A Case of Secondary Trigeminal Neuropathy Due to Local Malignant Invasion of the Maxillary and Mandibular Nerves at the Skull Base: A Case Report With Review of Differential Diagnosis

Abstract

Trigeminal neuropathies (TNp) are a group of well-characterized disorders that involve damage to or infiltration of the trigeminal nerve. The underlying etiology of trigeminal neuropathy can be traumatic, inflammatory, autoimmune, paraneoplastic, malignant, and very rarely infectious. We present a case of trigeminal neuropathy due to local malignant invasion of the mandibular nerve with mandibular nerve enhancement at the foramen ovale and foramen rotundum. In the process, we review various etiologies of trigeminal neuropathy associated with trigeminal nerve involvement at the foramina. We emphasize the importance of a comprehensive evaluation in patients with trigeminal neuropathy, which includes searching for perineural spread or invasion by a local head and neck malignancy, as well as ruling out an inflammatory or autoimmune etiology. Our case also demonstrates that a higher field strength magnet can reveal pathology unseen with a lower field strength magnet.

Neurological Complications of Local Anesthesia in Dentistry: A Review

“…Lingual nerve: A specific branch that originates from the mandibular division of the trigeminal nerve (V3) is responsible for providing sensory innervation to the front 2/3 of the tongue [ 12 , 72 ].…”

“…Inferior alveolar nerve (IAN): It is a mandibular division branch of the trigeminal nerve (V3) that innervates the lower teeth, chin, and lower lip [ 12 , 72 ].…”

“…Mental nerve: A terminal branch of IAN that provides sensory innervation to the lower lip and chin [ 12 , 72 ].…”

“…Posterior superior alveolar nerve (PSAN): The maxillary division of the trigeminal nerve (V2) innervates the upper molars and premolars [ 12 , 72 ].…”

“…There are many signs of neurological complications like complete or partial lack of sensation within the affected area, prolonged numbness of the tongue, cheek, or gingival tissue, loss of sensation beyond the expected duration after LA administration, numbness of the jaw and face, tingling sensation in the affected area, and unusual or persistent pain or burning sensation in the area where the LA was administered [ 12 , 72 ].…”