information highlighted below and resubmit the form. The intraoperative findings confirmed the presence of root canal filling material in and around the nerve. Department of Neurological Surgery. But you can slow the onset or progression of symptoms by taking care of your health in general and managing your medical conditions. This affects your lower eyelid, cheek, nostril, upper lip, and upper gum. This content does not have an English version. Oct. 6, 2021. Accessed Sept. 30, 2021. The nerve extends within the pterygopalatine fossa where its branches extend either directly from the body of the maxillary nerve or from its short pterygopalatine nerves that are added to the pterygopalatine ganglion. The most common symptoms of sinus cancer usually occur on just one side of the face due to physical blockage of one or more air spaces alongside the nose and cheek area. After removing the damaged portion of the nerve, the proximal and distal nerve stumps are approximated with microsutures, then covered with a porcine nerve protector. How long does an attack of facial pain typically last? Common signs and symptoms of chronic sinusitis include: Nasal inflammation; Thick, discolored discharge from the nose (runny nose) Drainage down the back of the throat (postnasal drainage) Blocked or stuffy (congested) nose causing difficulty breathing through your nose; Pain, tenderness and swelling around your eyes, cheeks, nose or . If you damage your trigeminal nerve through oral or sinus surgery, a stroke or from facial trauma, you may feel facial nerve pain that's similar to the symptoms of trigeminal neuralgia. On the lateral wall of the orbit, the zygomatic nerve makes anastomosis with the lacrimal nerve through their common connective branch. In balloon compression, your doctor inserts a hollow needle through your face and guides it to a part of your trigeminal nerve that goes through the base of your skull. Merck Manual Professional Version. The ophthalmic division of the trigeminal nerve, for instance, transmits sensory information to your brain from your upper eyelids, forehead, and scalp. If you are a smoker, heavy alcohol user, or work with industrial chemicals, you are at higher risk than the normal population of developing sinus cancer. In addition, the zygomatic branch may pass through the zygomatic bone before splitting up, as opposed to bifurcating prior to that. If the nerve is damaged during root canal therapy or visibly transected the patient should be scheduled for microsurgical repair as soon as possible; preferably within 48 hours of the injury. information submitted for this request. It affects the trigeminal nerve, or fifth cranial nerve, which provides feeling and nerve signaling to many parts of the head and face. Usually, there are three of them: one greater palatine nerve and two of the lesser palatine nerves. Each branch of the trigeminal nerve provides sensation or motor function to a different area of the head and face. Your doctor is likely to ask you a number of questions. Trigeminal neuralgia results in pain occurring in an area of the face supplied by one or more of the three branches of the trigeminal nerve. This nerve is the strongest branch of the maxillary nerve and is the ending branch. Anatomy. Accessed June 7, 2022. https://www.merckmanuals.com/professional/neurologic-disorders/autonomic-nervous-system/autonomic-neuropathies. Zygomatic branch: This branch is another one that arises directly from the maxillary nerve, exiting the pterygopalatine fossa through the inferior orbital fissure. Natural Medicines. Elsevier; 2022. https://www.clinicalkey.com. Due to its close associations with the trigeminal nerve, issues there will impact the maxillary nerve. Infections of the trigeminal ganglion by the herpes zoster virus (shingles) will cause very painful sensations among all sensory areas that are innervated by the trigeminal nerve, including the maxillary nerve. The rest of the nerves in your body emerge from the spinal cord, but the cranial nerves come from your brain. Figure 1A: Impacted #32 Proximity to IAN Figure 1B: S/P Coronectomy. Following antibiotic treatment for the sinusitis, the symptoms of the neuralgia resolved completely and no other therapy was necessary. Signs and symptoms of nasal and paranasal cancer. At 1 year post-op the neurosensory exam revealed the return of protective sensation with no pain. Sensory information from these areas passes via axons to the trigeminal ganglion, located within an area called Meckels cave, a special pouch within the middle cranial fossa. These branches converge to form the sensory root of