Trigeminal neuralgia due to vertebrobasilar dolichoectasia: three case reports.
We report here 3 cases of trigeminal neuralgia (TN) due to vertebrobasilar dolichoectasia (VBD) and discuss the clinician's role in such cases. All cases presented at our clinic with paroxysmal, electric shock-like pain over their maxillary or mandibular gingiva. To confirm a diagnosis of TN, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) were performed, and contact of the trigeminal nerve with a tortuous vertebrobasilar artery (VBA) was detected. Patients were informed about the therapeutic algorithm of TN before starting treatment. When medication became ineffective, the patients were referred to a neurosurgeon, and microvascular decompression (MVD) was consequently performed in 1 patient and radiofrequency thermocoagulation (RFTC) in the other 2 cases. VBD is associated with the risk of serious complications during follow-up and some limitations regarding second-line treatment. Dentists have a significant role in controlling orofacial pain and must be aware of this specific etiopathology of TN.
Noma
Noboru
N
Department of Oral Diagnosis, Nihon University School of Dentistry, Tokyo, Japan.
Kobayashi
Azusa
A
Kamo
Hiroshi
H
Imamura
Yoshiki
Y
D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use; D001488:Basilar Artery / Q000473:pathology; D002220:Carbamazepine / Q000627:therapeutic use; D017115:Catheter Ablation; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010347:Patient Care Planning; D014276:Trigeminal Nerve / Q000473:pathology; D014277:Trigeminal Neuralgia / Q000209:etiology*; D014711:Vertebral Artery / Q000473:pathology; D014715:Vertebrobasilar Insufficiency / Q000150:complications* / Q000188:drug therapy / Q000601:surgery
D018712:Analgesics, Non-Narcotic; D002220:Carbamazepine