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Hosack VB, Arce-McShane FI. 3D directional tuning in the orofacial sensorimotor cortex during natural feeding and drinking. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.07.02.601741. [PMID: 39005288 PMCID: PMC11244964 DOI: 10.1101/2024.07.02.601741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Directional tongue movements are essential for vital behaviors, such as feeding and speech, to position food for chewing and swallowing safely and to position the tongue for accurate sound production. While directional tuning has been well-studied in the arm region of the sensorimotor cortex during reaching tasks, little is known about how 3D tongue direction is encoded in the orofacial region during natural behaviors. Understanding how tongue direction is represented in the brain has important implications for improving rehabilitation for people with orolingual dysfunctions. The goal of this study is to investigate how 3D direction of tongue movement is encoded in the orofacial sensorimotor cortex (OSMCx) during feeding and drinking, and how this process is affected by the loss of oral sensation. Using biplanar video-radiography to track implanted markers in the tongue of behaving non-human primates ( Macaca mulatta ), 3D positional data was recorded simultaneously with spiking activity in primary motor (MIo) and somatosensory (SIo) areas of the orofacial cortex using chronically implanted microelectrode arrays. In some sessions, tasks were preceded by bilateral nerve block injections to the sensory branches of the trigeminal nerve. Modulation to the 3D tongue direction was found in a majority of MIo but not SIo neurons during feeding, while the majority of neurons in both areas were modulated to the direction of tongue protrusion during drinking. Following sensory loss, the proportion of directionally tuned neurons decreased and shifts in the distribution of preferred direction were observed in OSMCx neurons. Overall, we show that 3D directional tuning of MIo and SIo to tongue movements varies with behavioral tasks and availability of sensory information.
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Maramattom BV. Dermatomal Dissociated Facial Sensory Loss due to a Partial Trigeminal Pontine Principal Sensory Nucleus Lesion. Ann Indian Acad Neurol 2024; 27:330-332. [PMID: 38819398 PMCID: PMC11232824 DOI: 10.4103/aian.aian_1058_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 12/31/2023] [Accepted: 01/07/2024] [Indexed: 06/01/2024] Open
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Farag M, Kafiabadi S, Roy A, Rossor AM, Holmes P. Trigeminal neuropathy from root entry zone infarction. Pract Neurol 2023; 23:523-524. [PMID: 37524437 DOI: 10.1136/pn-2023-003823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2023] [Indexed: 08/02/2023]
Affiliation(s)
- Mena Farag
- Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Sina Kafiabadi
- Neuroradiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Amit Roy
- Neuroradiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Paul Holmes
- Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Chen LP, Li D, Li XJ, Song LR, Zhang LW, Wu Z, Zhang JT, Wang L. Postoperative trigeminal neuropathy outcomes following surgery for tumors involving the trigeminal nerve. Acta Neurochir (Wien) 2023; 165:2885-2893. [PMID: 37581723 DOI: 10.1007/s00701-023-05735-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/27/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE To observe the evolution and outcomes of postoperative trigeminal neuropathy following surgery of tumor involving the trigeminal nerve. METHODS A prospective observational study was conducted between October 2018 and February 2019 involving 25 patients with tumors confirmed to involve the trigeminal nerve during surgery by senior author. Pre- and postoperative trigeminal nerve function status and clinical data were recorded. RESULTS This study included 18 cases of meningioma and seven of trigeminal schwannoma. Among the meningioma cases, 55.6% of the patients reported facial sensory dysfunction before surgery, 33.3% presented ocular discomfort, and 5.6% had masticatory muscle atrophy. Postoperatively, all patients experienced facial paresthesia, 94.4% complained of eye dryness, and one (5.56%) exhibited keratitis. Additionally, one patient (5.56%) showed new-onset masticatory weakness. During follow-up, 50.0% of patients reported improvement in facial paresthesia, and one (5.56%) experienced deterioration. Eye dryness resolved in 35.3% of patients, and keratitis remission was observed in one patient. However, one patient (5.56%) developed neurotrophic keratitis. Overall, 55.6% of patients displayed mild masticatory weakness without muscle atrophy. In the cases of schwannoma, 28.6% of patients had facial paresthesia before surgery, 42.9% showed ocular discomfort, and one (14.3%) complained of masticatory dysfunction. Postoperatively, 85.7% of patients reported facial paresthesia and eye dryness, with one patient (16.7%) experiencing keratitis. During follow-up, 66.7% of patients demonstrated improvement in facial paresthesia, 28.6% showed eye dryness remission, and one patient (16.7%) recovered from keratitis. However, one patient (16.7%) developed new-onset neurotrophic keratitis. One patient (16.7%) experienced relief of masticatory dysfunction, but 42.9% reported mild deterioration. Another patient (14.3%) had facial anesthesia that had not improved. CONCLUSION Postoperative trigeminal neuropathy is a common complication with a high incidence rate and poor recovery outcomes after surgery for tumors involving the trigeminal nerve. When trigeminal nerve damage is unavoidable, it is essential to provide a multidisciplinary and careful follow-up, along with active management strategy, to mitigate the more severe effects of postoperative trigeminal neuropathy.
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Affiliation(s)
- Liang-Peng Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China
| | - Da Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China
| | - Xiao-Jie Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China
| | - Lai-Rong Song
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China
| | - Li-Wei Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China
| | - Jun-Ting Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China.
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
- Beijing Key Laboratory of Brain Tumor, National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing, 100070, China.
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De Souza JM, Trevisan TJ, Sepresse SR, Londe AC, França Júnior MC, Appenzeller S. Peripheral Neuropathy in Systemic Autoimmune Rheumatic Diseases-Diagnosis and Treatment. Pharmaceuticals (Basel) 2023; 16:ph16040587. [PMID: 37111344 PMCID: PMC10141986 DOI: 10.3390/ph16040587] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
Peripheral neuropathy (PN) is frequently observed in systemic rheumatic diseases and is a challenge in clinical practice. We aimed to review the evidence on the subject and proposed a comprehensive approach to these patients, facilitating diagnosis and management. We searched the MEDLINE database for the terms (and its respective Medical Subject Headings (MeSH) terms): "peripheral neuropathy" AND "rheumatic diseases" OR "systemic lupus erythematosus", "rheumatoid arthritis", "Sjogren syndrome", and "vasculitis" from 2000 to 2023. This literature review focuses on the diagnostic workup of PNs related to systemic lupus erythematosus, Sjögren's syndrome, rheumatoid arthritis, and systemic vasculitis. For every type of PN, we provide a pragmatic flowchart for diagnosis and also describe evidence-based strategies of treatment.
