MPS  Vol.4 No.1 , January 2014
The Effect of NeuroGen® Nerve Support Supplement on Pillar Pain after Endoscopic Carpal Tunnel Release
ABSTRACT

61 patients with clinically diagnosed and electromyographically confirmed carpal tunnel syndrome were enrolled in a prospective study to evaluate the effectiveness of a nerve supplement on pillar pain after carpal tunnel surgery. All of the patients underwent endoscopic carpal tunnel release. 15 of the patients also took the nerve support supplement NeuroGen? as part of their perioperative treatment. The supplement group demonstrated a significantly lower amount of pillar pain (VAS) at initial follow up compared to the control group (1.13 and 4.05 respectively). 46% (7/15) of the supplement group were completely free of pillar pain compared to only 9% (4/46) of the control group at the first follow up. 53% (8/15) of the NeuroGen? group did not require any pain medications compared to 35% (16/46) of the control group. The Nerve supplement NeuroGen? significantly reduces pain after carpal tunnel surgery.


Cite this paper
M. Fitzmaurice, "The Effect of NeuroGen® Nerve Support Supplement on Pillar Pain after Endoscopic Carpal Tunnel Release," Modern Plastic Surgery, Vol. 4 No. 1, 2014, pp. 5-10. doi: 10.4236/mps.2014.41002.
References
[1]   R. A. Brown, R. H. Gelberman, J. G. Seiler, S. O. Abrahamsson, A. J. Weiland, J. R. Urbaniak, et al., “Carpal Tunnel Release. A Prospective, Randomized Assessment of Open and Endoscopic Methods,” Journal of Bone & Joint Surgery, Vol. 75, No. 9, 1993, pp. 1265-1275.

[2]   C. Dumontier, C. Sokolow, C. Leclercq and P. Chauvin, “Early Results of Conventional versus Two-Portal Endoscopic Carpal Tunnel Release. A Prospective Study,” Journal of Hand Surgery, Vol. 20, No. 5, 1995, pp. 658-662. http://dx.doi.org/10.1016/S0266-7681(05)80130-5

[3]   G. Foucher and J. Braga Da Silva, “Endoscopic Opening of the Carpal Canal,” Chirurgie, Vol. 120, No. 12, 1994, pp. 100-104.

[4]   S. S. Bande, L. L. De Smet and G. G. Fabry, “The Results of Carpal Tunnel Release: Open versus Endoscopic Technique,” Journal of Hand Surgery, Vol. 19, No. 1, 1994, pp. 14-17. http://dx.doi.org/ 10.1016/0266-7681(94)90039-6

[5]   J. Menon, “Endoscopic Carpal Tunnel Release: Preliminary Report,” Arthroscopy, Vol. 10, No. 1, 1994, pp. 31-38. http://dx.doi.org/10.1016/S0749-8063(05)80290-7

[6]   I. Atroshi, G.-U. Larsson, E. Ornstein, M. Hofer, R. Johnsson and J. Ranstam, “Outcomes of Endoscopic Surgery Compared with Open Surgery for Carpal Tunnel Syndrome among Employed Patients: Randomised Controlled Trial,” BMJ, Vol. 332, No. 7556, 2006, p. 1473. http://dx.doi.org/10.1136/ bmj.38863.632789.1F

[7]   J. Oertel, H. W. S. Schroeder and M. R. Gaab, “Dual-Portal Endoscopic Release of the Transverse Ligament in Carpal Tunnel Syndrome: Results of 411 Procedures with Special Reference to Technique, Efficacy, and Complications,” Neurosurgery, Vol. 59, No. 2, 2006, pp. 333-340. http://dx.doi.org/ 10.1227/01.NEU.0000223500.25131.99

[8]   A. Biyani and E. Downes, “A Open Twin Incision Technique of Carpal Tunnel Decompression with Reduced Incidence of Scar Tenderness,” The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, Vol. 18, No. 3, 1993, pp. 331-334. http://dx.doi.org/10.1016/0266-7681(93) 90055-K

[9]   K. S. Ludlow, J. L. Merla, J. A. Cox and L. N. Hurst, “Pillar Pain as a Postoperative Complication of Carpal Tunnel Release: A Review of the Literature,” Journal of Hand Therapy, Vol. 10, No. 4, 2012, pp. 277-282.

