Trigeminal neuropathy

Abstract

Trigeminal neuropathies (TNs) are well recognized disorders characterized and manifesting as skin and mucosal numbness in the region innervated by the trigeminal nerve. Facial numbness indicates trigeminal sensory alteration affecting the trigeminal system. TNs always pose differential location difficulties as multiple diseases are capable of producing them: they can be the result of traumatism, tumors, or diseases of the connective tissue, infectious or demyelinating diseases, or may be of idiopathic origin. Their importance is explained by the fact that TN may represent the first manifestation of tumor disease, or of relapse in patients with prior neoplastic processes. As such, these manifestations are ominous, and patient life expectancy is often short. The clinical exploration reveals a loss of sensitivity in the cutaneous territory corresponding to the affected nerve, which can be partial (hypoesthesia) or complete (anesthesia). The sensory defect is occasionally associated with hyperesthesia (i.e., the patient suffers a decrease in sensory perception, but when sensation is perceived, it may cause considerable discomfort). Complementary studies are needed to establish the etiologic diagnosis, with laboratory tests to discard the possible causative diseases underlying the trigeminal neuropathy, and the opportune radiographic examinations in the form of plain X‐rays or a routine cranial computed tomography scan.

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

“…Trigeminal sensory neuropathy may present with hypofunction (partial or complete numbness) or hyperfunction with altered sensation (paraesthesia, dysaesthesia) and/or neuropathic pain (allodynia -pain on touch or hyperalgesia-increased pain with painful stimuli). 51 Examination often cannot differentiate the iatrogenic from the spontaneous neuropathies. The history is therefore essential to discern the cause of the symptoms.…”

“…51 These can be grouped into degenerative neurological disease, immunological, haematological, metabolic and endocrine. V 3 sensory neuropathy has been described both as an isolated symptom and as part of a disease process such as vasculitis, which can occur secondary to rheumatoid arthritis, 50 …”

Facial pain as first manifestation of anti-Hu paraneoplastic syndrome

“…However, the absence of anti-Ro/anti-SS-A, anti-SS-B antibodies and the normality of the labial salivary gland biopsy argued against this diagnosis. Trigeminal neuropathy has been also reported in association with other connective tissue diseases, such as scleroderma or mixed connective tissue diseases [3], but the lack of joint, renal, eye, skin involvement, and the normality of the immunologic tests prompted us to reject these diagnoses. There was no evidence of infection on serological screening.…”

Irritative and sensory disturbances in oral implantology. Literature review

“…Sensory deficits of the trigeminal nerve manifest as numbness, sometimes associated with dysesthesia or paresthesia, described as an unpleasant sensation, and rarely painful (1), being dental treatment the most common cause (2). The most frequently injured trigeminal nerve branches in oral surgery are the inferior alveolar nerve (IAN), the mental nerve and the lingual nerve.…”