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Affiliation(s)
- Jean Marcos De Souza
- Department of Internal Medicine, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
| | - Thiago Junqueira Trevisan
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas 13084971, Brazil
| | - Samara Rosa Sepresse
- Autoimmunity Laboratory, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
- Graduate Program in Child and Adolescent Health, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
| | - Ana Carolina Londe
- Autoimmunity Laboratory, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
- Post-Graduate Program in Physiopathology, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
| | | | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology, School of Medical Science, University of Campinas, Campinas 13084971, Brazil
- Autoimmunity Laboratory, School of Medical Science, University of Campinas, Campinas 13083881, Brazil
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Kinugawa K, Mano T, Nakagawa Y, Hotta N, Sugie K. Case report: Unilateral masticatory atrophy caused by pure trigeminal motor neuropathy. Radiol Case Rep 2022; 17:4542-4545. [PMID: 36189157 PMCID: PMC9520091 DOI: 10.1016/j.radcr.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 09/04/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kaoru Kinugawa
- Department of Neurology, Nara Medical University, Kashihara, Japan
| | - Tomoo Mano
- Department of Neurology, Nara Medical University, Kashihara, Japan
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
- Corresponding author.
| | - Yosuke Nakagawa
- Department of Oral and Maxillofacial Surgery, Nara Medical University, Kashihara, Japan
| | - Naoki Hotta
- Department of Rehabilitation Medicine, Nara Medical University, Kashihara, Japan
| | - Kazuma Sugie
- Department of Neurology, Nara Medical University, Kashihara, Japan
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Trigeminal neuropathy as presenting symptom of craniofacial venous metameric syndrome. Neurol Sci 2022; 43:6155-6157. [DOI: 10.1007/s10072-022-06179-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
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Kim H, Kang KW, Kim JM, Park MS. Uncommon cause of trigeminal neuritis and central nervous system involvement by herpes labialis: a case report. BMC Neurol 2022; 22:294. [PMID: 35931972 PMCID: PMC9354343 DOI: 10.1186/s12883-022-02823-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 07/29/2022] [Indexed: 11/26/2022] Open
Abstract
Background Trigeminal neuropathy is characterized by numbness in the region innervated by the trigeminal nerves, with or without neuropathic weakness in the muscles of mastication. Trigeminal neuritis is a form of trigeminal neuropathy in which the lesion is caused by an inflammation. Herein, we report a patient with trigeminal neuritis due to central nervous system (CNS) involvement of herpes labialis (HL) infection, which was successfully treated with anti-viral and anti-inflammatory agents. Case presentation A young healthy female presented with numbness in the left hemiface for two weeks. She had a preceding typical HL infection on left facial lip one week before the sensory symptom onset. Brain magnetic resonance imaging revealed high signal intensities and asymmetrical thickening with enhancement along the cisternal segment of the left trigeminal nerve. Additionally, brain MR angiography showed multifocal stenoses in the M1 segment of the middle cerebral artery and the cavernous portion of the internal carotid artery. Cerebrospinal fluid (CSF) examination showed mild pleocytosis with normal protein level, glucose ratio, but CSF polymerase chain reaction assay for specific anti-viral antibodies including herpes simplex virus was negative, and CSF culture also did not identify a specific pathogen. The results of serologic testing including tumor markers and autoimmune markers were all unremarkable. A tentative diagnosis of trigeminal neuritis as a complication of HL involving the CNS was made considering the clinical, neuroradiological, and laboratory findings of the patient. Therefore, the patient was treated with intravenous methylprednisolone and acyclovir for 10 days. After the treatments, her sensory disturbance was markedly improved. Brain MRI at the 3-month follow-up also demonstrated improvement of previously identified high signal intensity lesions and multifocal intracerebral artery stenoses. Conclusion HL is usually a self-limiting, benign disease without complications, but rarely presents as trigeminal neuritis due to CNS involvement. Therefore, meticulous evaluation may be necessary if trigeminal neuritis or CNS involving symptoms occur after HL.
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Affiliation(s)
- Hyunsoo Kim
- Department of Neurology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 58128, South Korea
| | - Kyung Wook Kang
- Department of Neurology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 58128, South Korea
| | - Jae-Myung Kim
- Department of Neurology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 58128, South Korea
| | - Man-Seok Park
- Department of Neurology, Chonnam National University Medical School and Hospital, 42 Jebong-ro, Dong-gu, Gwangju, 58128, South Korea.
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Pergolizzi JV, Gharibo C, Magnusson P, Breve F, LeQuang JA, Varrassi G. Pharmacotherapeutic management of trigeminal neuropathic pain: an update. Expert Opin Pharmacother 2022; 23:1155-1164. [PMID: 35695796 DOI: 10.1080/14656566.2022.2087507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Guidelines recommend a number of pharmacotherapeutic options used as monotherapy or in combination with others for treating the pain of trigeminal neuropathy. AREAS COVERED The authors examine the pharmacotherapeutic options for treating trigeminal neuralgia and supporting evidence in the literature. Guidelines reported the most effective treatment for trigeminal neuropathy, in particular trigeminal neuralgia, appears to be carbamazepine or oxcabazepine, but side effects can be treatment limiting. Lamotrigine and gabapentin are also recommended in guidance. In real-world clinical practice, baclofen, cannabinoids, eslicarbazepine, levetiracetam, brivaracetam, lidocaine, misoprostol, opioids, phenytoin, fosphenytoin, pimozide, sodium valproate, sumatriptan, tizanidine, tocainide, tricyclic antidepressants, and vixotrigine are sometimes used, either as monotherapy or in combination. The relatively small patient population has limited the number of large-scale studies and there is limited evidence on which to base prescribing choices. EXPERT OPINION While there is no optimal pharmacotherapy for treating trigeminal neuropathy, advancements in our understanding of the underlying mechanisms of this condition and drug development indicate promise for NaV inhibitors, despite the fact that not all patients respond to them and they may have potentially treatment-limiting side effects. Nevertheless, better understanding of NaV channels may be important avenues for future drug development for trigeminal neuropathy.
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Affiliation(s)
| | | | - Peter Magnusson
- Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.,Department of Medicine, Cardiology Research Unit, Karolinska Institutet, Stockholm, Sweden
| | - Frank Breve
- Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, Pennsylvania, USA
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Laurence-Chasen JD, Arce-McShane FI, Hatsopoulos NG, Ross CF. Loss of oral sensation impairs feeding performance and consistency of tongue-jaw coordination. J Oral Rehabil 2022; 49:806-816. [PMID: 35514258 PMCID: PMC9540871 DOI: 10.1111/joor.13336] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/07/2022] [Accepted: 04/13/2022] [Indexed: 11/24/2022]
Abstract
Background Individuals with impaired oral sensation report difficulty chewing, but little is known about the underlying changes to tongue and jaw kinematics. Methodological challenges impede the measurement of 3D tongue movement and its relationship to the gape cycle. Objective The aim of this study was to quantify the impact of loss of oral somatosensation on feeding performance, 3D tongue kinematics and tongue‐jaw coordination. Methodology XROMM (X‐ray Reconstruction of Moving Morphology) was used to quantify 3D tongue and jaw kinematics during feeding in three rhesus macaques (Macaca mulatta) before and after an oral tactile nerve block. Feeding performance was measured using feeding sequence duration, number of manipulation cycles and swallow frequency. Coordination was measured using event‐ and correlation‐based metrics of jaw pitch, anterior tongue length, width and roll. Results In the absence of tactile sensation to the tongue and other oral structures, feeding performance decreased, and the fast open phase of the gape cycle became significantly longer, relative to the other phases (p < .05). The tongue made similar shapes in both the control and nerve block conditions, but the pattern of tongue‐jaw coordination became significantly more variable after the block (p < .05). Conclusion Disruption of oral somatosensation impacts feeding performance by introducing variability into the typically tight pattern of tongue‐jaw coordination.
