Neuropathy of Trigeminal Nerve Branches After Oral and Maxillofacial Treatment (original) (raw)
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Evaluation of trigeminal nerve injuries in relation to third
2012
Trigeminal nerve injury is the most problematic consequence of dental surgical procedures with major medico-legal implications. This study reports the signs and symptoms that are the features of trigeminal nerve injuries caused by mandibular third molar (M3M) surgery. 120 patients with nerve injury following M3M surgery were assessed. All data were analysed using the SPSS statistical programme and Microsoft Excel. 53 (44.2%) inferior alveolar nerve (IAN) injury cases and 67 (55.8%) lingual nerve injury (LNI) cases were caused by third molar surgery (TMS). Neuropathy was demonstrable in all patients with varying degrees of paraesthesia, dysaesthesia (in the form of burning pain), allodynia and hyperalgesia. Pain was one of the presenting signs and symptoms in 70% of all cases. Significantly more females had IAN injuries and LNIs (p<0.05). The mean ages of the two groups of patients were similar. Speech and eating were significantly more problematic for patients with LNIs. In conclusion, chronic pain is often a symptom after TMS-related nerve injury, resulting in significant functional problems. Better dissemination of good practice in TMS will significantly minimize these complex nerve injuries and prevent unnecessary suffering.Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
International journal of oral and maxillofacial surgery, 2012
Trigeminal nerve injury is the most problematic consequence of dental surgical procedures with major medico-legal implications. This study reports the signs and symptoms that are the features of trigeminal nerve injuries caused by mandibular third molar (M3M) surgery. 120 patients with nerve injury following M3M surgery were assessed. All data were analysed using the SPSS statistical programme and Microsoft Excel. 53 (44.2%) inferior alveolar nerve (IAN) injury cases and 67 (55.8%) lingual nerve injury (LNI) cases were caused by third molar surgery (TMS). Neuropathy was demonstrable in all patients with varying degrees of paraesthesia, dysaesthesia (in the form of burning pain), allodynia and hyperalgesia. Pain was one of the presenting signs and symptoms in 70% of all cases. Significantly more females had IAN injuries and LNIs (p<0.05). The mean ages of the two groups of patients were similar. Speech and eating were significantly more problematic for patients with LNIs. In concl...
Trigeminal nerve injuries related to restorative treatment
Dental Update, 2018
Restorative dentistry provides many opportunities to cause trigeminal nerve damage. Chronic post-surgical pain, resulting from nerve damage, is rarely associated with dentistry as a result of local anaesthetic (LA) infiltration injections but is more commonly associated with injuries to the nerve trunks of division two and three caused by LA blocks, implants and endodontics. In dentistry, the term paraesthesia is often used inappropriately to mean neuropathy. Paraesthesia is only a descriptive term of symptoms, meaning altered sensation, and not a diagnosis. When sensory nerves are injured, a neuropathy (malfunction) may arise and this may be painful or non-painful. Fortunately, painful post-traumatic neuropathy, caused by injury to nerves, is rare in dentistry compared with other common general surgical procedures, where up to 20−40% of patients experience chronic post-surgical pain after limb amputation, thoracotomy and breast surgery. This article aims to highlight how to prevent nerve injuries using strategies for risk assessment, appropriate surgical techniques and suitable follow-up protocols to allow urgent management to optimize resolution of the nerve injuries when they occur. CPD/Clinical Relevance: Prevention of rare nerve injuries arising from common dental procedures is key, as many high risk procedures can cause lifelong neuropathic pain, functional and immense psychological impact for the patients involved, for which there is no simple remedy.
Iatrogenic trigeminal post-traumatic neuropathy: a retrospective two-year cohort study
International Journal of Oral and Maxillofacial Surgery, 2018
With the growing demand for dental work, trigeminal nerve injuries are increasingly common. This retrospective cohort study examined 53 cases of iatrogenic trigeminal nerve injury seen at the Department of Oral and Maxillofacial Surgery, University Hospitals of Leuven between 2013 and 2014 (0.6% among 8845 new patient visits). Patient records were screened for post-traumatic trigeminal nerve neuropathy caused by nerve injury incurred during implant surgery, endodontic treatment, local anaesthesia, tooth extraction, or specifically third molar removal. The patients ranged in age from 15 to 80 years (mean age 42.1 years) and 68% were female. The referral delay ranged from 1 day to 6.5 years (average 10 months). The inferior alveolar nerve (IAN) was most frequently injured (28 cases), followed by the lingual nerve (LN) (21 cases). Most nerve injuries were caused during third molar removal (24 cases), followed by implant placement (nine cases) and local anaesthesia injuries (nine cases). Pain symptoms were experienced by 54% of patients suffering IAN injury, compared to 10% of patients with LN injury. Persistent neurosensory disturbances were identified in 60% of patients. While prevention remains the key issue, timely referral seems to be a critical factor for the successful treatment of post-traumatic neuropathy.
