Managing iatrogenic trigeminal nerve injury: a case series and review of the literature.
This study describes the management of 216 patients with post-traumatic iatrogenic lingual nerve injuries (LNIs; n=93) and inferior alveolar nerve injuries (IANI; n=123). At initial consultation, 6% IANI and 2% LNI patients had undergone significant resolution requiring no further reviews. Reassurance and counselling was adequate management for 51% IANI and 55% LNI patients. Systemic or topical medication was offered as pain relief to 5% of patients. Additional cognitive behaviour therapy (CBT) was offered to 8% of patients. Topical 5% lidocaine patches reduced pain and allodynia in 7% of IANI patients, most often used without any other form of management. A small percentage of IANI patients (4%) received a combination of therapies involving CBT, surgery, medication and 5% lidocaine patches. Exploratory surgery improved symptoms and reduced neuropathic area in 18 LNI and 15 IANI patients resulting in improved quality of life. In conclusion, the authors suggest a more diverse and perhaps holistic strategy for management of patients with iatrogenic trigeminal nerve injuries and recommend pragmatic assessment criteria for measurement of treatment success in these patients.
King's College London Dental Institute, Denmark Hill Campus, London, UK. tara.renton@kcl.ac.uk
T
T
Renton
Z
Z
Yilmaz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000627:therapeutic use; D000714:Anastomosis, Surgical / Q000379:methods; D000779:Anesthetics, Local / Q000008:administration & dosage; D015928:Cognitive Behavioral Therapy; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003376:Counseling; D019299:Decompression, Surgical / Q000379:methods; D006801:Humans; D007049:Iatrogenic Disease; D008012:Lidocaine / Q000008:administration & dosage; D061222:Lingual Nerve Injuries / Q000628:therapy; D008340:Mandibular Nerve / Q000473:pathology; D008875:Middle Aged; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D011788:Quality of Life; D012075:Remission, Spontaneous; D020886:Somatosensory Disorders / Q000145:classification / Q000175:diagnosis; D061221:Trigeminal Nerve Injuries / Q000175:diagnosis / Q000628:therapy*; D014277:Trigeminal Neuralgia / Q000175:diagnosis / Q000628:therapy; D055815:Young Adult
D000700:Analgesics; D000779:Anesthetics, Local; D008012:Lidocaine