the trigeminal nerve and convey the sensory information to the brains at the level of the pons, a section associated with a range of bodily functions, such as sleep, breathing, swallowing, hearing, balance, among many others. The patient was taken to the operating room the next day. Pain. Most cases of this extremely painful condition are due to nerve compression of the mandibular and/or maxillary branches of the trigeminal nerve. In other cases, surgical injuries, stroke or facial trauma may be responsible for trigeminal neuralgia. Common symptoms of trigeminal neuralgia may include: The maxillary nerve is exclusively sensory, although its branches receive certain autonomous fibers that reach the maxillary nerve through the pterygopalatine ganglion. Sinus cancer symptoms are usually subtle and often go unnoticed because they mimic other benign (less-harmful) conditions like allergies, the common cold, and postnasal drip. The trigeminal nerve travels from the brainstem and around your head toward your face. Also, carbamazepine can trigger a serious drug reaction in some people, mainly those of Asian descent, so genetic testing may be recommended before you start carbamazepine. The neuroma was excised and neural continuity was re-established with microsutures. The latter accesses the skin of the cheek through multiple gaps in the zygomatic bone. Mayo Clinic. Trigeminal neuralgia can also be caused by a tumor compressing the trigeminal nerve. Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic. In this fossa, the nerve extends the most of its branches. Zakrzewska JM, Linskey ME. It helps relay sensation and pain messaging from the upper teeth, jaw, the mucosa (membranes) of the nasal cavity, as well as part of the tongue and face. National Institute of Neurological Disorders and Stroke. Since the cause of the injury was demonstrable, immediate repair via trans-oral exploration of the IAN and microsurgical reconstruction was planned. National Institute of Neurological Disorders and Stroke. Of the three branches of the trigeminal nerve, the mandibular nerve is the only one that serves both motor and sensory functions. Types of rhizotomy include: Glycerol injection. He has held positions with major news networks like NBC reporting on health policy, public health initiatives, diversity in medicine, and new developments in health care research and medical treatments. Soon after they leave the cranium, they unite by forming the pterygoid canal nerve. The medial posterior superior nasal nerve moves towards the middle, across the nasal roof. New York City: 212-308-9200 - Email | Lake Success: 516-775-1818 - Email | West Islip: 631-376-1560 - Email. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Accessed June 15, 2022. They arise from the body of the maxillary nerve inside the pterygopalatine fossa. The intraoperative findings revealed a traumatized lingual nerve with neuroma formation. Usually, the problem is contact between a normal blood vessel in this case, an artery or a vein and the trigeminal nerve at the base of your brain. Other drugs, including clonazepam (Klonopin), topiramate (Qsymia, Topamax, others), pregabalin (Lyrica) and gabapentin (Neurontin, Gralise, Horizant), also may be used. National Institute of Neurological Disorders and Stroke. Revolvy.com. He is president of the American Board of Facial Plastic and Reconstructive Surgery and treats skin cancer patients as part of his practice. You may opt-out of email communications at any time by clicking on The trigeminal nerve provides sensation and control of the face. The maxillary branch. National Institute of Neurological Disorders and Stroke. From that position, the nerve turns medially and enters the orbitthrough the inferior orbital fissure, where it is recognized by the name infraorbital nerve. What treatment approach do you recommend? This new approach eliminates the need for a second surgical site, decreases the time of the procedure and is associated with neurosensory recovery that is comparable to sural nerve grafting. 