[10]   J. M. Agee, H. R. J. McCarroll, R. D. Tortosa, D. A. Berry, R. M. Szabo and C. A. Peimer, “Endoscopic Release of the Carpal Tunnel: A Randomized Prospective Multicenter Study,” Journal of Hand Surgery (American Volume), Vol. 17, No. 6, 1992, pp. 987-995. http://dx.doi.org/10.1016/S0363-5023(09) 91044-9

[11]   M. W. Erdmann, “Endoscopic Carpal Tunnel Decompression,” Journal of Hand Surgery, Vol. 19, No. 1, 1994, pp. 5-13. http://dx.doi.org/10.1016/0266-7681(94)90038-8

[12]   G. G. G. Hallock and D. A. D. Lutz, “Prospective Comparison of Minimal Incision ‘Open’ and Two-Portal Endoscopic Carpal Tunnel Release,” Plastic and Reconstructive Surgery, Vol. 96, No. 4, 1995, pp. 941-947. http://dx.doi.org/10.1097/00006534-199509001-00027

[13]   A. P. Worseg, R. Kuzbari, K. Korak, K. H?cker, C. Wiederer, M. Tschabitscher, et al., “Endoscopic Carpal Tunnel Release Using a Single-Portal System,” British Journal of Plastic Surgery, Vol. 49, No. 1, 1996, pp. 1-10. http://dx.doi.org/10.1016/S0007-1226(96)90179-4

[14]   T. Futami, “Surgery for Bilateral Carpal Tunnel Syndrome. Endoscopic and Open Release Compared in 10 Patients,” Acta Orthopaedica Scandinavica, Vol. 66, No. 2, 1995, pp. 153-155.
http://dx.doi.org/10.3109/17453679508995510

[15]   J. C. Payne, R. S. Bergman and D. J. Ettinger, “Endoscopic Carpal Tunnel Release,” Journal of the American Osteopathic Association, Vol. 94, No. 4, 1994, pp. 295-298.

[16]   A. Thoma, K. Veltri, T. Haines and E. Duku, “A Systematic Review of Reviews Comparing the Effectiveness of Endoscopic and Open Carpal Tunnel Decompression,” Plastic and Reconstructive Surgery, Vol. 113, No. 4, 2004, pp. 1184-1191. http://dx.doi.org/10.1097/01.PRS.0000110202.08818. C1

[17]   R. Bhattacharya, P. D. Birdsall, P. Finn and J. Stothard, “A Randomized Controlled Trial of Knifelight and Open Carpal Tunnel Release,” Journal of Hand Surgery, Vol. 29, No. 2, 2004, pp. 113-115. http://dx.doi.org/10.1016/j.jhsb.2003.09.001

[18]   A. S. Morani and S. L. Bodhankar, “Early Co-Administration of Vitamin E Acetate and Methylcobalamin Improves Thermal Hyperalgesia and Motor Nerve Conduction Velocity Following Sciatic Nerve Crush Injury in Rats,” Pharmacological Reports, Vol. 62, No. 2, 2010, pp. 405-409.

[19]   X. Kong, X. Sun and J. Zhang, “The Protective Role of Mecobalamin Following Optic Nerve Crush in Adult Rats,” Eye Science, Vol. 20, No. 3, 2004, pp. 171-177.

[20]   V. V. Mikhailov and V. M. Avakumov, “Mechanism of the Effect of Methylcobalamin on the Recovery of Neuromuscular Functions in Mechanical and Toxin Denervation,” Farmakologiia i Toksikologiia, Vol. 46, No. 6, 1983, pp. 9-12.

[21]   K. Okada, H. Tanaka, K. Temporin, M. Okamoto, Y. Kuroda, H. Moritomo, et al., “Methylcobalamin Increases Erk1/2 and Akt Activities through the Methylation Cycle and Promotes Nerve Regeneration in a Rat Sciatic Nerve Injury Model,” Experimental Neurology, Vol. 222, No. 2, 2010, pp. 191-203. http://dx.doi.org/10.1016/j.expneurol.2009.12.017

[22]   K. Yamatsu, T. Kaneko, A. Kitahara and I. Ohkawa, “Pharmacological Studies on Degeneration and Regeneration of Peripheral Nerves. (1) Effects of Methylcobalamin and Cobamide on EMG Patterns and Loss of Muscle Weight in Rats with Crushed Sciatic Nerve,” Nippon Yakurigaku Zasshi, Vol. 72, No. 2, 1976, pp. 259-268. http://dx.doi.org/10.1254/fpj.72.259