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Affiliation(s)
- J D Laurence-Chasen
- Department of Organismal Biology and Anatomy, The University of Chicago, Chicago, IL, USA
| | | | - Nicholas G Hatsopoulos
- Department of Organismal Biology and Anatomy, The University of Chicago, Chicago, IL, USA
| | - Callum F Ross
- Department of Organismal Biology and Anatomy, The University of Chicago, Chicago, IL, USA
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Pasala M, Park G, Kesserwani HN. A Case of Secondary Trigeminal Neuropathy Due to Local Malignant Invasion of the Maxillary and Mandibular Nerves at the Skull Base: A Case Report With Review of Differential Diagnosis. Cureus 2022; 14:e24391. [PMID: 35619854 PMCID: PMC9126420 DOI: 10.7759/cureus.24391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 11/13/2022] Open
Abstract
Trigeminal neuropathies (TNp) are a group of well-characterized disorders that involve damage to or infiltration of the trigeminal nerve. The underlying etiology of trigeminal neuropathy can be traumatic, inflammatory, autoimmune, paraneoplastic, malignant, and very rarely infectious. We present a case of trigeminal neuropathy due to local malignant invasion of the mandibular nerve with mandibular nerve enhancement at the foramen ovale and foramen rotundum. In the process, we review various etiologies of trigeminal neuropathy associated with trigeminal nerve involvement at the foramina. We emphasize the importance of a comprehensive evaluation in patients with trigeminal neuropathy, which includes searching for perineural spread or invasion by a local head and neck malignancy, as well as ruling out an inflammatory or autoimmune etiology. Our case also demonstrates that a higher field strength magnet can reveal pathology unseen with a lower field strength magnet.
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Goglin S, Cho TA. Clinical approach to neuro-rheumatology. J Neurol Sci 2021; 431:120048. [PMID: 34768134 DOI: 10.1016/j.jns.2021.120048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/19/2021] [Accepted: 11/01/2021] [Indexed: 01/13/2023]
Abstract
Recognizing the neurologic manifestations of systemic rheumatologic diseases and certain isolated autoimmune neurologic diseases poses challenges to the clinician. Using a systematic approach allows the clinician to diagnose these conditions more readily and to initiate treatment more rapidly. Specific neurological syndromes frequently associated with rheumatologic or specific autoimmune conditions can suggest the diagnosis. A targeted history and examination can identify neurological and systemic clues that help to identify an underlying rheumatologic condition. Judicious use of laboratory and radiographic studies can help confirm suspected diagnoses. This article will review some of the neurological syndromes typical of rheumatologic disease and outline an approach to evaluating for unknown rheumatologic disease in this context.
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Affiliation(s)
- Sarah Goglin
- Division of Rheumatology, Department of Medicine, University of California, 1001 Potrero Ave, San Francisco, CA 94110, USA.
| | - Tracey A Cho
- Neuroimmunology Division, Department of Neurology, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
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Xu R, Xie ME, Jackson CM. Trigeminal Neuralgia: Current Approaches and Emerging Interventions. J Pain Res 2021; 14:3437-3463. [PMID: 34764686 PMCID: PMC8572857 DOI: 10.2147/jpr.s331036] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022] Open
Abstract
Trigeminal neuralgia (TN) has been described in the literature as one of the most debilitating presentations of orofacial pain. This review summarizes over 150 years of collective clinical experience in the medical and surgical treatment of TN. Fundamentally, TN remains a clinical diagnosis that must be distinguished from other types of trigeminal neuropathic pain and/or facial pain associated with other neuralgias or headache syndromes. What is increasingly clear is that there is no catch-all medical or surgical intervention that is effective for all patients with trigeminal neuralgia, likely reflective of the fact that TN is likely a heterogenous group of disorders that jointly manifests in facial pain. The first-line treatment for TN remains anticonvulsant medical therapy. Patients who fail this have a range of surgical options available to them. In general, microvascular decompression is a safe and effective procedure with immediate and durable outcomes. Patients who are unable to tolerate general anesthesia or whose medical comorbidities preclude a suboccipital craniectomy may benefit from percutaneous methodologies including glycerol or radiofrequency ablation, or both. For patients with bleeding diathesis due to blood thinning medications who are ineligible for invasive procedures, or for those who are unwilling to undergo open surgical procedures, radiosurgery may be an excellent option-provided the patient understands that maximum pain relief will take on the order of months to achieve. Finally, peripheral neurectomies continue to provide an inexpensive and resource-sparing alternative to pain relief for patients in locations with limited economic and medical resources. Ultimately, elucidation of the molecular mechanisms underlying trigeminal neuralgia will pave the way for novel, more effective and less invasive therapies.
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Affiliation(s)
- Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael E Xie
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher M Jackson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Thomas DC, Singer SR, Kodaganallur Pitchumani P, Katzmann GR, Kohli D. Facial pain and trigeminal neuralgia secondary to metastasis: A case report. J Am Dent Assoc 2021; 153:484-488. [PMID: 34489067 DOI: 10.1016/j.adaj.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OVERVIEW Trigeminal neuralgia due to a metastatic lesion is a relatively rare occurrence. These cases pose a diagnostic challenge for the clinician due to a complex clinical presentation. CASE DESCRIPTION The authors describe the case of a 65-year-old woman with left-sided facial pain and occasional numbness. The patient also reported autonomic features associated with facial pain, facial muscular weakness, and hearing and visual impairment. The patient's history of breast cancer, for which she was receiving treatment for bone metastasis, warranted diagnostic imaging. Magnetic resonance imaging with and without contrast was performed and revealed a possible metastatic lesion. CONCLUSIONS AND PRACTICAL IMPLICATIONS Unusual clinical features must be identified, and prompt appropriate imaging is instrumental in making at an accurate diagnosis and management plan.