2014;348:g474. other information we have about you. This contact puts pressure on the nerve and causes it to malfunction. For instance, it can be what is called bifid, meaning it is split into two parts. They might include: Dizziness and fainting when standing, caused by a sudden drop in blood pressure. . It is stuck into the slightly extended anterior foramen of the pterygoid canal, inferiorly and medially to the body of the maxillary nerve. This procedure involves relocating or removing blood vessels that are in contact with the trigeminal root to stop the nerve from malfunctioning. Trigeminal neuralgia symptoms may include one or more of these patterns: If you experience facial pain, particularly prolonged or recurring pain, or pain unrelieved by over-the-counter pain relievers, see your doctor. Doctors usually can effectively manage trigeminal neuralgia with medications, injections or surgery. Trigeminal neuralgia is a condition that causes painful sensations similar to an electric shock on one side of the face. If the imaging reveals a violation of the IAN, then removal of the implant is recommended. Balloon compression successfully controls pain in most people, at least for a period of time. The trigeminal nerve leaves the pons via two roots: After leaving the pons, these roots continue coursing forward to exit from the posterior cranial fossa. Anticonvulsants. Your surgeon inserts an electrode through the needle and sends a mild electrical current through the tip of the electrode. Even so, each pair is referred to as a single nerve. When the nerve leaves the canal, it enters directly to the pterygopalatine ganglion, bringing both sympathetic and parasympathetic fibers to it. A trigeminal nerve injury may affect a small area, like part of your gum, or a large area, like one side of your face. Trigeminal neuralgia symptoms may include one or more of these patterns: Episodes of severe, shooting or jabbing pain that may feel like an electric shock. If any symptoms persist for more than three months, you should see a healthcare professional. While compression by a blood vessel is one of the more common causes of trigeminal neuralgia, there are many other potential causes as well. Adrienne Dellwo is an experienced journalist who was diagnosed with fibromyalgia and has written extensively on the topic. More rarely, the damage may be linked to wisdom tooth extraction, corrective jaw surgery, and other dental procedures. Trigeminal neuralgia. Facial nerve damage can also affect the way you sense texture on the front portion of your tongue. 21st ed. McGraw Hill; 2022. https://accessmedicine.mhmedical.com. Signs and symptoms of autonomic neuropathy depend on which nerves are damaged. If a nerve injury does occur, a thorough history and neurosensory exam is critical in evaluating the case. Address: 1775 Village Center Cir #150, Las Vegas, NV 89134, Business Hours:Monday: 9:00 AM 4:30 PMTuesday: 9:00 AM 4:30 PMWednesday: 9:00 AM 4:30 PMThursday: 9:00 AM 4:30 PMFriday: 9:00 AM 4:30 PMSaturday: By appointment onlySunday: Closed, Address: 825 N. Gibson Road, Suite 441, Henderson NV 89011, Business Hours:Monday: 9:00 AM 4:30 PMTuesday: 9:00 AM 4:30 PMWednesday: 9:00 AM 4:30 PMThursday: 9:00 AM 4:30 PMFriday: 9:00 AM 4:30 PMSaturday: ClosedSunday: Closed, 2021 by Oral and Maxillofacial Surgery Associates of Nevada, Oral & Maxillofacial Surgery Associates of Nevada, 1775 Village Center Cir #150, Las Vegas, NV 89134, 825 N. Gibson Road, Suite 441, Henderson NV 89011. the unsubscribe link in the e-mail. TN is a type of neuropathic pain, typically caused by a nerve injury or . Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. How often do you experience bouts of facial pain, and have you noticed if anything seems to trigger your facial pain? These symptoms, like nasal congestion and postnasal drip, can mimic a cold, allergies, or sinusitis (inflammation of the sinuses). She also complained of biting her tongue while eating. These efferent ganglionic fibers are parasympathetic and through the pterygopalatine nerves, they reach the zygomatic nerve. . You may also experience facial swelling, loosened upper teeth, nasal pain, and double vision. These are: The orbit floor: As the maxillary nerve exits the pterygopalatine fossa via the inferior orbital fissure, it enters the orbit and becomes the infraorbital nerve. Treatment may include anti-inflammatories, such as steroids or ibuprofen, . Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Both qualitative and quantitative data is taken at each follow up appointment. Living with trigeminal neuralgia can be difficult. This procedure uses radiation to damage the trigeminal nerve and reduce or eliminate pain. It can appear suddenly or may be provoked by touching the region of the skin that is innervated by these nerves. Superior labial branches: There many of these smaller nerves, which serve to enervate the side of the cheek, the upper lip, oral mucosa, and labial glands (which help produce saliva). Thank you, {{form.email}}, for signing up. Nasal nerves: From the pterygopalatine ganglion, these branchesmost notably the medial and lateral posterior superior nasal nerves as well as the