Studies of traumatic neuralgias in the maxillofacial region: surgical pathology and neural mechanisms.
Microsurgical exploration of injured trigeminal nerves in patients with neuralgia revealed four variations of traumatic neuroma, associated foreign objects, and a sprouting of nerve collaterals from adjacent uninjured nerve. A comprehensive theory of traumatic trigeminal pain is proposed based on three sites of pathosis: peripheral neuroma, somatic and autonomic collateralization, and central deafferentation pathoses. Anesthesia dolorosa is related in this model to amputation neuromas and central pathosis. Sympathetic mediated pain is attributed to autonomic C-fiber units in peripheral injured zones. Hyperalgesia is attributed to mechanosensitive A-fiber units in the nerves being linked to corresponding irritable central nervous system neurons. Hyperpathia is explained on the basis of ephaptic transmission between adjacent fibers in neuromas.
Gregg
J M
JM
Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg.
D005157:Facial Pain / Q000209:etiology* / Q000601:surgery; D005547:Foreign Bodies; D006801:Humans; D006941:Hyperesthesia / Q000209:etiology; D006987:Hypesthesia / Q000209:etiology; D008036:Lingual Nerve / Q000503:physiopathology / Q000601:surgery; D061222:Lingual Nerve Injuries; D008340:Mandibular Nerve / Q000503:physiopathology / Q000601:surgery; D009463:Neuroma / Q000473:pathology / Q000503:physiopathology; D010292:Paresthesia / Q000209:etiology; D014276:Trigeminal Nerve / Q000503:physiopathology / Q000601:surgery; D061221:Trigeminal Nerve Injuries; D014277:Trigeminal Neuralgia / Q000209:etiology* / Q000601:surgery