Personalized tooth-supported digital guide plate used in the treatment of trigeminal neuralgia with balloon compression

Abstract

Background: Balloon compression (BC) is a simple and effective operation to treat trigeminal neuralgia (TN). The most difficult procedure in BC is related to fast and accurate foramen ovale (FO) insertion. In this study, we introduced a new method incorporating a personalized tooth-supported digital guide plate to reduce patient trauma, improve the accuracy and the success rate of insertion, and reduce surgeons' radiation exposure.Methods: In total, 15 TN patients aged 55-70 years were recruited between January 2019 and November 2020 and retrospectively analyzed. Before the operation, based on Mimics 3D reconstruction and the modeling of patients' maxillary teeth, personalized tooth-supported digital guide plates were designed and 3D printed. All operational procedures were simulated. Then, all patients underwent BC with a personalized tooth-supported digital guide plate.Results: In the study, guide plate insertion was completed within 60 seconds for all patients. Puncturing time was limited to 5 seconds. Successful insertion into the FO was achieved in 1 attempt for all 15 participants. No patients required more than 3 postinsertion adjustments to obtain a pear-shaped balloon.There were no postoperative complications, such as cerebrospinal fluid leakage, intracranial infection, or visual acuity change. The trigger points, attack frequency per day, attack duration, and Barrow Neurological Institute (BNI) pain intensity scores of all 15 participants were significantly improved postoperation.The visual analog scale (VAS) score significantly decreased postoperation compared with that obtained preoperation (all P<0.001) and gradually decreased with the extension of follow-up time.Conclusions: By applying a personalized tooth-supported digital guide plate, we can significantly avoid the use of an incision outside the mouth, decrease the difficulty of FO insertion, and reduce patient trauma. The operation is more suitable for novice surgeons and protects surgeons from the harm of radiation. This new technology may improve the success rate and accuracy of FO insertion, although a multicenter, large sample, randomized controlled trial is needed.

The efficacy and safety of gabapentin vs. carbamazepine in patients with primary trigeminal neuralgia: A systematic review and meta-analysis

“…An episode of PTN is often triggered by normal facial activities such as speaking, chewing, brushing, and washing, or by touching an area of the mouth or face called a “trigger point” ( 34 ). In order to avoid attacks, the patient should try to reduce the actions such as speaking, chewing, brushing their teeth, and washing their face, so as to avoid physical and psychological suffering.…”