nasopalatine nerveaccess the nasal cavity via the sphenopalatine foramen. Like the nerve that extends to two branches inside this canal, the canal itself also has two hallways that correspond to these branches: These terminal branches of the zygomatic nerve exit the zygomatic canal through the proper foramina named according to the branches: zygomaticofacial and zygomaticotemporal foramen. StatPearls. Aside From Micrognathia, What Do These Patients Have In Common? The mucosa of the nasopharynx, the palate, the nasal cavity and maxillary sinus. You'll be asked to indicate when and where you feel tingling. The follow up neurosensory exam at one month and two months later demonstrated no improvement in sensation. If the nerve is injured during implant placement, removal of the implant is recommended as soon as possible. In the infratemporal fossa, the nerve is located adjacent to the maxillary tuberosity. Its always important to talk to your healthcare provider if youre feeling any related pain or discomfort. In this procedure, a surgeon directs a focused dose of radiation to the root of your trigeminal nerve. Sinus cancer is very treatable in its early stages, so the sooner you get a diagnosis and treatment, the more likely you are to stave off life-altering medical complications. Read more. Autonomic neuropathy occurs when there is damage to the nerves that control automatic body functions. A vascular loop compressing the nerve may be the most frequent cause of trigeminal neuralgia. https://diabetes.org/diabetes/neuropathy/autonomic-neuropathy. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking or brushing teeth. Some may be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves. Mark Gurarie is a freelance writer, editor, and adjunct lecturer of writing composition at George Washington University. Diabetic autonomic neuropathy. Surgeries repairing this nerve following trigeminal neuralgia are largely successful, with all three major approachesmicrovascular decompression, radiosurgery, and radiofrequency lesioninghaving success rates at or above 80%. William Truswell, MD, is a board-certified facial plastic surgeon and otolaryngology (head and neck) surgeon. 2016; doi:10.4239/wjd.v7.i16.321. If you are a Mayo Clinic patient, this could To the best of our knowledge, this is the first report of maxillary nerve-mediated nasal allodynia after septoplasty. If you are a Mayo Clinic patient, this could June 20, 2022. In general, it supplies the teeth of the maxilla, skin from the lower eyelid above to the superior aspect of the mouth below, as well as the nasal cavity and the paranasal sinuses. McGraw-Hill; 2018. https://accessmedicine.mhmedical.com. In facial or dental surgery, a maxillary nerve block may need to be applied by an anesthesiologistnumbing the nerveand this procedure can also help with trigeminal neuralgia. These procedures can be directed to specific teeth as necessary. Brain stereotactic radiosurgery is successful in eliminating pain for the majority of people. Neuropraxia is the most mild and is often the result of blunt injury or pressure. Trigeminal neuralgia. Surgical outcomes for patients with numbness only tend to be better than those with pain and numbness (85% vs 65%). A lot of different structures are close to each other and even overlapping, making it hard for doctors to figure out exactly what's causing symptoms. 2010;55(2):112-119. doi:10.1111/j.1834-7819.2010.01216.x. Have your symptoms gotten worse over time? The fracture is mostly likely to occur in the middle of the forehead. In: Harrison's Principles of Internal Medicine. Shamard Charles, MD, is a physician-journalist and public health doctor who advances health policy through health communication and health promotion. The disorder may affect your interaction with friends and family, your productivity at work, and the overall quality of your life. Take steps to prevent or control high blood pressure. Symptoms. Autonomic nerve damage may produce the following symptoms: Inability to sense chest pain, such as angina or heart attack. By clicking Accept All Cookies, you agree to the storing of cookies on your device to enhance site navigation, analyze site usage, and assist in our marketing efforts. American Diabetes Association. If your symptoms last longer than expected or fail to respond to medication and other conservative treatment, your Oral & Maxillofacial Surgery Associates specialist may eventually recommend surgical repair to restore facial nerve function. It can affect blood pressure, temperature control, digestion, bladder function and even sexual function. Surgery is