Journal of Indian Academy of Oral Medicine and Radiology

CASE REPORT
Year
: 2017  |  Volume : 29  |  Issue : 3  |  Page : 235--237

Peripheral neurectomy in treatment of trigeminal neuralgia: A case report


Abhijeet Alok1, Kamal Hasan2, Abhinav Jha3, Dashmesh Thakur4,  
1 Department of Oral Medicine and Radiology, Sarjug Dental College and Hospital, Darbhanga, Bihar, India
2 Department of Oral and Maxillofacial Surgery, Sarjug Dental College and Hospital, Darbhanga, Bihar, India
3 Department of Oral Pathology and Microbiology, Sarjug Dental College and Hospital, Darbhanga, Bihar, India
4 Department of Orthodontics and Dentofacial Orthopedics, Sarjug Dental College and Hospital, Darbhanga, Bihar, India

Correspondence Address:
Abhijeet Alok
Department of Oral Medicine and Radiology, Sarjug Dental College and Hospital, Darbhanga, Bihar
India

Abstract

Neuropathic pain is nonadaptive and does not contribute to healing, such as would be the case with pain attributable to tissue inflammation, where pain results in adaptive behaviors, such as use limitation, guarding, rest, and avoidance, which contribute to healing. Trigeminal neuralgia is a debilitating, lancinating, and excruciating orofacial pain illness. Tic douloureux is the other popular name of trigeminal neuralgia because of the facial expression accompanying the episodic pain. Here we report a case of trigeminal neuralgia of infraorbital and greater palatine nerve in a 54-year-old female patient. Peripheral neurectomy was done under local anesthesia as the treatment.



How to cite this article:
Alok A, Hasan K, Jha A, Thakur D. Peripheral neurectomy in treatment of trigeminal neuralgia: A case report.J Indian Acad Oral Med Radiol 2017;29:235-237


How to cite this URL:
Alok A, Hasan K, Jha A, Thakur D. Peripheral neurectomy in treatment of trigeminal neuralgia: A case report. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2020 Dec 5 ];29:235-237
Available from: https://www.jiaomr.in/text.asp?2017/29/3/235/218712


Full Text

 Introduction



Trigeminal neuralgia is mostly unilateral in nature, accompanied by recurrent, intense, brief shock-like stabbing pain in the second or third branch of trigeminal nerve. The trigeminal neuralgia is well-recognized and exclusive in nature. The first detailed report of trigeminal neuralgia was given by John Fothergill in 1773. According to ICHD II criteria, it is defined as “a unilateral disorder characterized by brief electric shock-like pain, abrupt in onset and termination, limited to the distribution of one or more divisions of trigeminal nerve, pain is commonly evoked by trivial stimuli including washing, shaving, and smoking, talking or brushing the teeth (trigger factors), and frequently occurs spontaneously.[1] It still presents itself as one of the most painful conditions among the people.[2] The etiology of trigeminal neuralgia is still unknown. The disease mostly affects the persons aged above 40 years and also depicts major predilection for women approximately 1.5 times more than men.[3] Various treatment modalities include conservative approach as well as administration of drugs but the symptoms do persists. Different types of surgical interventions are carried for the treatment of trigeminal neuralgia.[4] Among all various surgical procedures, neurectomy is still the oldest form of surgical intervention.[5]

 Case Report



A female patient aged 54 years reported to the Department of Oral Medicine and Radiology with a chief complaint of pain in upper left back tooth region of jaw for the past 6 months [Figure 1]. History revealed that she was asymptomatic 6 months before when she started experiencing pain. The pain was sudden in onset, stabbing, lancinating type, unilateral and aggravated on taking food, hot and cold beverages, and also on speaking. Pain was referred to left cheek, eye, ear, head, and neck region. The duration of the pain was from few seconds to less than 2 min. Patient also gave a history that during an attack, she grimaces with pain and clutches her hand over the affected side of face. There were two to three episodes of pain in a day from the last 6 months. There was no history of disturbed sleep. Patient got treated in a private dental clinic where after medication her pain subsided but again after few months it reoccurred. Routine blood investigations as well as liver function tests were found to be normal. Orthopantomograph revealed no abnormality. Taking into account all the investigations and routine clinical examination a provisional diagnosis of trigeminal neuralgia of infraorbital and greater palatine nerve was made. Patient was advised 100 mg of carbamazepine three times daily for 5 days. She was recalled after 5 days for follow-up, and she gave a history of relief in pain after the intake of the drug. In following visits the dose of drugs was increased as per the symptoms. Patient complained of drowsiness, dizziness, confusion, and nausea. She was advised to go for Gamma-Knife surgery but due to poor socioeconomic status, she refused. So after the consultation with the Department of oral and maxillofacial surgery, peripheral neurectomy of infraorbital and greater palatine nerve under local anesthesia was performed [Figure 2], [Figure 3], [Figure 4]. Patient is under constant observation for the past 2 months with no relapse of her complaints.{Figure 1}{Figure 2}{Figure 3}{Figure 4}

 Discussion



Trigeminal neuralgia, also known as tic douloureux or Fothergill's disease, is a clinical syndrome characterized by brief paroxysms of unilateral lancinating pain that is triggered by cutaneous stimuli, such as wind on the face, talking, chewing, or brushing of teeth.[6],[7],[8] Female predominance ranges from 1:2 to 2:3. Since 1963 carmabazepine has been the treatment of choice for trigeminal neuralgias. The main goal during management of idiopathic neuralgia is control and elimination of pain and improving the quality of life.[9],[10] In the present study, an intraoral approach to the infraorbital and greater-palatine nerves has been employed. This approach is found to be better, primarily due to avoidance of postoperative facial scars. A single neurectomy may yield, on average, 26 months free of pain. Peripheral neurectomy is still one of the most result-oriented peripheral nerve destructive technique. Infraorbital neurectomy can be carried out in two ways, i.e., Caldwell-Luc incision approach or Braun's transantral approach. Peripheral neurectomy delivers minimum postoperative effects when compared to alcohol injection or cryotherapy. Differential diagnosis for these disorders may include dental pain, migraine, otitis media, bursts of headaches, sinusitis, postherpetic neuralgia, intracranial tumor, and temporomandibular joint disorders, etc. The treatment modalities are selected taking into account the various genuine factors such as patient's age, life expectancy, socioeconomic status, liver functions, and drug tolerance capabilities. The advantages of these procedures include ease in surgical process, tolerance, and acceptance by old and debilitated patients. Recently, use of titanium screws are yielding desired results, as thorough coverage of the foramen can be established.

 Conclusion



The treatment of trigeminal neuralgia is very annoying to the dental surgeon because most of the nonsurgical treatment does not provide the desired results and the patient is left out with agonising pain and side effects of the medications. One of the treatments with predictable outcome for chronic peripheral neuralgia is “peripheral neurectomy”. The peripheral neurectomy is an easy chair-side procedure which could be carried out with minimal side-effects and fast postoperative recovery and good patient compliance.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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