Abstract
Conventional medicine has little to offer to rectify sensory loss due to nerve damage . This case study explores the effects of Low level Laser Therapy – LLLT – (both Near Infra Red and Red) as a potential method to regenerate damaged nerve tissue. This 4 week study involved applied 12 sessions of LLLT for a male with long- term (duration 4.5 year) nerve damage to facial and jaw areas. Results were promising demonstrating improved sensation (for both sharp and soft imputs) and significantly reduced numb areas. Mood changes were also studied, showing improvements in sleep, energy, mood, nerve tension and mental clarity. Even though sensory improvements were only partially sustained after 2 months, overall benefits remained after the study. This shows LLLT may be a potential solution for repairing nerve damaged conditions.
Background
SJ, a 67 year old male presented with loss of sensation on his jaw, numbness of tongue and lower teeth, lips and chin areas (all right sided). He also experienced diminished taste sensation.
Symptoms commenced in early 2012 with tingling over the right side of the jaw which intensified for the first 6 months, then subsided with new symptoms of numbness in an area extending from the angle of the right jaw along the mandibular line almost to the midline of the chin, involving the right side of the lips.. There is also slight atrophy and asymmetry of muscles in the right side the jaw on the face
Symptoms were most likely caused by damage to his inferior alveolar dental nerve. It is uncertain if this damage was initiated by dental surgery malpractice or radiation therapy treatment to the area.
The damaged nerve area in his right jaw presented as a hardened lump, approximately 1.5 cm in diameter. Loss of sensation occurred distal to the lump.
Medical opinion holds that damaged nerve damage is irreparable if there are no noticeable changes within a couple of months after the injury. In this case, SJ’s nerve damage symptoms were first noted approximately 54 months ago. Specialists advised him that the nerve damage was permanent and regeneration would be impossible.
Aim
We decided to explore Low Level Laser Therapy (LLLT)’s effect on nerve regeneration for return of sensory function.
Method
A course of treatment was planned using LLLT spanning a period of 4 weeks. Three sessions were delivered weekly giving a total of 12 sessions.
An Avant LZ30 class 3B laser with 2 InGaAlP 635 nm diodes of maximum power 190 mW each and 2 GaAlAs 810 nm diodes of maximum power of 900 mW each was used. A pre-programmed pulsed setting of ‘Nerve’ was used to deliver 1.5 minutes (90 joules) of Near Infra Red (810 nm) per area to six 3 cm squared areas located on the right jaw and chin areas. This gave a total of 540 joules of Near Infra Red (NIR) delivered per session.
Additionally, a further 8 points intra-orally (inside the mouth) were irradiated with 635 nm for 1 minute each (delivering 13 Joules per approximately 3 sq. mm area per point). Three of these points were located on the lateral side of the affected gum, three on the medial side of the gum, one below the tongue and one above the tongue. This gave a total of 104 Joules of 635 nm inside the mouth per session.
Rationale
The irradiation locations were selected by reasoning of the dental nerve’s pathway through the lower jaw, gum and tongue areas. NIR was chosen for external application as NIR is known for its ability to regenerate cells, to increase circulation and penetrate deeply. A primary objective was to increase blood supply to the underlying numb areas to establish regeneration of nerve tissue.
Red (635 nm) was applied intra-orally (inside mouth) for it’s ability to stimulate circulation, neurological repair and for systemic benefits generally.
SJ also had a diagnosis of essential thrombocytaemia, a rare chronic blood disorder characterised by the overproduction of platelets. Red irradiation was also chosen to observe whether blood cell and platelet counts would vary from before to after the study. (See below for results).
Assessment Tests
A Self-Reporting Questionnaire for sensory nerve function was administered at the onset, throughout and at the completion of the study. Measurement scores of 0 to 10 were given by SJ for the following 3 parameters-
- Parasethesia (an altered sensation, not unpleasant)
- Dysthesia (an altered unpleasant sensation)
- Anaesthesia (loss of feeling)
Pin Prick Test
An acupuncture needle of 30 gauge was used to map out areas of sensation loss. Areas were mapped with cosmetic pencil and photographed at commencement of every week and at completion of 4 week study. An additional test and photograph was made 8 weeks post study as a follow up measure.
