1142 Chevalier et al.

Ethical approval

Not required.

Acknowledgement. The authors would liketo thank Ms. Marie-Paule Friocourt for herassistance.

References

1. Cohen Y, Lavie O, Granovsky-Gri-

saru S, Aboulafia Y, Diamant Y. Bellpalsy complicating pregnancy: a review.Obstet Gynecol Surv 2000: 55: 184–188.

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Desatnik A, Axelsson S, Pitkaranta

A, Hultcrantz M, Kanerva M, Han-

ner P, Jonsson L. Prednisolone andvalaciclovir in Bell’s palsy: a rando-mised, double-blind, placebo-controlled,multicentre trial. Lancet Neurol 2008: 7:993–1000.

3. Gillman GS, Schaitkin BM, May M,Klein SR. Bell’s palsy in pregnancy: astudy of recovery outcomes. OtolaryngolHead Neck Surg 2002: 126: 26–30.

4. Hato N, Sawai N, Teraoka M, Waki-

saka H, Takahashi H, Hinohira Y,Gyo K. Valacyclovir for the treatmentof Bell’s palsy. Expert Opin Pharmac-other 2008: 9: 2531–2536.

5. He L, Zhou MK, Zhou D, Wu B, Li N,Kong SY, Zhang DP, Li QF, Yang J,Zhang X. Acupuncture for Bell’s palsy.Cochrane Database Syst Rev 2007:17(4):CD002914 Review. P. 8.

6. Newlands C, Dixon A, Altman K.Ocular palsy following Le Fort 1 osteot-omy: a case report. Int J Oral MaxillofacSurg 2004: 33: 101–104.

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Bazargani H. Independent role ofhypertension in Bell’s Palsy: a case–con-trol study. Eur Neurol 2008: 60: 253–257.

8. Shenkman Z, Findler M, Lossos A,Barak S, Katz J. Permanent neurologicdeficit after inferior alveolar nerve block:a case report. Int J Oral Maxillofac Surg1996: 25: 381–382.

9. Tazi M, Soichot P, Perrin D. Facialpalsy following dental extraction: reportof 2 cases. J Oral Maxillofac Surg 2003:61: 840–844.

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palsy (idiopathic facial paralysis)(Review). Cochrane Database Syst Rev2008: 16 CD006283. Review.

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RV, Maurette PE, Carneiro SC.Facial nerve paralysis after impactedlower third molar surgery: a literaturereview and case report. Med Oral PatholOral Cir Bucal 2006: 11: E175–E178.

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JW. Bell’s palsy and pregnancy. Otolar-yngol Head Neck Surg 2007: 137: 858–861.

Address:Reza Arbab-ChiraniUFR d’Odontologie de Brest22 rue Camille Desmoulins29238 Brest Cedex 3FranceTel.: +33 298223330fax: +33 298016932E-mail: arbab@univ-brest.fr

doi:10.1016/j.ijom.2010.04.049

Case Report

Oral Medicine

Temporary eyelash lossfollowing dental treatmentS. Nezafati, S. Rahimi, H. Mohseni: Temporary eyelash loss following dentaltreatment. Int. J. Oral Maxillofac. Surg. 2010; 39: 1142–1144. # 2010 InternationalAssociation of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rightsreserved.

Abstract. The isolated absence or loss of eyelashes (madarosis) is associated withmany processes including systemic and local diseases. Madarosis of dental originhas not been reported. This paper is a report of the successful treatment of unilateraleyelash loss following root canal therapy of an upper posterior tooth.

S. Nezafati1, S. Rahimi2,H. Mohseni1

1Oral and Maxillofacial Surgery, Emam RezaHospital, Tabriz University of MedicalSciences, Tabriz, Iran; 2Dental Faculty, TabrizUniversity of Medical Sciences, Tabriz, Iran

Keywords: eyelash loss; dental treatment; ma-darosis.

Accepted for publication 27 April 2010Available online 3 July 2010

Loss of eyelashes, known as madarosis,may be the presenting feature of a numberof vision and life threatening conditions,including endocrinopathy (hypothyroid-ism), bacterial infections (leprosy), viralinfections (HIV/herpes zoster), autoim-mune disease (scleroderma, discoid lupus)

and malignant tumors4,9. It is divided intoscaring and non-scaring types, which indi-cate the potential for lash re-growth4. Lossof eyelashes following dental treatmenthas never been reported in the Englishmedical literature. This article presents acase of unilateral eyelash loss following

endodontic treatment of a posterior max-illary tooth.

Case report

A 25-year-old man was referred with thechief complaint of eyelash loss in the right

[(Fig._1)TD$FIG]

Fig. 1. Loss of eyelashes in the right lower lid.

Temporary eyelash loss following dental treatment 1143

lower eyelid. The patient’s progressiveloss of eyelashes began 1 month beforearriving at the hospital (Fig. 1). Previousmedications, including antibiotics andanti-inflammatory drugs, had not alle-viated the problem. There was no recordin the medical history of endocrinopathy,viral infections, autoimmune diseases orlocal inflammatory disease. His social andfamily history was normal. Reviewing hisdental history, the patient had root canaltherapy of the right maxillary secondmolar 2 months previously with persistingdull pain during mastication on the sametooth.

Physical examination showed completeloss of eyelashes on the right lower lidwithout scaring. There was also mild swel-ling and erythema over the right infra-orbital area as well as mild tenderness.The eyes had normal function (confirmedby ophthalmologic consultation). Theright upper vestibule was tender onintra-oral examination but there was nosinus tract .The patient had posterior nasaldischarge which had started recently.

