Please spare my teeth! Dental procedures and trigeminal neuralgia

Tripathi, Manjul; Sadashiva, Nishanth; Gupta, Anand; Jani, Parth; Pulickal, Sachin Jose; Deora, Harsh; Kaur, Rupinder; Kaur, Parwinder; Batish, Aman; Mohindra, Sandeep; Kumar, Narendra

doi:10.25259/sni_729_2020

Cited by 12 publications

(4 citation statements)

References 28 publications

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“…Although TN is a well-known condition, nonetheless is often misdiagnosed due to overlapping symptoms in the orofacial region. According to Tripathi et al, 11 more than 40% of patients with TN undergo dental extraction due to misdiagnosis. The rarity of the reported and treated cases is attributed to the missed diagnosis and inappropriate treatment before referral to neurologists and neurosurgeons.…”

Section: Discussionmentioning

confidence: 99%

Complex Neurovascular Syndromes: Is the Compressing Vessel Alone the Culprit?

Kulkarni¹

2022

JNRP

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Objective To describe and correlate the clinical, radiological, and intraoperative findings in patients with refractory neurovascular syndromes (NVS) not responding to conventional medical management and to determine the surgical outcome of the microvascular decompression (MVD) procedure. Methods Medical records of 17 patients with NVS (trigeminal neuralgia [TN] = 14 and hemifacial spasm = 3) who underwent surgery for symptom relief from January 2018 to July 2021 with follow-up data (1–36 months) were retrospectively analyzed. Patient demographics (age, sex), clinical features (site, duration of symptoms, distribution), magnetic resonance imaging (MRI) findings, micro-neurosurgical details (type of surgery, obstructive vessel), and postoperative outcome and complications were recorded. Statistical Analysis Descriptive analysis was performed. Variables were presented as either mean and standard deviation or frequency and percentages. Results The mean (standard deviation) age of patients in our study cohort was 52.6 (12.2) years. TN was common in females (64.3%). The mean duration of symptoms was longer in patients with hemifacial spasms than in patients with TN (3.3 vs. 2.7 years). While the right side was commonly affected in TN (64.3%), the left side was common in hemifacial spasm (66.7%). Most common neuralgia symptoms were distributed along the V2V3 (maxillary and mandibular division) branches (42.9%). MRI revealed neurovascular conflict in nine patients, epidermoid tumor in three patients, classical vestibular schwannoma in two patients, and short cisternal segments in three patients. Intraoperatively, superior cerebellar artery was the main offending vessel in TN followed by anterior inferior cerebellar artery (AICA) and venous compression, while tortuous vertebral artery and AICA along with thickened entangled arachnoid were seen in hemifacial spasms. Almost all patients (88.2%) reported immediate postoperative complete pain relief. One patient died secondary to chest infection after a month. Conclusion Arachnoid entanglement around the neurovascular bundle along with vascular compression over the cranial nerves is the main cause of NVS. Advanced micro-neurosurgical techniques used in MVD achieve excellent outcomes with improved quality of life. However, identifying the refractory NVS not responding to conventional medical management and early surgical management are paramount.

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Section: Discussionmentioning

confidence: 99%

Complex Neurovascular Syndromes: Is the Compressing Vessel Alone the Culprit?

Kulkarni¹

2022

JNRP

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“…The management of trigeminal neuralgia aims at efficient and long-lasting pain control to improve the patient's quality of life. 14 The options need to be individually weighed for their safety, efficacy, complication, feasibility profile, and overall patient's expectations and satisfaction. I suggest that the GKRS should only be considered as a salvage or rescue procedure for pain control and in elderly patients with dolichoectasia.…”

Section: What Is the Current Standing Of Gamma Knife Radiosurgery In The Management Of This Disorder?mentioning

confidence: 99%

Radiosurgery for Trigeminal Neuralgia Secondary to Dolichoectatic Vessels: Case Series and Review of Literature