[23]   A. Yamatsu, R. Matsumi, H. Atomi and T. Imanaka, “Isolation and Characterization of a Novel Poly(Vinyl Alcohol)-Degrading Bacterium, Sphingopyxis sp. PVA3,” Applied Microbiology and Biotechnology, Vol. 72, No. 4, 2006, pp. 804-811. http://dx.doi.org/10.1007/s00253-006-0351-4

[24]   T. Watanabe, R. Kaji, N. Oka, W. Bara and J. Kimura, “Ultra-High Dose Methylcobalamin Promotes Nerve Regeneration in Experimental Acrylamide Neuropathy,” Journal of the Neurological Sciences, Vol. 122, No. 2, 1994, pp. 140-143. http://dx.doi.org/10.1016/0022-510X(94)90290-9

[25]   K. Yamazaki, K. Oda, C. Endo, T. Kikuchi and T. Wakabayashi, “Methylcobalamin (Methyl-B12) Promotes Regeneration of Motor Nerve Terminals Degenerating in Anterior Gracile Muscle of Gracile Axonal Dystrophy (GAD) Mutant Mouse,” Neuroscience Letters, Vol. 170, No. 1, 1994, pp. 195-197.
http://dx.doi.org/10.1016/0304-3940(94)90272-0

[26]   W. C. Liao, J. R. Chen, Y. J. Wang and G. F. Tseng, “Methylcobalamin, but Not Methylprednisolone or Pleiotrophin, Accelerates the Recovery of Rat Biceps after Ulnar to Musculocutaneous Nerve Transfer,” Neuroscience, Vol. 171, No. 3, 2010, pp. 934-949. http://dx.doi.org/10.1016/j.neuroscience.2010.09. 036

[27]   A. A. Sima, M. Calvani, M. Mehra and A. Amato, “Acetyl-L-Carnitine Improves Pain, Nerve Regeneration, and Vibratory Perception in Patients with Chronic Diabetic Neuropathy: An Analysis of Two Randomized Placebo-Controlled Trials,” Diabetes Care, Vol. 28, No. 1, 2004, pp. 89-94.
http://dx.doi.org/10.2337/diacare.28.1.89

[28]   C. De Angelis, C. Scarfò, M. Falcinelli, E. Perna, E. Reda, M. T. Ramacci, et al., “Acetyl-L-Carnitine Prevents AgeDependent Structural Alterations in Rat Peripheral Nerves and Promotes Regeneration Following Sciatic Nerve Injury in Young and Senescent Rats,” Experimental Neurology, Vol. 128, No. 1, 1994, pp. 103-114. http://dx.doi.org/10.1006/exnr.1994.1117

[29]   Z. T. Kokkalis, P. N. Soucacos and J. K. Terzis, “Effect of Acetyl-L-Carnitine on Axonal Sprouting Following Donor Nerve Injury Distal to an End-to-Side Neurorrhaphy Model,” Journal of Reconstructive Microsurgery, Vol. 25, No. 8, 2009, pp. 483-495. http://dx.doi.org/10.1055/s-0029-1234027

[30]   C. De Angelis, C. Scarfò, M. Falcinelli, E. Reda, M. T. Ramacci and L. Angelucci, “Levocarnitine Acetyl Stimulates Peripheral Nerve Regeneration and Neuromuscular Junction Remodelling Following Sciatic Nerve Injury,” International Journal of Clinical Pharmacology Research, Vol. 12, No. 5-6, 1992, pp. 269-279.

[31]   E. Fernandez, R. Pallini, L. Lauretti, E. Marchese, V. Bozzini, A. Sbriccoli, et al., “Levocarnitine Acetyl Promotes The Regeneration of Peripheral Sensory Axons and Reduces the Hypertrophy of Axotomized Spinal Cord Motoneurons in Rats,” Drugs under Experimental and Clinical Research, Vol. 17, No. 12, 1991, 563-570.

