Post-traumatic Trigeminal Neuropathic Pain: Factors Affecting Surgical Treatment Outcomes

Abstract

Post-traumatic trigeminal neuropathic pain (PTTNp) is a painful condition that may result from injury to the sensory division of the trigeminal nerve. Treatment of this condition is challenging and consensus on treatment to resolve neuropathic pain has yet to be standardized. Equally as challenging is the identification of surgical outcome variables to guide surgical treatment of PTTNp. This is partly due to the variability in pain characteristics, severity of nerve injury, location, and duration from injury to surgery. In those with neuropathic pain prior to microsurgical intervention, the incidence of neuropathic pain after microsurgical intervention is 67%. It is unclear why nerve repair surgery is effective in resolving or decreasing neuropathic pain in some patients, whereas it has no effect on pain relief in others. Psychological, medical, and age-related factors have been identified as risk factors for developing chronic post-surgical pain due to post-traumatic neuropathic pain. Two factors: injury to surgery time and preoperative visual analog scale score have recently been identified as variables that influence surgical outcomes in the treatment of PTTNp.

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

“…The clinical characteristics of PTTN demonstrates considerable heterogeneity, attributable to an interplay of environmental, psychosocial, and genetic factors [9,10]. The clinical phenotype may include spontaneous and evoked pain, positive symptoms (e.g., paresthesias), and negative symptoms (e.g., numbness) [9,10]. PTTN typically manifests at the injury site or within the dermatomes corresponding to the affected nerves [9.10].…”

“…PTTN typically manifests at the injury site or within the dermatomes corresponding to the affected nerves [9.10]. It can be confined to the injury site, extend throughout the dermatome, or present as either localized or diffuse pain [9,10]. The intensity of pain experienced can range from mild to severe [9,10].…”

“…It can be confined to the injury site, extend throughout the dermatome, or present as either localized or diffuse pain [9,10]. The intensity of pain experienced can range from mild to severe [9,10].…”

Radiological assessment of the inferior alveolar canal and mental foramen using cone beam computed tomography for pre-operative evaluation of surgeries in the mandible: A single-center five-year retrospective study

“…Nerve injury resulting from dental extraction, placement of the dental implant, bilateral sagittal split osteotomy surgery, or genioplasty surgery are not uncommon ( Morse, 1997 ). Unfortunately, the treatment of nerve injury in the jaw area is not always a straightforward task and is related to several factors, including age and gender, cause of injury, healing status, and medical history of the patient ( Neal and Zuniga, 2022 ). Treatment of nerve injury is costly due to the time needed for long-term follow-up, the cost of medication, and the possibility of the need for further corrective surgery ( Van der Cruyssen et al, 2022 ).…”

Treatment of Yatrogenic Post-Traumatic Neuropathy Associated With Endodontic Therapy Using 3d Technologies

“…[23][24] Urgent surgery should be recommended for nerve injury caused by endodontic procedures or implants. 25 If the removal of excess endodontic material is delayed, irreversible nerve damage occurs and the prognosis for recovery remains difficult to predict. [26][27][28][29] In those clinical cases where the cause of damage to the mandibular nerve was a broken endodontic instrument that came out from the apex of the tooth root into the nerve canal, in this case the broken endodontic.…”