[(Fig._2)TD$FIG]

Fig. 2. Images for detecting foreign body: (A)

The laboratory profile, including thyr-oid hormones, showed normal values witha mild elevation in white blood cell count(11,500/mm3; compared with the normalrange of 6000–10,000/mm3). Blood serol-ogy for HIV was negative.

An orthopantomograph was taken torule out odontogenic pathology andshowed a severely decayed upper rightthird molar and radiopaque foreign bodiesin the right maxillary sinus related to thesecond molar root (Fig. 2A). A computedtomography (CT) scan revealed right max-illary sinusitis in the coronal and axialviews (Fig. 2B). These findings, the his-tory and physical examination suggested apossible inflammatory origin for the eye-lash loss.

The patient was scheduled for surgeryunder general anaesthesia to remove theforeign bodies from the maxillary sinus.The right maxillary sinus was approachedvia a classic Caldwell–Luc incision andanterior sinus wall window. The foreignbodies were surrounded by granulationtissue and small amounts of pus, which

orthopantomograph, (B) CT scan.

were removed completely. All pathologicsinus epithelium were also removed pre-serving the healthy mucosa and osteome.The periapical pathology was approachedvia the same incision and curetted withoutmanipulation of the root. The patient’sright upper third molar was extracted atthe same time. The incision was suturedwith 4.0 vycril and the patient was sent tothe recovery room. The removed tissueswere sent for histopathologic examination,which revealed hypertrophic sinus liningwith infiltration of inflammatory cellsaround the foreign bodies. Analysis ofthe foreign body showed a zinc-basedmaterial that is used routinely in root canaltherapy. The postoperative period wasuneventful and the patient was discharged5 days after surgery with oral wide spec-trum antibiotics, analgesics and topicaland systemic nasal decongestants. Thepatient was requested to come for regularfollow up every week. The patient did notreturn until 6 weeks later, in which timethere had been complete re-growth of theeyelashes in the involved eye (Fig. 3). Thepatient did not return for further follow up.

Discussion

Madarosis is derived from the ancientGreek word madao meaning ‘to fall off’and is defined as hair loss of the eyebrows(superciliary madarosis) or loss of eye-lashes (ciliary madarosis)5. Loss of eye-lashes is also known as milphosis4. Inaddition to the obvious cosmetic blemishfor which the patient usually presents todermatologists or ophthalmologists,madarosis may be the presenting sign ofmany systemic diseases and warrantsdetailed systemic examination and insome cases, consultation with an internistor endocrinologist for further treatment4,9.

[(Fig._3)TD$FIG]

Fig. 3. Eyelash growth following treatment.

1144 Nezafati et al.

Madarosis may be linked to skin dis-ease, infectious disease, endocrinopathies,drugs, trauma, neoplasms and congenitaldisease4,5,7,9. The results of previousinvestigations, by different specialists,did not suggest any of these conditionsin the present case.

Trichotillomania, the habit of hair pull-ing in patients with underlying psycho-pathology, can be considered in cases withisolated eyelash alopecia8. In factitiousdisease, the morphologic characteristicsof the eyelashes are different, the hairsare broken at different levels and may becoarse and sometimes tortuous as a resultof repeated trauma8. This patient was anactive and healthy male with no sign orsymptoms of psychopathology and thehairs were absent completely and uniquelyin one eye.

Focal infection can cause localized hairloss4,6,7. The importance of dental pathol-ogy in the therapy of alopecia areata (AA)has been pointed out2,6,10. Alopecia areataof dental origin is generally located on thescalp but occasionally affects the beardand more exceptionally the eyebrows2,6,7.The lesions are usually ipsilateral andposterior to the related tooth6. The lesionsof maxillary origin are located above thecommissure line6. The main mechanismof AA of dental origin is usually based onan immunologic hypothesis including thepresence of a perifollicular lymphocyticinfiltrate as a result of local T cell-mediated cytotoxic inflammatoryresponse. A trigemino-sympathetic reflexhas also been proposed, induced by a

peripheral infectious or mechanical stimu-lus and causing angiospasm of the pilose-baceous follicle6.

There have been reports of the migra-tion of root canal filling material into theparanasal sinuses1,3. Some ingredients inthese materials, such as zinc and calcium,have the potential to stimulate the growthof fungi, but in the previous cases ofmaxillary sinusitis resulting from dis-placed endodontic sealer materials, lossof eyelashes has not been reported1.Although maxillary sinusitis resultingfrom intra-sinus foreign bodies is notuncommon, there are different, interre-lated etiopathogenic factors for AA ofdental origin, so elimination of one factoras the main cause of hair loss is not alwayssufficient6.

This is possibly the first case of tem-porary eyelash loss following root canaltherapy of a maxillary tooth. The presenceof common immune mediators in thepathogenesis of both AA and dental infec-tion could account for the dental origin ofthe hair loss.

In conclusion, dental pathosis should beincluded in the differential diagnosis foreyelash loss.

Funding

No funding.

Competing interests

None declared.

Ethical approval

Not required.

References

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Address:Saeed NezafatiOral and Maxillofacial SurgeryEmam Reza HospitalTabriz University of Medical SciencesTabrizIranTel.: +98 9141150952fax: +98 4113346977E-mail: nezaf2000@yahoo.com

doi:10.1016/j.ijom.2010.04.052