[32]   A. McKay Hart, M. Wiberg and G. Terenghi, “Pharmacological Enhancement of Peripheral Nerve Regeneration in the Rat by Systemic Acetyl-L-Carnitine Treatment,” Neuroscience Letters, Vol. 334, No. 3, 2002, pp. 181-185. http://www.sciencedirect.com/science/article/pii/s0304394002009825 http://dx.doi.org/10.1016/S0304-3940(02)00982-5

[33]   A. D. H. Wilson, A. Hart, M. Wiberg and G. Terenghi, “Acetyl-l-Carnitine Increases Nerve Regeneration and Target Organ Reinnervation—A Morphological Study,” Journal of Plastic, Reconstructive & Aesthetic Surgery, Vol. 63, No. 7, 2009, pp. 1186-1195. http://dx.doi.org/10.1016/j.bjps.2009.05.039

[34]   S. Karsidag, A. Akcal, S. Sahin, S. Karsidag, F. Kabukcuoglu and K. Ugurlu, “Neurophysiological and Morphological Responses to Treatment with Acetyl-L-Carnitine in a Sciatic Nerve Injury Model: Preliminary Data,” Journal of Hand Surgery (European Volume), Vol. 37, No. 6, 2012, pp. 529-536. http://dx.doi.org/10.1177/1753193411426969

[35]   A. D. H. Wilson, A. Hart, T. Brannstrom, M. Wiberg and G. Terenghi, “Primary Sensory Neuronal Rescue with Systemic Acetyl-L-Carnitine Following Peripheral Axotomy. A Dose-Response Analysis,” British Journal of Plastic Surgery, Vol. 56, No. 8, 2003, pp. 732-739. http://dx.doi.org/10.1016/j.bjps. 2003.08.005

[36]   A. M. Hart, M. Wiberg, M. Youle and G. Terenghi, “Systemic Acetyl-L-Carnitine Eliminates Sensory Neuronal Loss after Peripheral Axotomy: A New Clinical Approach in the Management of Peripheral Nerve Trauma,” Experimental Brain Research, Vol. 145, No. 2, 2002, pp. 182-189.

[37]   E. Fernandez, R. Pallini, C. Gangitano, A. Del Fá, C. O. Sangiacomo, A. Sbriccoli, J. R. Ricoy and G. F. Rossi, “Effects of L-Carnitine, L-Acetylcarnitine and Gangliosides on the Regeneration of the Transected Sciatic Nerve in Rats,” Neurological Research, Vol. 11, No. 1, 1989, pp. 57-62.

[38]   V. K. Kostopoulos, C. L. Davis and J. K. Terzis, “Effects of Acetylo-L-Carnitine in End-to-Side Neurorrhaphy: A Pilot Study,” Microsurgery, Vol. 29, No. 6, 2009, pp. 456-463. http://www.ncbi.nlm. nih.gov/pubmed/19308954

[39]   G. Terenghi, A. Hart and M. Wiberg, “The Nerve Injury and the Dying Neurons: Diagnosis and Prevention,” Journal of Hand Surgery, European Volume, Vol. 36, No. 9, 2011, pp. 730-734. http://scholar.google.com/scholar?q=related:Me0jiiPdpc0J:scholar.google.com/&hl=en&num=30&as_sdt=0,5&as_ylo=2011&as_yhi=2011

[40]   E. Fernandez, R. Pallini, C. Gangitano, A. Del Fá, C. Olivieri-Sangiacomo, A. Sbriccoli, J. Ricoy and G. F. Rossi, “Studies on the Degenerative and Regenerative Phenomena Occurring after Transection and Repair of the Sciatic Nerve in Rats: Effects of Acetyl-L-Carnitine,” International Journal of Clinical Pharmacology Research, Vol. 10, No. 1-2, 1990, pp. 85-99.

[41]   E. Fernandez, R. Pallini, L. Lauretti, F. La Marca, A. Scogna and G. F. Rossi, “Motonuclear Changes after Cranial Nerve Injury and Regeneration,” Archives Italiennes Biologie, Vol. 135, No. 4, 1997, pp. 343-351.

[42]   R. De Simone, L. Aloe, L. Ferraris and M. T. Ramacci, “Levocarnitine Acetyl Treatment Promotes Iris Reinnervation Following 6-Hydroxydopamine-Induced Noradrenergic Denervation in Rats,” International Journal of Clinical Pharmacology Research, Vol. 12, No. 5-6, 1992, pp. 281-287.

[43]   K. Kotil, M. Kirali, M. Eras, T. Bilge and H. Uzun, “Neuroprotective Effects of Acetyl-L-Carnithine in Experimental Chronic Compression Neuropathy. A Prospective, Randomized and Placebo-Control Trials,” Turkish Neurosurgery, Vol. 17, No. 2, 2007, pp. 67-77.

