Acute and Chronic Pain in Orofacial Trauma Patients

Clinical insights into traumatic injury of the inferior alveolar and lingual nerves: a comprehensive approach from diagnosis to therapeutic interventions

OBJECTIVES

This scoping review explores the risk and management of traumatic injuries to the inferior alveolar and lingual nerves during mandibular dental procedures. Emphasizing the significance of diagnostic tools, the review amalgamates existing knowledge to offer a comprehensive overview.

MATERIALS AND METHODS

A literature search across PubMed, Embase, and Cochrane Library informed the analysis.

RESULTS

Traumatic injuries often lead to hypo-/anesthesia and neuropathic pain, impacting individuals psychologically and socially. Diagnosis involves thorough anamnesis, clinical-neurological evaluations, and radiographic imaging. Severity varies, allowing for conservative or surgical interventions. Immediate action is recommended for reversible causes, while surgical therapies like decompression, readaptation, or reconstruction yield favorable outcomes. Conservative management, utilizing topical anesthesia, capsaicin, and systemic medications (tricyclic antidepressants, antipsychotics, and serotonin-norepinephrine-reuptake-inhibitors), proves effective for neuropathic pain.

CONCLUSIONS

Traumatic nerve injuries, though common in dental surgery, often go unrecorded. Despite lacking a definitive diagnostic gold standard, a meticulous examination of the injury and subsequent impairments is crucial.

CLINICAL RELEVANCE

Tailoring treatment to each case's characteristics is essential, recognizing the absence of a universal solution. This approach aims to optimize outcomes, restore functionality, and improve the quality of life for affected individuals.

Duloxetine for the management of sensory and taste alterations, following iatrogenic damage of the lingual and chorda tympani nerve

OBJECTIVES

Nerve injury may lead to pain and sensory changes such as dysesthesia and paresthesia. Quantitative sensory testing (QST) is a psychophysical testing method used to quantify nerve damage and monitor its recovery. Duloxetine is used in the management of neuropathic pain conditions, but its effect on taste recovery has not been previously reported.

CASE REPRESENTATION

A 65-year-old female, presented to the orofacial pain clinic, with a chief complaint of a burning sensation on the tongue, taste changes and a feeling of tightness beneath the tongue for five months. She reported that the complaints began subsequent to a complicated dental extraction during which she experienced trauma to the tongue. Patient was advised to take duloxetine 60 mg in divided doses three times daily. The assessment and monitoring of the recovery pattern were performed using QST. Electrical taste detection (mediated by chorda tympani) and electrical detection/tingling thresholds were performed at periodic intervals for up to a year following the nerve injury in the chorda tympani and lingual nerve territory. The patient reported complete recovery in taste sensation with duloxetine and this correlated with the QST results. QST documented at the end of one year revealed the electrical taste detection threshold and electrical detection threshold return to near normal values.

CONCLUSIONS

QST may be a useful diagnostic tool to assess and monitor lingual and chorda tympani nerve injuries. Duloxetine may aid in the recovery of the taste changes following lingual and chorda tympani nerve injury.