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Post-traumatic trigeminal neuropathy

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warning Attention! Please do not confuse the diagnosis of "trigeminal neuropathy" described in this article with the diagnoses of "trigeminal neuralgia" and "facial nerve neuropathy".

Post-traumatic trigeminal neuropathy

Neuropraxia is a disease of the peripheral nervous system, during which the continuity of the trigeminal nerve trunk is not disrupted and there is a temporary loss of motor and sensory function due to blockage of nerve conduction. For a long time, one of the central problems of neurology has been diseases of the peripheral nervous system. Moreover, peripheral traumatic neuritis of the trigeminal nerve is the most frequent complication of injuries, surgical interventions, and dental manipulations on the jaws and is noted in 85% of cases, and neuritis of the lower and upper alveolar nerves is diagnosed in 15% of patients.

The site of injury to the trigeminal nerve (V3 branch) in case of improper performance of conduction anesthesia.

Neuritis of the trigeminal nerve of traumatic origin, as a rule, develops as a result of injuries to the zone of innervation of the trigeminal nerve, namely:

  • fractures of the base of the skull
  • fractures of the upper and lower jaws
  • surgical interventions on the jaw bones
  • operations on the maxillary sinus
  • difficult tooth extraction
  • improper performance of local anesthesia
  • improper dentition
  • the presence of foreign bodies that injure the nerve trunk or nerve endings (filling material, implants)

After an injury to the bones of the facial skeleton, the morphologically nerve trunk with injury to the trigeminal nerve can be in the following states:

  • the continuity of the trigeminal nerve trunk is not broken (neuropraxia)
  • the nerve trunk of the trigeminal nerve is pinched by bone fragments
  • overstretching of the trigeminal nerve trunk
  • rupture of the trigeminal nerve trunk
Neuropraxia of the infraorbital nerve (V2 - a branch of the trigeminal nerve) as a result of its damage with blunt trauma.

 

Diagnostics of the trigeminal neuropathy

To establish the type of damage to the trigeminal nerve, a clear diagnosis of the level of its damage is required. You will need to conduct:

  • neurological examination of the patient
  • electroneurography (ENG)
  • MRI of the paranasal sinuses and orbits
  • CT scan of the brain and skull bones

Clinically, traumatic trigeminal neuropathy is manifested by impaired sensitivity in the innervation zone of the affected branches of the trigeminal nerve, paresthesia, constant aching pain of varying intensity. If the inferior alveolar nerve is damaged in traumatic neuropathy of the trigeminal nerve, motor disorders are observed.

Diagnosis of the level of nerve damage of the trigeminal nerve, like any other nerve, is performed using electroneurography (ENG).

With traumatic neuropathy of the trigeminal nerve, there may be a loss or decrease in all types of sensitivity in the zone of innervation of the trigeminal nerve, as well as soreness with the percussion of some teeth. Electroexcitability of dental pulp with traumatic neuropathy of the trigeminal nerve is reduced or absent.

Sometimes neuropathy of individual branches of the trigeminal nerve is observed: chin, lingual, buccal, upper alveolar, palatine nerve.

Sensory zones are innervated by the trigeminal nerve on the skin of the face.
Sensory zones are innervated by the trigeminal nerve on the skin of the face.

Chin neuropathy is characterized by paresthesia, pain, and sensory disturbances in the region of the lower lip and chin of the corresponding side.

For neuropathy of the superior alveolar nerves, a persistent long course is characteristic. Palatine nerve neuropathy is characterized by burning and dryness in the area of half of the palate from the affected side. There may be a decrease or lack of sensitivity in the area of innervation of the palatine nerve.

 

Treatment of trigeminal neuropathy

Disruption of nerve impulse transmission in neuropraxia usually lasts an average of 6–8 weeks until it is fully restored. Treatment for trigeminal neuritis is selected individually in each case. It includes a set of conservative procedures:

  • acupuncture
  • nerve stimulation muscle stimulation
  • vitamins of group "B", "C 'and" E "
  • NSAIDs (nalgesin, ibuprofen, meloxicam, etc.)
  • antipsychotics (finlepsin, lyrica, etc.)
  • homeopathic remedies
The use of acupuncture is very effective in treating trigeminal neuropathy.

It is known that acupuncture, used for traumatic trigeminal neuropathy, is aimed at:

  • providing anti-inflammatory effects
  • removal of edema and swelling of the nerve trunk
  • achieving a sensitizing effect
  • increasing the general resistance of the body
  • inclusion of adaptive and compensatory reactions
  • the most complete restoration of the lost conduction of impulses along the nerve trunk

The duration of treatment and its frequency for traumatic neuropathy of the trigeminal nerve is dictated in the future by the state of the nerve itself and the restoration of the sensitivity of the facial skin and oral mucosa.

Timely removal of a dental implant that has suffered damage (compression) to one of the branches of the trigeminal nerve is important.

The elimination of paresthesia and pain (neuralgia) on the skin of the face and teeth in the treatment of trigeminal neuropathy is accelerated with the use of physiotherapy.

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