Research paper thumbnail of Peripheral and Central Pain of Temporomandibular Disorders

Research paper thumbnail of Application of psychometric testing for validation in the field of orofacial pain

Research paper thumbnail of History Taking of the Facial Pain Patient with the Assistance of a Comprehensive Questionnaire

Cranio-the Journal of Craniomandibular Practice, 1993

Research paper thumbnail of Pain and dysfunction of the temporomandibular joint

Research paper thumbnail of Combined Palliative and Anti-Inflammatory Medications as Treatment of Temporomandibular Joint Disc Displacement Without Reduction: A Systematic Review

Cranio-the Journal of Craniomandibular Practice, Jul 1, 2013

The aim of this study was to evaluate the efficacy of self-care combined with anti-inflammatory m... more The aim of this study was to evaluate the efficacy of self-care combined with anti-inflammatory medications in the treatment of temporomandibular joint (TMJ) pain associated with disc displacement without reduction (DDWOR). A systematic review of randomized clinical trials was done by the authors. The databases searched were Medline (1966 to July 2012); EMBASE (1980 to July 2012); and LILACS (from 1982 to July 2012). The review authors independently assessed trials for eligibility and methodological quality and also extracted all data. The data was double-checked for accuracy. There was no language restriction in the searches of EMBASE, PubMed, and LILACS databases, or in the manual search. The risk of bias and the heterogeneity of the studies taken into consideration were assessed. Two studies, randomizing 175 patients, were included in this review. The first study (n = 106) compared the following interventions: medical treatment, rehabilitation, arthroscopic surgery with postoperative rehabilitation, or arthroplastic surgery with post-operative rehabilitation. The second study (n = 69) compared the use of nonsteroidal anti-inflammatory medications and self-care instructions, nonsteroidal anti-inflammatory medications, occlusal splint, and mobilization therapy. The third group received no treatment; patients were only informed of their prognosis. There is no sufficient evidence regarding efficacy and safety of the palliative treatments associated with anti-inflammatory versus other treatments, or absence of treatment on pain reduction in patients with TMJ DDWOR.

Research paper thumbnail of Differentiation of Orofacial Pain Related to Lyme Disease from Other Dental and Facial Pain Disorders

Dental Clinics of North America, Apr 1, 1997

The diagnostic process for the orofacial pain patient is often perplexing. Compounding the proces... more The diagnostic process for the orofacial pain patient is often perplexing. Compounding the process of solving a diagnostic mystery is the multiplicity of etiologic factors. The propensity for Lyme disease to present with symptoms mimicking dental and temporomandibular disorders makes the task even more complex. It is hoped that the reader is cognizant of the fact that a pathologic process of dental structures--the teeth and their attachments to the mandible and maxilla, the temporomandibular joints, masticatory musculature, and vascular supply and sensory innervation of the oromandibular anatomy--may also be the source of facial pain. Although unique, similar complaints may also be manifestations of other causes, including pain associated with Lyme disease. The informed and fastidious clinician does not overlook these possibilities when evaluating the headache and facial pain patient. The clinician should be equipped with the knowledge and minimal armamentarium to evaluate the patient appropriately. To paraphrase from Sherlock Holmes, we must first eliminate the impossible, whatever is left is the truth, no matter how unlikely. A differential diagnosis must be achieved based on clinical experience, unbiased observations, and probability.

Research paper thumbnail of The role of sensory input of the chorda tympani nerve and the number of fungiform papillae in burning mouth syndrome

Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology, Jul 1, 2011

Research paper thumbnail of Use of a Hybrid Training Program to Teach Nutrition Focused Physical Examination to Dietetic Educators and Dietitians in Malaysia

Journal of the Academy of Nutrition and Dietetics, Sep 1, 2020

Learning Outcome: Describe the relationships between body composition and clinical outcomes in pe... more Learning Outcome: Describe the relationships between body composition and clinical outcomes in pediatric Cystic Fibrosis. Background: Cystic Fibrosis (CF) alters the body's sodium-chloride transport mechanisms and leads to mucus accumulation throughout the lungs, pancreas, and intestines, leading to malabsorption. This can cause normal weight adiposity (NWA), lean mass deficits (LMD) and alterations in fat and lean mass indexes (FMI, LMI). Pro-inflammatory cytokines secreted by adipose tissue can contribute to systemic inflammation, leading to declines in clinical outcomes. Methods: This chart review was conducted at Nationwide Children's Hospital (NCH) for patients with CF, aged 8-18 years (n¼114). Frequency/descriptive statistics, t-tests, and Pearson correlations were used to determine relationships between NWA, FMI/LMI percentiles, LMD and FEV1%, lumbar spine bone mineral density (LS BMD), and frequency of hospital admissions. Results: Means for the NWA group show declines in clinical outcomes. Weak, positive relationships between FMI and LMI percentiles were observed for FEV1%

Research paper thumbnail of Letter to the Editor regarding “The Alliance of TMD Organizations: A Call to Action” from CRANIO®

Cranio-the Journal of Craniomandibular Practice, Nov 2, 2017

Research paper thumbnail of The relation of temporomandibular disorders and dental occlusion: a narrative review

PubMed, Apr 5, 2022

Objective: The term temporomandibular disorders (TMDs) encompasses a variety of disorders of the ... more Objective: The term temporomandibular disorders (TMDs) encompasses a variety of disorders of the temporomandibular joint (TMJD) and the associated musculature (MMD). Occlusion and its role in the genesis of TMDs is one of the most controversial topics in this arena. The objective of the narrative review was to summarize the implications of TMDs and its relationship to dental occlusion in two scenarios: 1) TMD as an etiologic factor in dental occlusal changes; 2) The role of dental occlusion as a causative factor in the genesis of TMDs. Data sources: Indexed databases were searched from January 1951 to August 2021 using the terms TMJ, TMD, temporomandibular disorders, temporomandibular joint, and dental occlusion . Conclusion: There is lack of good primary research evaluating true association and showing the cause-and-effect relationship between dental occlusion and TMD. Systematic reviews suggest that the role of occlusion as a primary factor in the genesis of TMDs is low to very low. However, a variety of TMDs can lead to secondary changes in dental occlusion. Distinction between the two is paramount for successful management.