We hereupon present a case of injured temporomandibular joint (TMJ) associated with fluoxetine monotherapy-induced repeated yawning. Further information is needed regarding the relationship between fluoxetine administration and clinically significant yawning. Clinicians should be more careful to listen to their patients when they describe unexpected reactions to medications.
Fluoxetine ; Humans ; Rhinitis* ; Temporomandibular Joint ; Yawning

Biological Evolution ; Habits ; Humans ; Yawning ; physiology

Dislocation of the temporomandibular joint(TMJ) is fairly frequent but backward dislocation of TMJ during induction of anesthesia is rarely reported. The causes include congenital weakness of the capsule or malformation of the condyles of both. The physical causes are as follows ; The joint may be strained or injured during general anesthesia, 1) possible straing or injureyto the joint, 2) yawning, 3) attempts by children to insert large objects into the mouth, 4) and positional pressures during sleep. Acase of backward dislocation of TMJ occureed during induction of anesthesia and treated with nanual reduction and subsequent intermaxillary fixation.
Anesthesia* ; Anesthesia, General ; Child ; Dislocations* ; Humans ; Joints ; Mouth ; Temporomandibular Joint* ; Yawning

OBJECTIVES: Dislocation of the temporomandibular joint may occur for various reasons. Although different invasive methods have been advocated for its treatment, this study highlights the value of non-invasive treatment options even in chronic cases in a resource-poor environment. MATERIALS AND METHODS: A seven-year retrospective analysis of all patients managed for temporomandibular joint dislocation in our department was undertaken. Patient demographics, risk factors associated with temporomandibular joint dislocation and treatment modalities were retrieved from patient records. RESULTS: In all, 26 patients were managed over a seven-year period. Males accounted for 62% of the patients, and yawning was the most frequent etiological factor. Conservative treatment methods were used successfully in 86.4% of the patients managed. Two (66.7%) of the three patients who needed surgical treatment developed complications, while only one (5.3%) patient who was managed conservatively developed complications. CONCLUSION: Temporomandibular joint dislocation appears to be associated with male sex, middle age, yawning, and low socio-economic status, although these observed relationships were not statistically significant. Non-invasive methods remain an effective treatment option in this environment in view of the low socio-economic status of the patients affected.
Demography ; Dislocations* ; Humans ; Male ; Middle Aged ; Nigeria* ; Retrospective Studies ; Risk Factors ; Temporomandibular Joint* ; Yawning

The temporomandibular joint can be dislocated during anesthesia as a result of excessive oral opening and direct laryngoscope handling. Occasionally, yawning can be observed during the induction of anesthesia with propofol. The forceful and voluntary yawning after a propofol injection can lead to a dislocation of the temporomandibular joint. We report a case of an anterior dislocation of the temporomandibular joint upon induction with propofol, which caused difficulties in mask ventilation and endotracheal intubation. Although intubation had been carried out successfully in this case, an unanticipated difficult airway can be confronted at anytime. Therefore, anesthesiologists should be aware of the management of a difficult airway and practice various methods according to a difficult airway algorithm.
Anesthesia* ; Dislocations ; Intubation ; Intubation, Intratracheal ; Jaw* ; Laryngoscopes ; Masks ; Propofol ; Temporomandibular Joint ; Ventilation ; Yawning

Premature ejaculation is the most common male sexual dysfunction and defined as persistent or recurrent occurrences of ejaculation before or shortly after penetration. But there has never been any effective oral agents for the patients with premature ejaculation. Recently, fluoxetine, a potent serotonin reuptake inhibitor, being used as antidepressant, has been suggested to be helpful for the patients with premature ejaculation. Twenty three male outpatients with premature ejaculation were randomly divided into fluoxetine (n=12) and placebo (n=11) group. In the fluoxetine group, the dose of fluoxetine was 20 mg/day for the first one week and 40 mg/day for the remaining 5 weeks. Patient and his female partner were interviewed separately before starting medication, three weeks and six weeks after medication. The mean intravaginal ejaculation latency time increased to 187.5 seconds after 3 weeks and 254.2 seconds after 6 weeks front 46.7 seconds before treatment (p<0.05). Only 1 out of 12 patients in the fluoxetine group was able to have thrusts over 30 times before treatment. After 3 weeks of Treatment, 8of 12 patients and after 6 weeks of treatment, 7 patients were able to have thrusts over 30 times. There was no significant improvement of intravaginal ejaculation latency time and number of thrusts in the placebo group. Symptomatic improvement was noticed in 75% with fluoxetine group and 18.2% with placebo group. Side reactions of fluoxetine, fatigue and yawning, were noticed in 41% of the patients, but they did not interfere with their daily activities. These findings suggest that fluoxetine can be safely used as a good pharmacotherapeutic treatment for the patients with premature ejaculation.
Ejaculation ; Fatigue ; Female ; Fluoxetine* ; Humans ; Male ; Outpatients ; Premature Ejaculation* ; Serotonin ; Yawning