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Tewari S, Vashishth A. Painful trigeminal neuropathy in patients with invasive fungal sinusitis post COVID-19 infection. Pain Pract 2021; 22:295. [PMID: 34409735 PMCID: PMC8420506 DOI: 10.1111/papr.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 08/15/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Saipriya Tewari
- Department of Pain and Palliative Care, Manipal Hospitals, New Delhi, India
| | - Ashish Vashishth
- Department of Otorhinolaryngology, Cranial Base Surgery and Auditory Implants, Manipal Hospitals, New Delhi, India
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Characterization of Infraorbital Nerve Sequelae After Orbital Floor or Zygomaticomaxillary Complex Fractures. J Craniofac Surg 2021; 33:52-56. [PMID: 34292246 DOI: 10.1097/scs.0000000000007881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Neurological sequelae of infraorbital nerve (ION) lesion 6 months after orbital floor or zygomaticomaxillary complex (ZMC) fractures, associated with initial ION injury, were compared according to the treatment performed and the type of fracture. The topographic and symptomatic sequelae at 6 months were described. MATERIALS AND METHODS Patients with orbital floor or ZMC fracture associated with initial ION injury, between November 2018 and April 2020 and clinically reassessed 6 months after trauma were included. Detailed neurological symptomatology was assessed by a questionnaire. RESULTS A total of 81 patients were included. Forty-two patients (51.8%) showed persistent neurological signs, i.e., isolated hypoesthesia in 28 patients (66.7%), isolated pain in 10 patients (23.8%) and both in 5 patients (9.5%). The most affected area was the cheek (42.8%). Thirty-eight patients (46.9%) presented associated signs, which were intermittent in 78.9% of cases. A pronounced improvement happened for 65.1% of patients and 76.7% were not or only slightly hindered in their daily activities. There were significantly more neurologic symptoms at 6 months in the surgical group than in the observational group and more in the ZMC fracture group than in the orbital floor fracture group. DISCUSSION Neurological symptomatology was more frequent in patients treated surgically. Our results suggest the interest of a surgical decompression when orbital or ZMC fracture is associated with nerve damage but more data are needed. Neurological injury requires a careful initial clinical evaluation and regular follow-up to help patients coping, painful symptoms may benefit from specialized care.
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Robertson C. Cranial Neuralgias. Continuum (Minneap Minn) 2021; 27:665-685. [PMID: 34048398 DOI: 10.1212/con.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article discusses the differential diagnosis, evaluation, and management of trigeminal neuralgia and reviews other neuralgias of the head and neck, including those that contribute to neuralgic ear pain. RECENT FINDINGS Most cases of trigeminal neuralgia are related to vascular compression, a demyelinating plaque, or a compressive mass affecting the trigeminal nerve. However, recent studies have shown that up to 11% of patients have a family history of trigeminal neuralgia, suggesting that some patients may have a genetic predisposition to demyelination or nerve hyperexcitability. In these patients, trigeminal neuralgia may occur at a younger age, on both sides of the face, or in combination with other neuralgias. SUMMARY When a patient presents with neuralgic pain, the diagnosis is made by careful history and neurologic examination, with attention to the dermatome involved, the triggers, and the presence of any associated sensory deficit. All patients with new neuralgia or neuropathic facial pain warrant a careful evaluation for a secondary cause. The presence of sensory deficit on bedside examination is particularly concerning for an underlying secondary etiology.
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Gwathmey KG, Satkowiak K. Peripheral nervous system manifestations of rheumatological diseases. J Neurol Sci 2021; 424:117421. [PMID: 33824004 DOI: 10.1016/j.jns.2021.117421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 05/02/2020] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
Rheumatological diseases result in immune-mediated injury to not only connective tissue, but often components of the peripheral nervous system. These overlap conditions can be broadly categorized as peripheral neuropathies and overlap myositis. The peripheral neuropathies are distinctive as many have unusual presentations such as non-length-dependent, small fiber neuropathies and sensory neuronopathies (both due to dorsal root ganglia dysfunction), multiple mononeuropathies (e.g. vasculitic neuropathies), and even cranial neuropathies. Overlap myositis is increasingly recognized and is often associated with specific autoantibodies. Sarcoidosis also has widespread neurological manifestations and impacts both the peripheral nerves and muscle. Much work is needed to fully characterize the vast presentations of these overlap diseases. Given the rarity of these disorders, they are understudied, resulting in significant knowledge gaps with regards to their underlying pathophysiology and the best treatment approach. A basic knowledge of these disorders is mandatory for both practicing rheumatologists and neurologists as prompt recognition and early initiation of immunotherapy may prevent significant morbidity and permanent disability.
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Affiliation(s)
- Kelly G Gwathmey
- Virginia Commonwealth University, Department of Neurology, 1101 E Marshall St., PO Box 980599, Richmond, VA 23298, USA.
| | - Kelsey Satkowiak
- University of Virginia, Department of Neurology, Charlottesville, VA, USA
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Pipeline embolization device for treatment of atypical facial pain caused by a cavernous sinus aneurysm. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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20
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Revisiting the Corneal and Blink Reflexes for Primary and Secondary Trigeminal Facial Pain Differentiation. Pain Res Manag 2021; 2021:6664736. [PMID: 33628353 PMCID: PMC7886525 DOI: 10.1155/2021/6664736] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/01/2021] [Indexed: 11/25/2022]
Abstract
Trigeminal neuralgia is often misdiagnosed at initial presentation due to close connotation with dental pain and is often over diagnosed for the very same reasons leading to numerous unnecessary surgical procedures such as peripheral neurectomy and alcohol injections, while the actual cause may remain elusive for decades. Evaluation of the neurosensory system may disclose the correct anatomical location of the etiology. The neurological examination may be clouded by the sensory deficits subsequent to previous peripheral surgical procedures. The corneal and blink reflexes are integral measures of the trigeminal and facial neurosensory assessment, and their abnormal function may facilitate the identification of intrinsic disease of the brain stem. These reflexes can be employed to discover pathological lesions including intracranial space-occupying trigeminal, lateral medullary, cerebral hemispheric lesions, and degenerative diseases of the central nervous system. Dental surgeons and oral and maxillofacial surgeons should consider corneal reflex in neurological assessment of patient presenting with trigeminal neuralgia-like symptoms. Failure to evaluate corneal sensitivity may lead to delayed or inaccurate diagnosis and unsuitable or redundant treatment interventions. This simple noninvasive reflex can be performed by chair-side and may provide significant information regarding the origin of facial pain and is an invaluable part of clinical methods especially in remote and peripheral healthcare center practitioners where sophisticated radiographic investigations such as computed tomography and magnetic resonance imaging may not be available.