Static Touch Detection Test
A cotton tip applicator was used to determine soft sensations on chin and adjacent jaw areas.
Direction of Movement Test
A soft brush was used (with the patient’s eyes closed) to determine the patient’s ability to detect both sensation and direction of movement.
Results
The Self-Reporting Questionnaire showed the following :
The following images show the progression of the numb areas in the Pin Prick Test –
Onset – 19 Sept, 2016
Begin of Week 2 – 26 Sept, 2016
Begin of Week 3 – 5 October, 2016
End of Week 4 – 13 October, 2016
Follow Up 8 Weeks Later – 5 Dec, 2016
Static Touch Detection Test
At onset, SJ had numbness over whole chin area generally.
At beginning of week 2, there was more recognition of soft touch around the mouth.
At beginning of week 3, numb area for soft touch was reduced to area indicated above in photo.
At end of week 4, SJ could feel the cotton bud sensation everywhere except a numb area at top of chin approximately 1 cm square size.
At follow up, 8 weeks later, numb area on the chin closely correlated to the pin prick test area (shown in above photo). The upper lip and upper chin area did experience sensation.
Direction of Movement Test
At onset, correct movement of brush was detected close to lip (upper chin) but otherwise the whole jaw, cheek and chin areas were imperceptible to directional movements.
At beginning week 3, SJ was able to detect directional movements in all areas except below the lips and had some difficulty in the middle of the chin.
At end of week 4, SJ could detect correct directional changes everywhere except a small central area on the chin, where he could feel the brush, but not identify the direction.
At follow up 8 weeks later, SJ could correctly identify directions near the lip, over the jaw and cheek areas, but not over the right chin area.
Other Noticeable Changes
By the end of week 4, SJ reported some returned sensation in lips (previously had none) His teeth on the right side were no longer numb (the right teeth being now equal in sensation to the left teeth). He also reported that he perceived the size of the lump on the jaw (area of nerve damage) had diminished slightly. His taste sensation had also improved slightly.
Medical Tests
SJ provided results of a blood test collected 29th Sept, 2016 (at the commencement of week 2). Abnormal ranges were shown as follows –
Discussion and Conclusion
It is clear that SJ experienced a steady improvement of returned sensory function (improved taste, skin sensation, perception of pain, soft touch, directional brushing and tooth sensations). Additionally, the reported area of sensory nerve loss decreased significantly to approximately one sixth of the original size.
Reported numbness sensation levels were also reduced by 50 percent.
The results were not entirely sustained 8 weeks later, with a partial return of numb areas to be approximately one half the size of the original commenced size.
This study indicates that LLLT is effective to restore nerve damage and function. However, a period longer than 4 weeks treatment may be required to offer long lasting regenerative beneficial effects.
References
- Avant Quick reference Guide PDF
- Tunér, J Lars Hode!, L , Laser Phototherapy – Clinical Practice and Scientific Background
- Kreisel,V and Weber, M 2012, Laser Acupuncture – A Practical Handbook, Fuchtenbusch Verlag, Starnberg
Additional Notes
For extra information, a mood questionnaire was also conducted for SJ at the commencement, week 2, week 3 and at completion of the study. This was performed to observe if there were any noticeable changes in mood as a result of the LLLT. The following graphs show the changes.
From these results, it can be seen that as the study progressed, all mood parameters improved. It is uncertain whether this is due to the LLLT’s effects or other circumstantial events in his life (eg. sale of a property). Repeated similar studies would need to be repeated to gain a clearer understanding of the mood effects of LLLT. If the mood improvements are due to LLLT, there may be potential therapeutic benefits using this therapy to alter mood disorders.