Trigeminal neuralgia is a well known facial pain syndrome characterized by excruciating, paroxysmal, shock like pain attacks located in the somatosensory distribution of the trigeminal nerve. It occurs in both genders (with a slight female predominance), and the diagnosis is most common over age 50. Treatment options are varied for this condition ranging from medical therapy to invasive surgical procedures. No treatment modality to date is totally recurrence free. Peripheral neurectomy is one of the oldest surgical modalities which is least invasive and with few complications
A 53 year old male patient was referred to a general dental practitioner with acute bouts of severe pain on the right side evoked by perioral triggers. He was under medical therapy (Tab.Carbamazepine 200 mg, twice daily) for the past 8 months. Diagnosis was confirmed at by asking the patient to stop carbamazepine for a period of 3 days and by giving diagnostic test blocks of local anesthesia.considering the patient’s age and his reluctance to undergo invasive neurosurgical procedures under general anesthesia, treatment plan was advocated for peripheral neurectomy under local anesthesia.
The mental nerve was accessed through a vestibular incision and the identified nerve trunk was avulsed out from the inferior alveolar canal (figure I,). 100% alcohol was injected into the inferior alveolar canal through the mental foramen to burn the remaining nerve segment in the canal. Infra-orbital neurectomy was performed through a vestibular incision. Muco-periosteal flap was reflected upto the infraorbital foramen and all the three branches of the infra-orbital nerve. The supra-orbital nerve was accessed through a supra-orbital incision and the nerve trunk was avulsed out. Closure was performed through simple interrupted sutures with 3-0 vicryl
The patient was prescribed antibiotics and analgesics and was discharged on the same day. The patient was free of neuralgic pain symptoms all along the follow–up period.
In conclusion treatment for trigeminal neuralgia is widespread and should be selected based on individual merits. There is no ideal surgical treatment which is minimally invasive and acceptable to the patient, lacks complications and has no side effects or recurrences. Peripheral neurectomy is an ideal treatment of choice in old age patients, refractory to medical therapy and patients not indicated for invasive procedures under general anesthesia.
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