Signs and symptoms, quality of life and psychosocial data in 1331 post‐traumatic trigeminal neuropathy patients seen in two tertiary referral centres in two countries

Abstract

Background Post‐traumatic trigeminal neuropathy (PTN) is a disturbance of function or pathological change of the trigeminal nerve branches following trauma and has an important impact on patient's quality of life (QoL). Objectives To provide diagnostic data on PTN and illustrate differences in aetiology, injured nerve, pain distribution, sensory profile and QoL between PTN subgroups. Methods 1331 patients with painful or non‐painful PTN were retrospectively reviewed in two centres, extracting demographic data, time and cause of trauma, clinical findings including signs and symptoms, basic neurosensory testing, imaging modalities, treatments, and QoL or psychosocial assessment. Results More females were represented (70%) than males. The inferior alveolar nerve was most frequently damaged (60%) followed by the lingual nerve (28%). Wisdom teeth removal was considered the main cause (48%). Pain was reported in 63% of patients and pain frequency increased with age without clinically significant gender differences. Numbness was reported in 50% of PTN patients. Neurosensory testing showed larger affected dermatome involvement in persistent injuries, with no differences between the non‐painful and painful PTN groups. Patient clustering indicated different sensory profile distributions when stratified according to aetiology or affected nerve branch. High interference with lifestyle was reported (78%), and patients suffering from painful PTN had worse QoL and psychosocial outcomes. Conclusion Patients with painful PTN had different clinical profiles and lower QoL scores than those with non‐painful PTN. Sensory profiles may provide important prognostic and therapeutic information; however, more research is needed to assess the clustering procedure and link these clusters to therapeutic guidelines.

Post-traumatic trigeminal neuropathy: correlation between objective and subjective assessments and a prediction model for neurosensory recovery

“…We found third molar surgery to be the most common cause of PTN (47%), as most others have reported [13,22,33,36,40]. Almost all cases were referred by oral and maxillofacial surgeons (89%), and injury to the third division of the trigeminal nerve was most frequent, with the IAN affected in 64% and the LN in 28% of cases, also in accordance with the literature [13,22,33,40].…”

“…The average age of the study population was 42 years, and most (64%) were women, in accordance with other population-based studies on PTN [13,19,22,30,34,40]. The reason for this sex skew remains a matter of debate.…”

“…The major impact that PTN can have on patient quality of life is broadly accepted [3,5,9,11,13,[15][16][17][18][19]22,24,[26][27][28][29][30][34][35][36]40,43,44]. In the current study, average quality of life improved from 59/100 to 72/100 upon study completion.…”

“…We used this image to describe a percentage of the affected dermatome as well as to visualize its evolution. For this purpose, the reverse end of an anesthetic needle was moved across the surface from the unaffected to affected area [28,40]. Then, two-point discrimination, stimulus localization, and directional discrimination were examined using a light brush technique, along with response to hot and cold stimuli, all based on previously described methods [20,26,28,32].…”

“…Also, 64% of patients reported neurosensory loss as their primary burden, and 36% said that their impaired functioning was mainly caused by pain complaints or other positive symptoms. In a large study of 1331 patients with PTN, Van der Cruyssen et al [40] said that 63% reported pain as the primary symptom and 50% cited numbness. In two other studies, 57% [22] and 66% [19] of PTN cases reported pain.…”