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Korczeniewska OA, Khan J, Eliav E, Benoliel R. Molecular mechanisms of painful traumatic trigeminal neuropathy-Evidence from animal research and clinical correlates. J Oral Pathol Med 2020; 49:580-589. [PMID: 32557871 DOI: 10.1111/jop.13078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/09/2020] [Indexed: 01/02/2023]
Abstract
Painful traumatic trigeminal neuropathy (PTTN) may occur following major craniofacial or oral trauma, or may be subsequent to relatively minor dental interventions. Following injury, pain may originate from a peripheral nerve, a ganglion, or from the central nervous system. In this review, we focus on molecular mechanisms of pain resulting from injury to the peripheral branch of the trigeminal nerve. This syndrome has been termed painful traumatic trigeminal neuropathy (PTTN) by the International Headache Society and replaces previous terms including atypical odontalgia, deafferentation pain, traumatic neuropathy and phantom toothache. We emphasize the scientific evidence supporting the events purported to lead to PTTN by reviewing the pathophysiology of PTTN based on relevant animal models. Additionally, we briefly overview clinical correlates and pathophysiological manifestations of PTTN.
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Affiliation(s)
- Olga A Korczeniewska
- Center for Orofacial Pain and Temporomandibular Disorders, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
| | - Junad Khan
- Eastman Institute of Oral Health, University of Rochester Medical Center, Rochester, New Jersey, USA
| | - Eli Eliav
- Eastman Institute of Oral Health, University of Rochester Medical Center, Rochester, New Jersey, USA
| | - Rafael Benoliel
- Center for Orofacial Pain and Temporomandibular Disorders, Department of Diagnostic Sciences, Rutgers School of Dental Medicine, Rutgers, The State University of New Jersey, Newark, New Jersey, USA
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Cho KH, Shah HA, Schimmoeller T, Machado AG, Papay FA. An Anatomical Study of the Foramen Ovale for Neuromodulation of Trigeminal Neuropathic Pain. Neuromodulation 2020; 23:763-769. [PMID: 32243026 DOI: 10.1111/ner.13140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 01/18/2020] [Accepted: 02/11/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Neuromodulation for trigeminal pain syndromes such as trigeminal neuropathic pain (TNP) necessitates accurate localization of foramen ovale (FO). The Härtel-type approach is very well-established and safe, ideal for temporary cannulation of the FO for ablative procedures such as balloon microcompression. A key shortcoming of the Hartel approach for placement of neuromodulation leads is the limited opportunity for secure anchoring. The aim of this study is to introduce a novel surgical approach for the treatment of TNP by investigating key osseous landmarks and their spatial relationships to the FO. MATERIALS AND METHODS Sixteen sides of cadaver heads were dissected to investigate a surgical route of the FO via transoral gingival buccal approach. Alveolar arch of the maxilla and zygomaticomaxillary suture were selected to serve as an osseous landmark for the surgical guidance to the FO. Through the intraoral route, a needle simulating electrode was traversed to aim the FO from the inferior lateral to the superior medial direction to target specific fibers of the aimed division of the nerve. RESULTS Visual identification and access to the trigeminal nerve at the external opening of FO was successful in all 16 hemifacial cadavers. A needle successfully targeted different regions of the trigeminal nerve by changing the angle of the trajectory allowing the needle to reach a specific division of the trigeminal nerve. CONCLUSIONS This study provides a novel means of approaching the FO via transoral gingival buccal access.
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Affiliation(s)
- Ki-Hyun Cho
- Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Hirsh A Shah
- Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tyler Schimmoeller
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Andre G Machado
- Departments of Neurological Surgery and Center for Neurological Restoration, Neurologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Francis A Papay
- Department of Plastic Surgery, Dermatology and Plastic Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
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Abstract
PURPOSE OF REVIEW This article describes the clinical features and diagnostic criteria, pathophysiology (when known), and treatment strategies of the major cranial neuralgias. RECENT FINDINGS Abnormal vascular loops compressing cranial nerves are the most common known pathogenesis associated with the primary neuralgias. SUMMARY The most frequently encountered primary neuralgias are trigeminal neuralgia, occipital neuralgia, and, rarely, glossopharyngeal neuralgia. Nervus intermedius neuralgia is even more rare. All neuralgias merit a careful workup for secondary causes. Drug treatment generally relies on antiepileptic drugs, antidepressants, and baclofen. OnabotulinumtoxinA can be useful in treating some cranial neuralgias. Surgical and invasive treatments include ablation, gamma knife treatment, and microvascular decompression.
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24
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Facial numbness in the ophthalmology clinic. A portentous sign. Eye (Lond) 2019; 34:663-668. [PMID: 31471563 DOI: 10.1038/s41433-019-0565-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/25/2019] [Accepted: 07/16/2019] [Indexed: 11/08/2022] Open
Abstract
AIM To report a case series of 14 patients presenting with facial numbness primarily to the ophthalmology clinic. METHODS All patients presenting with facial numbness to the ophthalmology clinic at the University of California, Los Angeles, were reviewed for study entry between 1993 and the present. Patients with a history of trauma or surgery were excluded. RESULTS Fourteen patients (eight females and six males) presented to the ophthalmology clinic with numbness. Nine patients (64%) presented primarily with numbness. This symptom was associated with mortality (57%) and significant morbidity. The most common cause was neoplastic pathology (n = 10, 71%), with perineural spread from squamous cell carcinoma being the most common (five cases, 36%). The remaining cases were related to infection (n = 4, 29%). CONCLUSIONS Most of the patients presenting to our service with numbness eventually died due to their condition. Given the poor prognosis of the patients in our case series, numbness of the face may be a portentous sign and therefore warrants a thorough examination with close follow up.
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Abstract
PURPOSE OF REVIEW Neuralgias are characterized by pain in the distribution of a cranial or cervical nerve. Typically, they are brief, paroxysmal, painful attacks, although continuous neuropathic pain may occur. The most commonly encountered conditions are trigeminal, postherpetic, and occipital neuralgia. Less common neuralgias include glossopharyngeal, superior laryngeal, auriculotemporal, and nervus intermedius neuralgia, among others. The approach to diagnosis and treatment of this group of disorders is reviewed. RECENT FINDINGS Recent guidelines of medication administration, the use of botulinum toxin, and more targeted procedures have improved treatment of neuralgias. Patients who present with neuralgias should have imaging studies to investigate for structural abnormalities unless the etiology is apparent. Management of both common and rare neuralgias can be challenging and is best guided by the most recent available evidence.
