Trigeminal neuropathy following orthognathic surgery

Abstract

Traumatic trigeminal neuropathy occupies a special place in the pain continuum. The clarification of genesis and clinical and neurophysiological findings makes it possible to perform differentiation treatment.Objective: to evaluate the clinical and neurophysiological efficiency of repetitive magnetic stimulation (RMS) and vitamin B complex therapy for traumatic trigeminal neuropathy.Patients and methods. The investigation enrolled 36 patients (26 women and 10 men) aged 25 to 35 years with inferior alveolar neuropathy following bilateral sagittal split osteotomy. The DN4 questionnaire was used to identify a neurogenic pain component. The intensity of pain syndrome was assessed using a visual analogue scale. A neurophysiological examination involving the recording of brainstem auditory evoked potentials (BAEPs) and trigeminal evoked potentials (TEPs) was made using a Neuro-MEP device (Neurosoft, Russia). Therapy including vitamin B complex was performed in 12 patients. Twenty-four patients received low-frequency pulsed magnetic field therapy using a Neuro-MS magnetic stimulator.Results and discussion. The clinical picture in patients with traumatic inferior alveolar neuropathy after corrective mandible surgery is characterized by the polymorphism of pain sensations and sensory disorders. The development of pain syndrome is due to a neuropathic component. The 10-day vitamin group B therapy cycle had no substantial impact on the time course of clinical and neurophysiological changes. After the 10-day RMS cycle, there were reductions in swelling and the intensity of pain syndrome and the severity of sensory disorders in the lower lip, chin, and mandible. The data on BAEPs showed shortening in the interpeak intervals III–V; those on TEPs demonstrated a decrease in the P1–N1 amplitude.Conclusion. Unlike vitamin B complex therapy, the RMS cycle in patients with traumatic trigeminal neuropathy makes it possible to reduce the intensity of pain syndrome and the severity of sensory disorders, as well as excitability of the nonspecific structures of the brainstem and the central structures of the trigeminal system.

Peripheral magnetic stimulation for chronic peripheral neuropathic pain: A systematic review and meta‐analysis

“…Of the included studies, 15 were randomized controlled trials, 14,21-34 5 were case series, [35][36][37] 2 were case reports, 38,39 and 1 was a non-randomized trial. 40…”

“…Studies were published across several countries (according to location of primary author) including Azerbaijan (n = 1), 37 Canada (n = 2), 35,38 Egypt (n = 4), 21,29,31,32 Germany (n = 1), 22 India (n = 1), 30 Italy (n = 2), 39,41 Japan (n = 1), 42 Poland (n = 2), 26,27 Romania (n = 1), 23 Russia (n = 1), 40 Thailand (n = 1), 33 Turkey (n = 1), 28 and United States (n = 5). 14,24,25,34,36 The total number of patients across all studies was 1123.…”

“…PMS was evaluated across several neuropathic pain disorders: carpal tunnel syndrome (n = 3), 24,27,33 chemotherapy-induced polyneuropathy (n = 1), 22 complex regional pain syndrome (n = 3), 28,35,39 diabetic peripheral neuropathy (n = 5), 25,26,30,34,37 glossopharyngeal neuralgia (n = 1), 38 lumbar radiculopathy (n = 2), 23,32 orofacial pain (n = 1), 41 phantom limb pain (n = 1), 14 post-herpetic neuralgia (n = 1), 29 post-traumatic neuroma/nerve entrapment (n = 1), 36 pudendal neuralgia (n = 1), 42 traumatic brachial plexopathy (n = 1), 31 and trigeminal neuropathy (n = 2). 21,40 Nine studies compared PMS to a sham device, while the other studies compared a number of different controls (physiotherapy, 23 physiotherapy and vitamins, 33 transcutaneous electrical nerve stimulation, 29 laser therapy 21,27 ), or no additional treatment above the standard of care. 30,40 Included studies used varying types of PMS devices including round coils, 21,28,42 figure-of-eight coils, 31,35,36,38 racetrack coils, 23,33 diamagnetic pumps, 39 wearable devices, 24,41 and magnetic mattresses.…”

“…21,40 Nine studies compared PMS to a sham device, while the other studies compared a number of different controls (physiotherapy, 23 physiotherapy and vitamins, 33 transcutaneous electrical nerve stimulation, 29 laser therapy 21,27 ), or no additional treatment above the standard of care. 30,40 Included studies used varying types of PMS devices including round coils, 21,28,42 figure-of-eight coils, 31,35,36,38 racetrack coils, 23,33 diamagnetic pumps, 39 wearable devices, 24,41 and magnetic mattresses. 26,27 The range of magnetic field intensities ranged from 0.1 to 1500 mT, with variable frequencies ranging from 1 Hz to 1 MHz (median 20 Hz [IQR 70 Hz]).…”

“…39 Two studies looked at PMS for trigeminal neuropathy. 21,40 In one study, a locally placed device that generated 1.5 Tesla at 1 Hz for 20 min/day for 10 days was used in 24 patients, while complex B vitamins were used in 12 patients (the control group). 40 VAS pain scores were significantly improved in the PMS group, together with reduced severity of sensory disorders.…”