Post-implant neuropathy of the trigeminal nerve: A case series
Background The incidence of implant-related inferior alveolar nerve injuries (IANI) is steadily increasing within the UK population.Aims This study prospectively reviewed thirty cases (35% male; 65% female) of implant-related IANI seen in a specialist nerve injury clinic.Methods Neurosensory examinations were carried out to ascertain a quantifiable rating of the perception, pain profiling and functional difficulties. Data were analysed using SPSS software.Results Patients were aware of signing consent forms for the surgery in 11 cases and 8 of those felt they were not explicitly warned about nerve injury. Over 70% of patients were referred after six months post injury. Implant surgery planning involved intra-oral films only (30%), CBCT (10%), dental pantomograph (50%) and long cone peri-apical radiographs (48%). However, no radiographic evidence pre- or postoperatively was provided by the referring practitioner in 15% of cases. Intra-operative problems included bleeding and neurolog...
Profiling of Patients Presenting with Posttraumatic Neuropathy of the Trigeminal Nerve
Aims: To describe the cause, clinical signs, and symptoms of patients presenting to a tertiary care center with iatrogenic lesions to the mandibular branches of the trigeminal nerve. Methods: Pain history, pain scores using the visual analog scale, and mechanosensory testing results were recorded from 93 patients with iatrogenic lingual nerve injuries (LNI) and 90 patients with iatrogenic inferior alveolar nerve injuries (IANI). Results were analyzed using the SPSS statistical software. Chi-square tests were applied for nonparametric testing of frequencies, where P ⋜ .05 indicated statistical significance. Appropriate correlations were also carried out between certain data sets. Results: Significantly more females were referred than males (P < .05). Overall, third molar surgery (TMS) caused 73% of LNI, followed by local anesthesia (LA) (17%). More diverse procedures caused IANI, including TMS (60%), LA (19%), implants (18%), and endodontics (8%). Approximately 70% of patients presented with neuropathic pain coincident with anesthesia and÷or paresthesia. Neuropathy was demonstrable in all patients with varying degrees of loss of mechanosensory function, paresthesia, dysesthesia, allodynia, and hyperalgesia. Functionally, IANI and LNI patients mostly had problems with speech and eating, where speech was affected amongst significantly more patients with LNI (P < .001). Sleep, brushing teeth, and drinking were significantly more problematic for IANI patients (P < .05, P < .001, and P < .0001, respectively). Conclusion: Neuropathic pain, as well as anesthesia, frequently occurs following iatrogenic trigeminal nerve injury similar to other posttraumatic sensory nerve injuries. This must be acknowledged by clinicians as a relatively common problem and informed consent appropriately formulated for patients at risk of trigeminal nerve injuries in relation to dentistry requires revision.
Acta Odontológica Latinoamericana, 2021
It is essential to maintain the alveolar bone ridge to ensure the success of implant therapy. Platelet-rich fibrin (PRF) may benefit bone repair, but its quantitative microscopic results are still inconclusive. The aim of this study was to histomorphometrically analyze human dental alveoli after extraction treated with autologous fibrin, biphasic calcium phosphate or sticky bone. The sample consisted of healthy adult volunteer patients, with clinical and tomographic indication for single post-extraction graft of upper premolars for maintenance of the alveolar ridge and subsequent implantation. The 10 remaining patients in the study were divided into three groups according to the type of filling used in the dental socket: autologous PRF plug covered by a PRF membrane (G1), PRF associated with an alloplastic graft based on hydroxyapatite with beta tricalcium phosphate covered by a collagen membrane (G2) or alloplastic graft based on beta tricalcium phosphate covered by collagen membra...
Collegium antropologicum, 2014
The aim of the study was to explore certain risk factors for trigeminal neuralgia (TN), assess the prevalence of misdiagnoses of TN made by primary care dentists, compare the treatment practice for TN at the Department of Oral Surgery with the guidelines, and the importance of interdisciplinary approach in TN treatment. The study included 237 patient records (70 men and 167 women, aged 5-91 years) referred to the Department under the diagnosis of TN. From their medical records, demographic data, referral diagnose, clinical diagnose, additional diagnostic procedures and treatment were analysed. Neuralgia of the trigeminal nerve affects predominantly elderly female population, while the impact of the season on the incidence of the disease has not been determined. The most common therapy used at the Department were blockades, carbamazepine or their combination. 63.3% patients were referred for further diagnostic tests following the first examination. The number of misdiagnosed cases re...