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Affiliation(s)
- Danielle Wilhour
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Stephanie J Nahas
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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26
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Misko AL, Batra A, Faquin WC, Cohen AB. An Isolated Trigeminal Sensory Neuropathy. Neurohospitalist 2018; 8:152-155. [PMID: 29977447 DOI: 10.1177/1941874417750926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Albert L Misko
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ayush Batra
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - William C Faquin
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Adam B Cohen
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Johns Hopkins Hospital, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Health Technologies, National Health, The Johns Hopkins University Applied Physics Lab, Laurel, MD, USA
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27
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Bobba S, Narasimhan M, Zagami AS. Isolated painful trigeminal neuropathy as an unusual presentation of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids: A case report. Cephalalgia 2018; 39:316-322. [PMID: 29863408 DOI: 10.1177/0333102418781789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is an inflammatory central nervous system disorder, typically presenting with subacute symptoms referable to brainstem and cerebellar pathology. This is the first report of CLIPPERS presenting with a painful trigeminal neuropathy. CASE REPORT We report an unusual case of CLIPPERS presenting with facial pain and sensory symptoms, in the absence of other brainstem or cerebellar signs. Perivascular enhancement of peri-pontine structures on neuroimaging, lymphocytic infiltrate on histopathology and rapid clinical and radiological responsiveness to glucocorticosteroids were key to diagnosis. Extensive investigations excluded various differential aetiologies. CONCLUSION The pathogenesis of CLIPPERS is poorly understood, and the diagnostic criteria are yet to be validated. In this case, facial pain was not associated with other brainstem or cerebellar signs, broadening current understanding of how CLIPPERS may present. This has clinical implications in guiding future investigations for patients presenting with painful trigeminal neuropathy.
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Affiliation(s)
- Samantha Bobba
- 1 Department of Ophthalmology, Westmead Hospital, Sydney, Australia.,2 Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | | | - Alessandro S Zagami
- 2 Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.,4 Institute of Neurological Sciences, Prince of Wales Hospital, Sydney, Australia
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Devine M, Hirani M, Durham J, Nixdorf DR, Renton T. Identifying criteria for diagnosis of post-traumatic pain and altered sensation of the maxillary and mandibular branches of the trigeminal nerve: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 125:526-540. [PMID: 29426749 DOI: 10.1016/j.oooo.2017.12.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/20/2017] [Accepted: 12/29/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The aim of the study was to systematically identify criteria used to diagnose patients with trigeminal nerve injury. STUDY DESIGN A systematic review of the literature registered in the PROSPERO database. Inclusion criteria were patients diagnosed with nerve injury of the sensory divisions of the maxillary or mandibular branches of the trigeminal nerve, with reported tests and criteria used for diagnosis and persistent pain or unpleasant sensation associated with nerve injury. RESULTS In total, 28 articles were included. Diagnostic tests included clinical neurosensory tests (89%), thermal quantitative sensory testing (QST; 25%), electromyography (7%), and patient interview (14%). Neuropathic pain was assessed by using the visual analogue scale (39%); patient use of neuropathic medication (7%); questionnaires, including McGill and PainDETECT (21%). Functional impact was assessed in 14% and psychological impact in 7% of articles. Methodology in performing clinical neurosensory tests, application of diagnostic terms and diagnostic grading of nerve injury was found to be inconsistent among the included articles, making direct comparison of results difficult. CONCLUSIONS Recommendations for assessment and diagnosis of trigeminal nerve injury have been made based on the best available evidence from the review. There is an urgent requirement for a consensus in diagnostic criteria, criteria for assessment, and outcome reporting among stakeholder organizations to improve knowledge in this field.
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Affiliation(s)
- Maria Devine
- Department of Oral Surgery, King's College London Dental Institute, London, UK.
| | - Murtaza Hirani
- Department of Oral Surgery, King's College London Dental Institute, London, UK
| | - Justin Durham
- Centre for Oral Health Research and School of Dental Sciences, Newcastle University. Newcastle-Upon-Tyne Hospitals' NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Donald R Nixdorf
- Department of Diagnostic and Biological Sciences, School of Dentistry, Department of Neurology, Medical School, University of Minnesota and HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | - Tara Renton
- Department of Oral Surgery, King's College London Dental Institute, London, UK
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29
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Hopman AJG, Baart JA, Brand HS. Articaine and neurotoxicity – a review. Br Dent J 2017; 223:501-506. [DOI: 10.1038/sj.bdj.2017.782] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 11/09/2022]
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Hossain MZ, Unno S, Ando H, Masuda Y, Kitagawa J. Neuron-Glia Crosstalk and Neuropathic Pain: Involvement in the Modulation of Motor Activity in the Orofacial Region. Int J Mol Sci 2017; 18:ijms18102051. [PMID: 28954391 PMCID: PMC5666733 DOI: 10.3390/ijms18102051] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 09/19/2017] [Accepted: 09/21/2017] [Indexed: 01/06/2023] Open
Abstract
Neuropathic orofacial pain (NOP) is a debilitating condition. Although the pathophysiology remains unclear, accumulating evidence suggests the involvement of multiple mechanisms in the development of neuropathic pain. Recently, glial cells have been shown to play a key pathogenetic role. Nerve injury leads to an immune response near the site of injury. Satellite glial cells are activated in the peripheral ganglia. Various neural and immune mediators, released at the central terminals of primary afferents, lead to the sensitization of postsynaptic neurons and the activation of glia. The activated glia, in turn, release pro-inflammatory factors, further sensitizing the neurons, and resulting in central sensitization. Recently, we observed the involvement of glia in the alteration of orofacial motor activity in NOP. Microglia and astroglia were activated in the trigeminal sensory and motor nuclei, in parallel with altered motor functions and a decreased pain threshold. A microglial blocker attenuated the reduction in pain threshold, reduced the number of activated microglia, and restored motor activity. We also found an involvement of the astroglial glutamate–glutamine shuttle in the trigeminal motor nucleus in the alteration of the jaw reflex. Neuron–glia crosstalk thus plays an important role in the development of pain and altered motor activity in NOP.
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Affiliation(s)
- Mohammad Zakir Hossain
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan.
| | - Shumpei Unno
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan.
| | - Hiroshi Ando
- Department of Biology, School of Dentistry, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano 399-0781, Japan.
| | - Yuji Masuda
- Institute for Oral Science, Matsumoto Dental University, 1780 Gobara, Hirooka, Shiojiri, Nagano 399-0781, Japan.
| | - Junichi Kitagawa
- Department of Oral Physiology, School of Dentistry, Matsumoto Dental University, 1780 Gobara Hirooka, Shiojiri, Nagano 399-0781, Japan.
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Lu SY, Huang SH, Chen YH. Numb chin with mandibular pain or masticatory weakness as indicator for systemic malignancy - A case series study. J Formos Med Assoc 2017; 116:897-906. [PMID: 28728749 DOI: 10.1016/j.jfma.2017.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/02/2017] [Accepted: 07/04/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/PURPOSE Numb chin syndrome (NCS) is a critical sign of systemic malignancy; however it remains largely unknown by clinicians and dentists. The aim of this study was to investigate NCS that is more often associated with metastatic cancers than with benign diseases. METHODS Sixteen patients with NCS were diagnosed and treated. The oral and radiographic manifestations were assessed. RESULTS Four (25%) of 16 patients with NCS were affected by nonmalignant diseases (19% by medication-related osteonecrosis of the jaw and 6% by osteopetrosis); yet 12 (75%) patient conditions were caused by malignant metastasis, either in the mandible (62%) or intracranial invasion (13%). NCS was unilateral in 13 cases and bilateral in three cases. Mandibular pain and masticatory weakness often dominate the clinical features in NCS associated with cancer metastasis. In two patients, NCS preceded the discovery of unknown malignancy (breast cancer and leukemia). In nine others, NCS heralded malignancy relapse and progression. Metastatic breast cancer in four (36%) cases accounted for the most common malignancy. Other metastatic diseases included two multiple myelomas, and one each of leukemia, prostate cancer, colon cancer, lung cancer, maxillary sinus adenoid cystic carcinoma and adrenal gland neuroblastoma. Radiographic examinations showed obvious mandibular metastasis with compression of the inferior alveolar nerve or mental nerve in nine patients, and leptomeningeal seeding or intracranial metastasis to the trigeminal nerve root at the skull base in two patients. CONCLUSION NCS without obvious odontogenic causes or trauma often signals systemic malignancy. It may be the first clue of occult malignancy.