[44]   A. D. H. Wilson, A. Hart, T. Br?nnstr?m, M. Wiberg and G. Terenghi, “Delayed Acetyl-L-Carnitine Administration and Its Effect on Sensory Neuronal Rescue after Peripheral Nerve Injury,” Journal of Plastic Reconstructive & Aesthetic Surgery, Vol. 60, No. 2, 2007, pp. 114-118.

[45]   E. Fernandez, R. Pallini, L. Lauretti, E. Marchese, C. Gangitano, A. Del Fá, C. Olivieri-Sangiacomo, A. Sbriccoli and G. F. Rossi, “Levocarnitine Acetyl Prevents Cell Death Following Long-Term Section of the Vagus Nerve in Rats,” International Journal of Clinical Pharmacology Research, Vol. 12, No. 5-6, 1992, pp. 289-297.

[46]   A. Love, M. A. Cotter and N. E. Cameron, “Effects of the Sulphydryl Donor N-Acetyl-L-Cysteine on Nerve Conduction, Perfusion, Maturation and Regeneration Following Freeze Damage In Diabetic Rats,” European Journal of Clinical Investigation, Vol. 26, No. 8, 1996, pp. 698-706.

[47]   D. Welin, L. N. Novikova, M. Wiberg, J.-O. Kellerth and L. N. Novikov, “Effects of N-Acetyl-Cysteine on the Survival and Regeneration of Sural Sensory Neurons in Adult Rats,” Brain Research, Vol. 1287, 2009, pp. 58-66.

[48]   T. Karlidag, M. Yildiz, S. Yalcin, N. Colakoglu, I. Kaygusuz and E. Sapmaz, “Evaluation of the Effect of Methylprednisolone and N-Acetylcystein on Anastomotic Degeneration and Regeneraton of the Facial Nerve,” Auris Nasus Larynx, Vol. 39, No. 2, 2012, pp. 145-150.

[49]   J. Brown, J. I. Bianco, J. J. McGrath and D. W. Eyles, “1,25-Dihydroxyvitamin D3 Induces Nerve Growth Factor, Promotes Neurite Outgrowth and Inhibits Mitosis in Embryonic Rat Hippocampal Neurons,” Neuroscience Letters, Vol. 343, No. 2, 2003, pp. 139-143. http://dx.doi.org/10.1016/S0304-3940(03) 00303-3

[50]   M. Fukuoka, K. Sakurai, T. Ohta, M. Kiyoki and I. Katayama, “Tacalcitol, an Active Vitamin D3, Induces Nerve Growth Factor Production in Human Epidermal Keratinocytes,” Skin Pharmacology and Skin Physiology, Vol. 14, No. 4, 2001, pp. 226-233. http://dx.doi.org/10.1159/000056351

[51]   J.-F. Chabas, O. Alluin, G. Rao, S. Garcia, M.-N. Lavaut, J. J. Risso, et al., “Vitamin D 2Potentiates Axon Regeneration,” Journal of Neurotrauma, Vol. 25, No. 10, 2008, pp. 1247-1256. http://dx.doi.org/10. 1089/neu.2008.0593

[52]   M. Goudarzvand, M Javan, J. Mirnajafi-Zadeh, S. Mozafari and T. Tiraihi, “Vitamins E and D3 Attenuate Demyelination and Potentiate Remyelination Processes of Hippocampal Formation of Rats Following Local Injection of Ethidium Bromide,” cellular and Molecular Neurobiology, Vol. 30, No. 2, 2010, pp. 289-299.

[53]   Y. Xu, B. Ku, L. Cui, X. Li, P. A. Barish, T. C. Foster and W. O. Ogle, “Curcumin Reverses Impaired Hippocampal Neurogenesis and Increases Serotonin Receptor 1A mRNA and Brain-Derived Neurotrophic Factor Expression in Chronically Stressed Rats,” Brain Research, Vol. 1162, 2007, pp. 9-18.

[54]   K.-K. Liao, M.-J. Wu, P.-Y. Chen, S.-W. Huang, S.-J. Chiu, C.-T. Ho and J. H. Yen, “Curcuminoids Promote Neurite Outgrowth in PC12 Cells through MAPK/ERK-and PKC-Dependent Pathways,” Journal of Agricultural Food Chemistry, Vol. 60, No. 1, 2012, pp. 433-443.

[55]   M. A. Jalaludin, “Methylcobalamin Treatment of Bell’s Palsy,” Methods and Findings in Experimental and Clinical Pharmacology, Vol. 17, No. 8, 1995, pp. 539-544.

