Effectiveness, Safety, and Predictors of Response to 5% Lidocaine-Medicated Plaster for the Treatment of Patients With Trigeminal Neuralgia: A Retrospective Study

5.6% lidocaine aerosol anesthesia for supragingival ultrasonic scaling in patients with chronic periodontitis or dental plaque-induced gingivitis

The aim of this study was to evaluate the efficacy and patient satisfaction of lidocaine aerosol for pain management during periodontal scaling and root planning in patients with chronic periodontitis or dental plaque-induced gingivitis. This study specifically concentrated on comparing the effectiveness of lidocaine aerosol as a topical anesthetic against a placebo, assessing its impact on pain perception during the procedure. Additionally, the relationship between periodontal treatment and the reduction of oxidative stress markers in these patients was assessed. Eighty-six patients with chronic periodontitis or dental plaque-induced gingivitis were included. Notably, 5.6% lidocaine and placebo aerosols were randomly applied to the labial (buccal) and lingual (palatal) sides, approximately 3 mm from the gingival surface, with three sprays on each side, prior to supragingival ultrasonic scaling in these patients. In this controlled, double-blind study, the effectiveness of a 5.6% lidocaine aerosol in reducing pain during supragingival ultrasonic scaling was evaluated. The study involved 50 patients who divided into two groups: one receiving the lidocaine aerosol and the other a placebo. Pain was assessed using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). The results revealed a statistically significant reduction in pain scores in the lidocaine group compared with the placebo group. Specifically, the mean VAS score in the lidocaine group was 2.1 ± 1.3, compared with 5.6 ± 1.7 in the placebo group (P < 0.01). Similarly, the NRS scores were significantly lower in the lidocaine group (2.3 ± 1.2) compared with the placebo group (5.9 ± 1.8, P < 0.01). No adverse reactions were found in none of the groups. 5.6% lidocaine aerosol holds promise as an effective anesthetic option for reducing pain during supragingival ultrasonic scaling procedures in patients with chronic periodontitis or dental plaque-induced gingivitis. Chinese Clinical Trial Registry (No. ChiCTR2000029831, date: 2020-02-15).

Pathophysiology and Management of Refractory Trigeminal Neuralgia

PURPOSE OF REVIEW

Discuss the current understanding of the pathophysiology and management of refractory trigeminal neuralgia (TN). This includes a discussion on why TN can recur after microvascular decompression and a discussion on "outside of the box" options when both first- and second-line management strategies have been exhausted.

RECENT FINDINGS

This review discusses second- and third-line oral medication options, botulinum toxin A, repeat microvascular decompression, repeat ablative procedures, internal neurolysis, trigeminal branch blockade, and neuromodulation using TMS or peripheral stimulation. Additional management for chronic neuropathic facial pain such as deep brain stimulation, motor cortex stimulation, and focused ultrasound thalamotomy are also discussed, though evidence in trigeminal neuralgia is limited. Treatment of recurrent TN despite multiple surgeries can be challenging, and multiple minimally invasive and more invasive management options have been reported in small studies and case reports. Further studies are needed to determine an optimal stepwise approach.

Trigeminal Neuralgia in the Presence of a Vascular Loop and Response to Medical Management: Experience From Saudi Arabia

INTRODUCTION

Trigeminal neuralgia (TN) is a neurovascular disorder characterized by severe, episodic facial pain, often attributed to vascular compression of the trigeminal nerve. The commonly reported artery responsible for compression is the superior cerebellar artery. Additionally, the anterior inferior cerebellar artery is also noted as a potential contributor to vascular loop compression. These vascular structures can lead to nerve root atrophy or displacement, which is significant in the pathophysiology of TN. While extensively studied globally, the specific characteristics of TN in the Saudi Arabian population remain underexplored. The primary objective of this study is to evaluate the response to medical management in patients with TN and vascular loop compression.

METHODS

The study was conducted at King Fahad Specialist Hospital in Dammam, Saudi Arabia, from April to August 2023, and utilized a retrospective case series design to review medical reports of 13 patients diagnosed with TN and vascular loop compression. The primary objective was to evaluate the response to medical management in this specific patient population.