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Affiliation(s)
- Shin-Yu Lu
- Oral Pathology and Family Dentistry Section, Department of Dentistry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
| | - Shu-Hua Huang
- Department of Nuclear Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yen-Hao Chen
- Department of Hemato-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Intravenous Immunoglobulin for Mixed Connective Tissue Disease Presenting With Bilateral Trigeminal Neuropathy. Am J Ther 2017; 25:e383-e385. [PMID: 28079540 DOI: 10.1097/mjt.0000000000000553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Benoliel R, Teich S, Eliav E. Painful Traumatic Trigeminal Neuropathy. Oral Maxillofac Surg Clin North Am 2016; 28:371-80. [DOI: 10.1016/j.coms.2016.03.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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34
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Carter E, Yilmaz Z, Devine M, Renton T. An update on the causes, assessment and management of third division sensory trigeminal neuropathies. Br Dent J 2016; 220:627-35. [DOI: 10.1038/sj.bdj.2016.444] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2016] [Indexed: 11/09/2022]
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Abstract
A 63-year-old man presented with the loss of the sensations of pain and temperature sensation in the right facial region innervated by the trigeminal nerve (V1 to 3). He showed abnormal lesions in the pons and the trigeminal nerve on magnetic resonance imaging (MRI). He had recurrent herpes in the nasal cavity, and a history of left facial palsy. We herein present the unique MRI findings and suggest that herpes simplex infection may cause trigeminal neuropathy. This is the first reported case of dissociated trigeminal neuropathy with herpes simplex infection which was accompanied by a pontine lesion on MRI.
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Affiliation(s)
- Yoichi Ohnuki
- Division of Neurology, Department of Internal Medicine, Tokai University School of Medicine, Japan
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36
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Malec-Milewska M, Horosz B, Kosson D, Sekowska A, Kucia H. The effectiveness of neurolytic block of sphenopalatine ganglion using zygomatic approach for the management of trigeminal neuropathy. Neurol Neurochir Pol 2015; 49:389-94. [PMID: 26652873 DOI: 10.1016/j.pjnns.2015.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/20/2015] [Accepted: 08/31/2015] [Indexed: 11/15/2022]
Abstract
This study was performed to present the outcomes of trigeminal neuropathy management with the application of neurolytic block of sphenopalatine ganglion. This type of procedure is used in cases where pain is not well controlled with medical treatment. Twenty patients were treated with sphenopalatine ganglion neurolysis after their response to pharmacological management was not satisfactory. Significant pain relief was experienced by all but one patient and they were able to reduce or stop their pain medication. The time of pain relief was between a few months and 9 years during the study period. Number of procedures implemented varied as some of the patients have been under the care of our Pain Clinic for as long as 18 years, satisfied with this type of management and willing to have the procedure repeated if necessary. It appears that neurolytic block of sphenopalatine ganglion is effective enough and may be an option worth further consideration in battling the pain associated with trigeminal neuropathy.
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Affiliation(s)
- Malgorzata Malec-Milewska
- Pain Clinic: Department of Anesthesiology and Intensive Care, Medical Center for Postgraduate Education, Warsaw, Poland.
| | - Bartosz Horosz
- Pain Clinic: Department of Anesthesiology and Intensive Care, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Dariusz Kosson
- Pain Clinic: Department of Anesthesiology and Intensive Care, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Agnieszka Sekowska
- Pain Clinic: Department of Anesthesiology and Intensive Care, Medical Center for Postgraduate Education, Warsaw, Poland
| | - Hanna Kucia
- Pain Clinic: Department of Anesthesiology and Intensive Care, Medical Center for Postgraduate Education, Warsaw, Poland
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Abstract
"Numb chin syndrome" (NCS) refers to new-onset numbness of the lower lip and chin within the distribution of the mental or inferior alveolar nerves. While this focal numbness may be downplayed or even overlooked by patients and clinicians, in the right clinical scenario this may be the presenting symptom of an underlying malignancy. In the absence of any obvious, temporally related dental cause, there are certain conditions that clinicians should consider including orofacial and systemic malignancies as well as several inflammatory disorders. Thorough diagnostic evaluation should always be performed when no clear cause is evident. This paper will discuss the differential, recommended evaluations, and the prognosis, for a patient presenting with NCS.
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Affiliation(s)
- Ryan M Smith
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55901, USA
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38
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Cruccu G, Pennisi EM, Antonini G, Biasiotta A, di Stefano G, La Cesa S, Leone C, Raffa S, Sommer C, Truini A. Trigeminal isolated sensory neuropathy (TISN) and FOSMN syndrome: despite a dissimilar disease course do they share common pathophysiological mechanisms? BMC Neurol 2014; 14:248. [PMID: 25527047 PMCID: PMC4301795 DOI: 10.1186/s12883-014-0248-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 12/11/2014] [Indexed: 12/15/2022] Open
Abstract
Background Patients presenting with bilateral trigeminal hypoesthesia may go on to have trigeminal isolated sensory neuropathy, a benign, purely trigeminal neuropathy, or facial-onset sensory motor neuronopathy (FOSMN), a malignant life-threatening condition. No diagnostic criteria can yet differentiate the two conditions at their onset. Nor is it clear whether the two diseases are distinct entities or share common pathophysiological mechanisms. Methods Seeking pathophysiological and diagnostic information to distinguish these two conditions at their onset, in this neurophysiological and morphometric study we neurophysiologically assessed function in myelinated and unmyelinated fibres and histologically examined supraorbital nerve biopsy specimens with optic and electron microscopy in 13 consecutive patients with recent onset trigeminal hypoesthesia and pain. Results The disease course distinctly differed in the 13 patients. During a mean 10 year follow-up whereas in eight patients the disease remained relatively stable, in the other five it progressed to possibly life-threatening motor disturbances and extra-trigeminal spread. From two to six years elapsed between the first sensory symptoms and the onset of motor disorders. In patients with trigeminal isolated sensory neuropathy (TISN) and in those with FOSMN neurophysiological and histological examination documented a neuronopathy manifesting with trigeminal nerve damage selectively affecting myelinated fibres, but sparing the Ia-fibre-mediated proprioceptive reflex. Conclusions Although no clinical diagnostic criteria can distinguish the two conditions at onset, neurophysiological and nerve-biopsy findings specify that in both disorders trigeminal nerve damage manifests as a dissociated neuronopathy affecting myelinated and sparing unmyelinated fibres, thus suggesting similar pathophysiological mechanisms.