commonly used to remove sinus tumors. If nerve pain is present and is relieved with a diagnostic block, then surgical repair is considered for this scenario as well. These can be found in the mandibular branch itself or in the masseter, temporal, auriculotemporal, or lingual nerves. Disorders of the autonomic nervous system. Middle meningeal branchto supply the . Group members often know about the latest treatments and tend to share their own experiences. Accessed June 17, 2022. Often compared to an electrical shock, nerve (neuropathic) pain is a shooting, stabbing, or burning discomfort in areas linked to the distribution of the damaged nerve. Lingual Nerve Injury: Surgical Anatomy and Management. The nerve repair unit at NYCOMS is here to assist in any way we can. Often compared to an electrical shock, nerve (neuropathic) pain is a shooting, stabbing, or burning discomfort in areas linked to the distribution of the damaged nerve. Historically, the sural nerve graft was harvested from the lower leg. It is a branch of the trigeminal nerve (the fifth cranial nerve) which serves both a sensory (afferent) and motor (efferent) function. Brock C, et al. For more details, see our Privacy Policy. AskMayoExpert. Conversely, an injury may also result in heightened sensitivity in the same areas. The most common symptoms of nasal and sinus cancer are frequent nosebleeds and nasal blockage that is not relieved by blowing your nose. Accessed Sept. 30, 2021. Most notably, it may be impacted by trigeminal neuralgia, a disorder at the nerves root that causes pain in and around the jaw. The mandibular nerve is the largest branch of the trigeminal nerve. The motor nerves that branch off of the mandibular connect to and move numerous muscles in your face, including: The main sensory nerves that branch off from the mandibular nerve include: Pain or other problems related to the mandibular nerve can be hard to diagnose due to the complexity of the anatomy in the head and neck. 2023 Dotdash Media, Inc. All rights reserved. The pain is usually in the region of both the mandibular nerve and the maxillary nerves. Nasal branches: Supplying the skin of the side surface of the nose, the internal nasal branch accesses the nasal septum and vestibule (or nostril), while others link up with nerves in the face and coming from the eye. Accessed June 16, 2022. Be sure to check with your doctor before trying an alternative treatment because it may interact with your other treatments. When did you first develop these symptoms? Your doctor may order additional tests to rule out other conditions. A high-impact injury to the head can cause a fracture of the frontal bone and floor of the sinuses. Autonomic neuropathy may also be caused by an immune system attack triggered by some cancers (paraneoplastic syndrome). For an accurate diagnosis and top-level specialty care for facial nerve injuries,schedule an evaluationat Oral & Maxillofacial Surgery Associates of Nevada today. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Lupus can damage nerves in the body by causing inflammation of the nerves or the tissue around the nerves. Register now The larger of the two is sensory, and the smaller one is motor. Although this may occur in the . A mandibular nerve block, which deadens feeling in a nerve with anesthetic, is frequently used for jaw surgery or dental work. Reviewer: This procedure entails removing scar tissue and covering the nerve with a porcine nerve protector. Other conditions can also impact the maxillary nerve, including lesions of the zygomatic nerve, which helps produce the liquid layer of film that goes around the eye. This condition can affect the trigeminal nerve and all of its pathways, leading to uncomfortable sensations and sensitivity to heat and cold in the teeth due to inflammation in the nerve. Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. https://www.uptodate.com/contents/search. Chewing muscles (medial pterygoid, deep temporal, lateral pterygoid, masseter), Mylohyoid, which forms the floor of your mouth, Digastric, which is a small muscle under your jaw, Tensor veli palatini, which lifts the soft palate at the back of your mouth, Tensor tympani, inside the ear, which dampens loud noises, Meningeal branch, which serves the dura mater (a thick membrane that surrounds the brain and spinal cord). Autonomic neuropathy. Palatine branches extend from the pterygopalatine nerves and course inferiorly. doi:10.1136/bmj.g474, Biasiotta A, Cascone P, Cecchi R, et al. Gibbons CH. But for smokers, industrial plant workers, and those with a personal history of cancer, persistent