Tripathi

Mohindra

Madan

et al. 2021

JNRP

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Even for seasoned neurosurgeons who have mastered the microvascular decompression (MVD) techniques, trigeminal neuralgia (TGN) secondary to vertebrobasilar dolichoectatic vessels remains a challenge. Often, patient is either medically infirm or unwilling for invasive surgical interventions. Alternative treatment options including Gamma Knife radiosurgery (GKRS) are considered in such a situation with variable success. This study aimed to evaluate the role of GKRS in patients with trigeminal neuralgia with dolichoectatic vessels and severe cross compression. We prospectively managed three male patients of intractable TGN secondary to dolichoectatic vascular compression with single-session GKRS. The cisternal component of the trigeminal nerve was targeted with 90 Gy radiation at 100% isodose with a single 4-mm collimator. The patients were regularly evaluated on clinical parameters for pain relief (Barrow Neurological Institute (BNI) score), sensory complaints, and outcome. All patients had satisfactory pain control (BNI I–IIIa) at 3 months of interval only to get recurrent pain (BNI IV–V) after 6 months. The treatment was eventually considered a failure after 6-month duration and one patient needed MVD for pain control. Post-GKRS pain control remains inferior in patients with dolichoectasia compared with typical TGN. GKRS should be offered only as a salvage or rescue procedure and should not be used as an alternative treatment of MVD in patient population with dolichoectatic vessels.

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“…Approximately 82% of TN patients initially consulted a dentist because the pain is frequently triggered by eating, and 53% of these patients routinely underwent unnecessary invasive dental procedures—including tooth extractions and root canals, sometimes multiple times—due to misdiagnosis. 10 , 11 Neurologists are well aware of the tumultuous journey that TN patients face and even implement workflows to prioritize the triage of new TN patients as quickly as possible to ease the pain and frustration that they have experienced.…”

Section: Introductionmentioning

confidence: 99%

Digital screening method using social media advertising for the remote assessment of trigeminal neuralgia

Chen

Barbosa

2023

DIGITAL HEALTH

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Objective Global trends, such as improving accessibility to healthcare services through the Internet, and the COVID-19 pandemic are among the driving factors in the adoption of digital health. This study hypothesized that digital solutions can reach and gather data from a large number of patients with trigeminal neuralgia (TN), a commonly misdiagnosed neuropathic facial pain syndrome, and quickly and fast-track their diagnosis by suggesting them to consult a neurologist. We developed an accessible digital screening tool based on patient symptoms and history to test this hypothesis and used social media advertisement to screen a general population for TN. Methods The standard diagnostic criteria, International Classification of Orofacial Pain, for facial pain is digitized as a web-based questionnaire that allows easy access to the evaluation for patients with suspected TN symptoms. Targeted search with relevant keywords and display campaigns on Google search engine and Facebook social media platform were used to reach large numbers of subjects. A report was autogenerated, which included a summary of a subject's symptoms, likely or likely not TN diagnosis, and information to seek appropriate medical assistance. Results The website was live for seven weeks and generated 240 screening questionnaire submissions, with a total spending of $2482. Forty-four subjects (18.3%) that reported typical symptoms of TN experienced unilateral and episodic pain in one of the trigeminal nerve regions. Conclusions We have demonstrated the feasibility of social media advertisement and digitally screening a general population for TN, gathering valuable clinical data, such as pain characteristics, through a web-based questionnaire. Based on these data, patients with similar symptoms of TN are suggested to consult a neurologist for diagnosis. This study provides a framework for using digital screening tools to improve the healthcare experience of patients who would spend several months before finding appropriate diagnosis for their specific conditions.

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Please spare my teeth! Dental procedures and trigeminal neuralgia

Cited by 12 publications

References 28 publications

Complex Neurovascular Syndromes: Is the Compressing Vessel Alone the Culprit?

Complex Neurovascular Syndromes: Is the Compressing Vessel Alone the Culprit?

Radiosurgery for Trigeminal Neuralgia Secondary to Dolichoectatic Vessels: Case Series and Review of Literature

Digital screening method using social media advertising for the remote assessment of trigeminal neuralgia

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