BACKGROUND: We can usually see the yawning at induction of anesthesia, however, it has not been studied as such an indicator of anesthesia. The yawning is one means of changing arousal level, and a sign or marker that such a change is occurring, although its functions are not well understood. The purpose of the present study was to evaluate the yawning whether it could be used as an indicator of induction of anesthesia, using its property as a marker of changed arousal level. METHODS: In 60 adult patients, group 1 was done propofol target controlled infusion (TCI) with Stelpump software, while group 2 was done thiopental TCI similarly. Clinical indicators of induction of anesthesia were measured as follows: loss of verbal control (LOV), loss of eyelash reflex (LOE), the yawning. In addition, the occurrence of apnea (OOA) were measured, too. We assessed the hypnosis levels of indicators of induction of anesthesia including the yawning and demonstrate their effect site concentrations and elapsed time. Furthermore, we compared the incidences of yawning and apnea between both groups. RESULTS: Clinical indicators of induction occurred in the order of LOV > LOE > the yawning >> OOA in both groups. With respect to BIS, the yawning showed the lowest BIS and the highest effect site concentrations except OOA in both groups. The incidence of the yawning in group 2 was higher than in group 1 (about 82 vs 63%). On the contrary, the incidence of apnea in group 1 was higher than in group 2 (about 79 vs 53%). CONCLUSIONS: As far as the yawning could be shown, we could observe, it approximated most closely to their clinical impression of the 'true' induction in terms of the hypnosis level and its effect site concentration.
Adult ; Anesthesia* ; Apnea ; Arousal ; Humans ; Hypnosis ; Incidence ; Propofol ; Reflex ; Thiopental ; Yawning*

Acupuncture Therapy ; Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Respiration Disorders ; physiopathology ; therapy ; Yawning ; Young Adult

Tonsillectomy is one of the most common procedures performed by an otorhinolaryngologist. Postoperative hemorrhage and dehydration are two of the most common complications, but glossopharyngeal neuralgia is an unusual complication encountered in tonsillectomy. Glossopharyngeal neuralgia is characterized by paroxysms of ipsilateral and severe lancinating pain occurring in the distribution of the nerve. The pain may be spontaneous or precipitated by a variety of actions that stimulate the region supplied by the glossopharyngeal nerve namely yawning, coughing, swallowing and talking. The proximity between the glossopharyngeal nerve and the tonsillar fossa suggests that dissection in the correct surgical plane during tonsillectomy is important for avoiding injury to the glossopharyngeal nerve. Glossopharyngeal neuralgia after tonsillectomy is induced by intraoperative cauterization, nerve compression or iatrogenic trauma. Management of glossopharyngeal neuralgia induced by tonsillectomy should be given a trial of anti-convulsant medication like carbamazepine or glossopharyngeal nerve resection. A case of glossopharyngeal neuralgia caused by tonsillectomy was experienced by a 29-year-old man, and this case was reported and its aetiology was discussed.
Adult ; Carbamazepine ; Cautery ; Cough ; Deglutition ; Dehydration ; Glossopharyngeal Nerve ; Glossopharyngeal Nerve Diseases* ; Humans ; Postoperative Hemorrhage ; Tonsillectomy* ; Yawning

The systemic administration of low doses of dopamine(DA) agonist, such as apomorphine, LY 171555 and n-propyl norapomorphine induces penile erection and yawning in rats. Such a response is apparently mediated by the stimulation of central DA receptors of the D2 type and studies have suggested a localization of this action to the paraventricular nucleus(PVN) of the hypothalamus. We have investigated the effect of serum testosterone level on the apomorphine induced penile erection and yawning and the effect of serum testosterone level on the in vitro binding of [3H]N -n -propyl norapomorphine ( [3H]NPA) in cryostat from the paraventricular nucleus (PVN) of the hypothalamus in rats. All rats of control group demonstrated an erectile response and yawning behavior. Castrated rats did not have erections and had diminished yawning but responded normally after testosterone administration. In autoradiography, castration elicited significant reduction in the specific binding of 0.25 nM [ 3H] NPA to D2 receptor sites in paraventricular nucleus, but after testosterone replacement the specific binding increased above control level. Testosterone was necessary to the maintenance of a specific dopaminergic centrally mediated erection and it's blood level affects the binding properties of tritium NPA from paraventricular nucleus of hypothalamus. In these study we could suggest one aspect of androgen action on penile erection and the rationale of androgen replacement therapy.
Animals ; Apomorphine ; Autoradiography ; Castration ; Dopamine ; Hypothalamus ; Male ; Models, Animal* ; Paraventricular Hypothalamic Nucleus ; Penile Erection* ; Rats* ; Testosterone ; Tritium ; Yawning