head and neck symptoms may be a serious sign worthy of a doctors visit. It arises between the trigeminal's ophthalmic and mandibular divisions in a region called the trigeminal ganglion, a cluster of nerves involved in relaying sensory information to the brain as well as chewing motor function. This procedure selectively destroys nerve fibers associated with pain. Then, your doctor threads a thin, flexible tube (catheter) with a balloon on the end through the needle. All rights reserved. If a tooth is considered high risk then a coronectomy is indicated. She also complained of biting her lip while eating. Jameson JL, et al., eds. Surgical complications from head and neck surgeries include: To help restore the appearance and functions of facial features affected by cancer or its treatment, reconstructive surgery may be an option. Nerve injuries can be classified into three main categories: neuropraxia, axonotmesis, and neurotmesis. Accessed June 15, 2022. This nerve represents the terminal branch of the maxillary nerve. Loscalzo J, et al., eds. information is beneficial, we may combine your email and website usage information with Have you ever had dental surgery or surgery on or near your face, such as sinus surgery? Merck Manual Professional Version. Is a Burning Nose Feeling a Symptom of COVID-19? This includes the patients response to sensory challenges involving directional determination, two point discrimination, soft touch and pinprick. If your condition is due to another cause, such as multiple sclerosis, your doctor will treat the underlying condition. https://www.uptodate.com/contents/search. Since the matter is complex, students can easily forget why they even have to know all of that information. Pterygopalatine fossa: The middle course of the nerve, at the pterygopalatine fossa on each side of the skull, the maxillary nerve accesses the pterygopalatine ganglion and gives off a vast majority of its branches. If you're recommending medications, what are the possible side effects? Anatomical variations of the mandibular nerve and its branches correlated to clinical situations. Siessere S, Hallak Regalo SC, Semprini M, et al. Post-op imaging is always suggested. It courses forward through the lateral dural wall of the cavernous sinus, inferiorly and laterally to the ophthalmic nerve. The trigeminal nerve (cranial nerve V)is a mixed nerve, meaning that it is made of both afferent and efferent neuronal fibers. While inside the orbit, the nerve courses along its lateral wall and then enters the canal present in the zygomatic bone. Sissere S, Hallak regalo SC, Semprini M, et al. . The initial qualitative and quantitative neurosensory exam revealed complete anesthesia of her left lip and chin with no protective sensation. Autonomic neuropathy. It can take 6-12 months to recover, but may result in some permanent dysfunction depending on the nature and severity of injury. The lateral posterior superior nasal nerve runs to the side of the cavity, innervating the mucosa of the sidewall of the nasal cavity. These kinds of abnormalities can lead to nerve damage during surgery or dental procedures because the doctor doesn't expect the nerve to be where it is. However, some people have a later recurrence of pain, and many experience facial numbness or tingling. Sometimes sinus cancer symptoms start to impact nearby structures like facial nerves and the brain. Read our, The Anatomy of the Pterygopalatine Ganglion, The Anatomy of the Superior Laryngeal Nerve, The Anatomy of the Auriculotemporal Nerve, The Anatomy of the Inferior Alveolar Nerve, Trigeminal neuralgia FAQ. Minerva Stomatol; 58(5):209-15. Understanding cranial nervescan easily be a problem that is hard to overcome in the process of studying anatomy. Trigeminal neuralgia. Typical variations can be something like the lingual nerve being closer to or farther away from the lower wisdom teeth, or the path of one or more branches being different in relation to other structures. Pharyngeal nerve: This nerve originates in the pterygopalatine ganglion and crosses to the mucosa and the nasopharynx glands via a structure called the palatovaginal canal. Thank you, {{form.email}}, for signing up. Disorders and conditions affecting the maxillary nerve can have a significant impact on quality of life. June 12, 2020. Sinus cancer chemotherapy treatments may cause various side effects, including: Most treatment-related side effects go away within a few weeks or months, but some may take longer to subside. Get appropriate treatment if you have an autoimmune disease.
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