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Affiliation(s)
- Giorgio Cruccu
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | - Elena M Pennisi
- Neurology Division, Neurosciences Department, San Filippo Neri Hospital, Rome, Italy.
| | | | | | - Giulia di Stefano
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | - Silvia La Cesa
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | - Caterina Leone
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | - Salvatore Raffa
- Cellular Diagnostics Unit, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Rome, Italy.
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany.
| | - Andrea Truini
- Department of Neurology and Psychiatry, Sapienza University, Rome, Italy.
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Karam SD, Tai A, Snider JW, Bhatia S, Bedrick EJ, Rashid A, Jay A, Kalhorn C, Nair N, Harter KW, Collins SP, Jean W. Refractory trigeminal neuralgia treatment outcomes following CyberKnife radiosurgery. Radiat Oncol 2014; 9:257. [PMID: 25497053 PMCID: PMC4273323 DOI: 10.1186/s13014-014-0257-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/06/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION A handful of studies have reported outcomes with CyberKnife radiosurgery (CKRS) for the treatment of trigeminal neuralgia. However, the follow-up has been short with no minimum follow-up required and have included patients with short duration of symptoms. Here we report our institutional experience on patients with a minimum follow-up of 1 year and a median follow-up of 28 months (mean 38.84 months). METHODS Twenty-five patients with medically and surgically intractable TN received CKRS with a mean marginal radiation dose of 64 Gy applied to an average isodose line of 86% of the affected trigeminal nerve. Follow-up data were obtained by clinical examination and telephone questionnaire. Outcome results were categorized based on the Barrow Neurological Institute (BNI) pain scale with BNI I-III considered to be good outcomes and BNI IV-V considered as treatment failure. BNI facial numbness score was used to assess treatment complications. RESULTS A large proportion of patients (42.9%) reported pain relief within 1 month following CKRS treatment. The mean time to recurrence of severe pain was 27.8 months (range 1-129 months). At median follow-up of 28 months (mean 38.84 months), actuarial rate of freedom from severe pain (BNI ≥ III) was 72%. At last follow-up 2 (8%) patients had freedom from any pain and no medications (BNI I) and the majority (48%) had some pain that was adequately controlled with medications. Seven patients (28%) had no response to treatment and continued to suffer from severe pain (BNI IV or V). Patient's diabetic status and overall post-treatment BNI facial numbness scores were statistically significant predictors of treatment outcomes. CONCLUSION CKRS represents an acceptable salvage option for with medically and/or surgically refractory patients. Even patients with severely debilitating symptoms may experience significant and sustained pain relief after CKRS. Particularly, CKRS remains an attractive option in patients who are not good surgical candidates or possibly even failed surgical therapy. This data should help in setting realistic expectations for weighing the various available treatment options.
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Affiliation(s)
- Sana D Karam
- Department of Radiation Oncology, University of Colorado Hospital, Aurora, CO, USA.
| | - Alexander Tai
- Department of Radiation Oncology, Medstar Georgetown University Hospital, Washington, DC, USA.
| | - James W Snider
- Department of Radiation Oncology, University of Maryland, Baltimore, MD, USA.
| | - Shilpa Bhatia
- Department of Radiation Oncology, University of Colorado Hospital, Aurora, CO, USA.
| | - Edward J Bedrick
- Department of Biostatistics and Bioinformatics, University of Colorado, Aurora, CO, USA.
| | - Abdul Rashid
- Department of Radiation Oncology, Medstar Georgetown University Hospital, Washington, DC, USA.
| | - Ann Jay
- Department of Radiation Oncology, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA.
| | - Christopher Kalhorn
- Department of Neurosurgery, Georgetown University Hospital, Washington, DC, USA.
| | - Nathan Nair
- Department of Neurosurgery, Georgetown University Hospital, Washington, DC, USA.
| | - K William Harter
- Department of Radiation Oncology, Medstar Georgetown University Hospital, Washington, DC, USA.
| | - Sean P Collins
- Department of Radiation Oncology, Medstar Georgetown University Hospital, Washington, DC, USA.
| | - Walter Jean
- Department of Radiation Oncology, Georgetown University Hospital, 3800 Reservoir Road, NW, Washington, DC, 20007, USA. .,Department of Neurosurgery, Georgetown University Hospital, Washington, DC, USA.
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Zakrzewska JM. Multi-dimensionality of chronic pain of the oral cavity and face. J Headache Pain 2013; 14:37. [PMID: 23617409 PMCID: PMC3642003 DOI: 10.1186/1129-2377-14-37] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 04/09/2013] [Indexed: 11/10/2022] Open
Abstract
Orofacial pain in its broadest definition can affect up to 7% of the population. Its diagnosis and initial management falls between dentists and doctors and in the secondary care sector among pain physicians, headache neurologists and oral physicians. Chronic facial pain is a long term condition and like all other chronic pain is associated with numerous co-morbidities and treatment outcomes are often related to the presenting co-morbidities such as depression, anxiety, catastrophising and presence of other chronic pain which must be addressed as part of management . The majority of orofacial pain is continuous so a history of episodic pain narrows down the differentials. There are specific oral conditions that rarely present extra orally such as atypical odontalgia and burning mouth syndrome whereas others will present in both areas. Musculoskeletal pain related to the muscles of mastication is very common and may also be associated with disc problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are specific diagnosis with defined care pathways. Other trigeminal neuropathic pain which can be associated with neuropathy is caused most frequently by trauma but secondary causes such as malignancy, infection and auto-immune causes need to be considered. Management is along the lines of other neuropathic pain using accepted pharmacotherapy with psychological support. If no other diagnostic criteria are fulfilled than a diagnosis of chronic or persistent idiopathic facial pain is made and often a combination of antidepressants and cognitive behaviour therapy is effective. Facial pain patients should be managed by a multidisciplinary team.
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Affiliation(s)
- Joanna M Zakrzewska
- Facial pain unit, Division of Diagnostic, Surgical and Medical Sciences, Eastman Dental Hospital, UCLH NHS Foundation Trust, 256 Gray's Inn Road, London, WC1X 8LD, UK.
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A high prevalence of autoimmune indices and disorders in primary nummular headache. J Neurol Sci 2012; 320:127-30. [DOI: 10.1016/j.jns.2012.07.029] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 07/11/2012] [Indexed: 11/19/2022]
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