[56]   A. D. Kandhare, K. S. Raygude, P. Ghosh, A. E. Ghule and S. L. Bodhankar, “Therapeutic Role of Curcumin in Prevention of Biochemical and Behavioral Aberration Induced by Alcoholic Neuropathy in Laboratory Animals,” Neuroscience Letters, Vol. 511, No. 1, 2012, pp. 18-22.

[57]   D. J. Fitzhugh, S. Shan, M. W. Dewhirst and L. P. Hale, “Bromelain Treatment Decreases Neutrophil Migration to Sites of Inflammation,” Clinical Immunology, Vol. 128, No. 1, 2008, pp. 66-74.

[58]   L. Gaspani, E. Limiroli, P. Ferrario and M. Bianchi, “In Vivo and in Vitro Effects of Bromelain on PGE(2) and SP Concentrations in the Inflammatory Exudate in Rats,” Pharmacology, Vol. 65, No. 2, 2002, pp. 83-86.

[59]   L. P. Hale, M. Chichlowski, C. T. Trinh and P. K. Greer, “Dietary Supplementation with Fresh Pineapple Juice Decreases Inflammation and Colonic Neoplasia in IL-10-Deficient Mice with Colitis,” Inflammatory Bowel Diseases, Vol. 16, No. 12, 2010, pp. 2012-2021.

[60]   S. Muller, R. Marz, M. Schmolz, B. Drewelow, K. Eschmann and P. Meiser, “Placebo-Controlled Randomized Clinical Trial on the Immunomodulating Activities of Lowand High-Dose Bromelain after Oral Administration—New Evidence on the Antiinflammatory Mode of Action of Bromelain,” Phytotherapy Research, Vol. 27, No. 2, 2012, pp. 199-204.

[61]   F. Inchingolo, M. Tatullo, M. Marrelli, A. M. Inchingolo, V. Picciariello, A. D. Inchingolo, G. Dipalma, D. Vermesan and R. Cagiano, “Clinical Trial with Bromelain in Third Molar Exodontia,” European Review of Medical Pharmacological Sciences, Vol. 14, No. 9, 2010, pp. 771-774.

[62]   M. Masson, “Bromelain in Blunt Injuries of the Locomotor System. A Study of Observed Applications in General Practice,” Fortschritte der Medizin, Vol. 113, No. 19, 1995, pp. 303-306.

[63]   S. Jadav, N. Patel, T. Shah, M. Gajera, H. Trivedi and B. Shah, “Comparison of Anti-Inflammatory Activity of Serratiopeptidase and Diclofenac in Albino Rats,” Journal of Pharmacology & Pharmacotherapeutics, Vol. 1, No. 2, 2010, pp. 116-117.

[64]   A. H. M. Viswanatha Swamy and P. A. Patil, “Effect of Some Clinically Used Proteolytic Enzymes on Inflammation in Rats,” Indian Journal of Pharmacetical Sciences, Vol. 70, No. 1, 2008, pp. 114-117.

[65]   A. Mazzone, M. Catalani, M. Costanzo, A. Drusian, A. Mandoli, S. Russo, E. Guarini and G. Vesperini, “Evaluation of Serratia peptidase in Acute or Chronic Inflammation of Otorhinolaryngology Pathology: A Multicentre, Double-Blind, Randomized Trial Versus Placebo,” Journal of International Medical Research, Vol. 18, No. 5, 1990, pp. 379-388.

[66]   T. H. Al-Khateeb and Y. Nusair, “Effect of the Proteolytic Enzyme Serrapeptase on Swelling, Pain and Trismus after Surgical Extraction of Mandibular Third Molars,” International Journal of Oral and Maxillofacial Surgery, Vol. 37, No. 3, 2008, pp. 264-268.

[67]   P. M. Esch, H. Gerngross and A. Fabian, “Reduction of Postoperative Swelling. Objective Measurement of Swelling of the Upper Ankle Joint in Treatment with Serrapeptase—A Prospective Study,” Fortschritte der Medizin, Vol. 107, No. 4, 1989, pp. 67-68,71-72.

[68]   M. Tachibana, O. Mizukoshi, Y. Harada, K. Kawamoto and Y. Nakai, “A Multi-Centre, Double-Blind Study of Serrapeptase versus Placebo in Post-Antrotomy Buccal Swelling,” Pharmatherapeutica, Vol. 3, No. 8, 1984, pp. 526-530.

 
 
Top