title: Prognosis After Surgical Treatment of Trigeminal Neuropathy with a PGA-c Tube: Report of 10 Cases.
abstract: Although surgery using a polyglycolic acid-collagen (PGA-c) tube is effective for peripheral nerve injury-induced chronic hand pain, it has not been applied to trigeminal nerve lesions because of the difficult approach. We used a PGA-c tube during surgery for trigeminal neuropathy and evaluated its prognosis based on the outcomes.
  
  
  
  Case report.
  
  
  
  In the dental anesthesia division of a university hospital, 11 patients with severe dysesthesia underwent surgical repair of a damaged lingual nerve (LN) or inferior alveolar nerve (IAN). One patient was lost to follow-up. Changes in quantitative sensory testing (QST) and the presence of dysesthesia as a treatment outcome were compared preoperatively and postoperatively in 10 patients. Two surgical treatments, bridging or encircling peripheral nerves, were applied. Bridging of both stumps was selected when neurotmesis was detected or the nerve was lacerated during surgery (N = 4). Otherwise, a longitudinal PGA-c tube was used to encircle the lesion (N = 6). Outcomes were evaluated 2 months to 8 years postoperatively.
  
  
  
  Both methods improved the patients' condition based on QST results (brush stroke perception, mechanical touch threshold, sensitivity to cold/hot stimuli). Preoperative allodynia or dysesthesia was resolved in six patients and greatly reduced in four. Two patients (one with inflammation-induced pain, one with implant-related pain) developed prolonged postoperative allodynia requiring pain-relief medication.
  
  
  
  Use of a PGA-c tube for surgical treatment of intractable pain due to LN or IAN neuropathy helps alleviate sensory impairment. The possibility of new dysesthesias emerging postoperatively, however, should be noted.
authors.affiliation: *Division of Dental Anesthesiology, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, Niigata seo@dent.niigata-u.ac.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Seo
authors.affiliation: *Division of Dental Anesthesiology, Department of Tissue Regeneration and Reconstruction, Niigata University Graduate School of Medical and Dental Sciences, Niigata.
authors.forename: Makoto
authors.initials: M
authors.lastname: Terumitsu
authors.affiliation: Department of Orthopaedic Surgery, Inada Hospital, Nara.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Inada
authors.affiliation: Department of Orthopaedic Surgery, Inada Hospital, Nara.
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Nakamura
authors.affiliation: Department of Bioartificial Organs, Institute for Frontier Medical Sciences, Kyoto University, Kyoto.
authors.forename: Keiji
authors.initials: K
authors.lastname: Shigeno
authors.affiliation: Division of Dental Anesthesiology, Niigata University Medical and Dental Hospital, University of Niigata, Niigata, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D003094:Collagen; D005260:Female; D006801:Humans; D061222:Lingual Nerve Injuries / Q000150:complications / Q000601:surgery*; D008297:Male; D008340:Mandibular Nerve / Q000601:surgery*; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D010148:Intractable Pain / Q000209:etiology* / Q000601:surgery*; D011100:Polyglycolic Acid; D011379:Prognosis; D016896:Treatment Outcome; D020433:Trigeminal Nerve Diseases / Q000209:etiology*
chemical_list: D011100:Polyglycolic Acid; D003094:Collagen
keywords: Artificial Organs; Humans; Nerve Regeneration; Somatosensory Disorder; Treatment Outcome; Trigeminal Nerve Injuries