An update on the causes, assessment and management of third division sensory trigeminal neuropathies

Abstract

Introduction Sensory neuropathies of the mandibular division of the trigeminal (V3) nerve can be debilitating, causing difficulty with daily function. It has a variety of causes, including iatrogenic injury, usually caused by third molar removal, local anaesthetic administration, implant placement or endodontic treatment. Non-iatrogenic causes include infection, primary or secondary neoplasia and various medical conditions.Objective To review the aetiology, evaluation and management of V3 neuropathy in a retrospective case-series of patients referred to a specialist nerve injury clinic over an eight-year period, particularly focusing on the non-iatrogenic causes of this presentation.Methods A retrospective analysis of the case notes of 372 patients referred to the specialist nerve injury clinic between 2006 and 2014 was carried out to establish the cause of the neuropathy and subsequent management or referral. The assessment protocol of trigeminal neuropathy used in the clinic is also outlined.Results Most patients (89.5%) presented with neuropathy due to iatrogenic injury. Of the non-iatrogenic causes (10.5%), malignancy accounted for a fifth of presentations, and infection almost two-fifths, demonstrating the importance of prompt identification of a cause and management by the clinician, or referral to the appropriate specialty. Other, more rare causes are also presented, including multiple sclerosis, sickle-cell anaemia and Paget's disease, highlighting the importance to the clinician of considering differential diagnoses.Conclusions This case series demonstrates the less frequent, but nevertheless important, non-iatrogenic causes which clinicians should consider when assessing patients with trigeminal neuropathy.

Accidental intraosseous displacement of mandibular premolar root during extraction with guidance and literature review

“…There are many different options available for management of cases and these are generally grouped into reassurance and counselling, or psychological techniques, pharmacological and surgical management. [24][25][26] Immediate surgical intervention for the inferior alveolar nerve is usually reserved for symptomatic cases with an obvious iatrogenic cause which can be removed, such as a displaced tooth, or for cases with suspected neurotmesis. 23 Surgical intervention involves epineural repair with nylon sutures by attempting to apposition the nerve endings.…”

Considerations in the Diagnosis and Treatment of Post-Traumatic Neuropathic Pain: A<strong> </strong>Narrative Review

“…This study aims to provide a comprehensive overview of the current understanding and management strategies concerning Post-Traumatic Neuropathic Pain (PTTN) arising from dental procedures or traumatic events. PTTN refers explicitly to neuropathic pain arising after injury to the trigeminal nerve, the fifth cranial nerve governing sensory and motor functions across the maxillofacial region through its divisions: V1, V2, and V3 [1]. It serves as the conduit for sensory input related to temperature, pain, and tactile sensations in the facial region while also contributing significantly to motor control of masticatory muscles [1].…”

“…PTTN refers explicitly to neuropathic pain arising after injury to the trigeminal nerve, the fifth cranial nerve governing sensory and motor functions across the maxillofacial region through its divisions: V1, V2, and V3 [1]. It serves as the conduit for sensory input related to temperature, pain, and tactile sensations in the facial region while also contributing significantly to motor control of masticatory muscles [1]. When these nerves sustain an injury, the pain persists beyond the typical healing period.…”

“…When these nerves sustain an injury, the pain persists beyond the typical healing period. This persistence manifests in a spectrum of symptoms, ranging from the absence of pain to sensations of tingling and severe discomfort [1,2].…”

Does the addition of cone-beam CT to panoral imaging reduce inferior dental nerve injuries resulting from third molar surgery? A systematic review

“…Injury to the inferior dental nerve (IDN) is a known risk of mandibular third molar (MTM) surgery that can be very unpleasant and distressing for patients [1]. Consequently, preoperative radiographic imaging is essential to indicate the anatomical relationship of the tooth with the IDN [2].…”