RESULTS

In this study, we included 13 patients with TN, providing a comprehensive snapshot of the patient population under study, encompassing demographic characteristics, clinical presentations, treatment responses, and other relevant variables. The mean age of the patients in the study is 48.23 years, with a standard deviation of 11.7, and a range from 30 to 71 years. The main findings of this study underscore the positive response to medical management in patients with TN and vascular loop compression. All patients in the study responded positively to the treatment, indicating a favorable overall response rate. The time to respond varied, with the majority responding within three months (46.16%), followed by those responding within 12 months (38.46%).

CONCLUSION

This study highlights the potential efficacy of non-surgical approaches in managing the debilitating facial pain associated with TN. The positive outcomes observed in response to medical management emphasize the need for further exploration and validation of non-surgical approaches in the context of TN with vascular loop compression. This finding contributes to the global understanding of TN and offers promise for improving patient quality of life in Saudi Arabia.

Botulinum toxin-A as a treatment option for refractory idiopathic trigeminal neuralgia of the ophthalmic branch: a case report and literature review

Trigeminal neuralgia is one of the most common neurological pains affecting the head and neck and is associated with severe, lancinating, electrical pain episodes. The maxillary and mandibular branches are usually affected. The ophthalmic branch is rarely involved and, when present, it requires a comprehensive workup to rule out major conditions. Pharmacotherapy and surgery are the most common treatment options for this condition. Systemic medications may pose a wide range of side effects and effectiveness may decrease over time while surgery has inherent complications. Injectable onabotulinum toxins have been utilized for various applications in medicine and dentistry. There is, however, limited data on their use for the management of refractory trigeminal neuralgia of the ophthalmic branch. We present the case of a 58-year-old male diagnosed with refractory idiopathic trigeminal neuralgia affecting the ophthalmic branch, which was unresponsive to standard care and successfully managed with onabotulinum toxin type A. This treatment should be considered in cases of refractory trigeminal neuralgia prior to surgery. We reviewed the relevant literature concerning the application of Onabotulinum toxin A for managing trigeminal neuralgia of the ophthalmic branch. This case report and review aim to enlighten the application of Onabotulinum toxin A for managing refractory trigeminal neuralgia of the ophthalmic branch. Our case report and review show that Onabotulinum toxin A could be used for managing TN of the ophthalmic branch.

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.

Alleviating effect of lavender (Lavandula angustifolia) and its major components on postherpetic pain: a randomized blinded controlled trial

BACKGROUND

Postherpetic neuralgia (PHN) causes severe pain which can lead to decreased quality-of-life. This study aimed to evaluate the effects of inhalation of lavender (Lavandula angustifolia) oil and its major components (linalool and linalyl acetate) on the pain in patients with PHN.

METHODS

This study was performed at an outpatient clinic. Sixty-four patients with postherpetic neuralgia were randomly allocated to a control group (almond oil) or one of three experimental groups (lavender oil, linalool, or linalyl acetate diluted in almond oil at concentration of 1% v/v), and the participants inhaled the aroma by natural breathing. Quality, severity, and intensity of pain were measured before and after the intervention.

RESULTS

Six patients discontinued the intervention for personal reasons; hence, data from 58 patients were analyzed (control group, n = 14; 1% lavender oil group, n = 15; 1% linalool, n = 15; 1% linalyl acetate, n = 14). Reduction in sensory pain was greater in the 1% lavender oil group, 1% linalool group, and 1% linalyl acetate group than in the control group (all P < 0.001). Reduction in affective pain was greater in the 1% lavender group (P < 0.001) and the 1% linalool group (P = 0.007) than in the control group. Decreases in pain severity and intensity were significantly greater in all three intervention groups than in the control group.

CONCLUSIONS

Inhalation of lavender oil and its major volatile components effectively reduced the quality, severity, and intensity of postherpetic pain, suggesting that lavender oil, linalool, and linalyl acetate may each be an effective intervention for reducing pain in patients with postherpetic neuralgia.

TRIAL REGISTRATION

This study was retrospectively registered on the Clinical Research Information Service.

REGISTRATION NUMBER

KCT0007772, first registration 06/10/2022.