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

Fréderic Van der Cruyssen, Frederik Peeters, Thomas Gill, Antoon De Laat, Reinhilde Jacobs, Constantinus Politis, Tara Renton, Fréderic Van der Cruyssen, Frederik Peeters, Thomas Gill, Antoon De Laat, Reinhilde Jacobs, Constantinus Politis, Tara Renton

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.

Keywords: diagnosis; neuropathic pain; quality of life; trigeminal nerve; trigeminal nerve disorder.

Conflict of interest statement

The authors declare no financial or non‐financial interest in the subject matter or materials discussed in this manuscript.

© 2020 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Symptom distribution. Most frequently involved area is situated in the mental area
FIGURE 2
FIGURE 2
Clusters of sensory phenotype frequency and overlap for post‐traumatic trigeminal neuropathic pain. Sizes of circles are to scale; overlaps are not to scale
FIGURE 3
FIGURE 3
Distribution of the three clusters within the injured nerve branch and within aetiologies
FIGURE 4
FIGURE 4
Self‐reported interference of lifestyle of Post‐traumatic trigeminal neuropathy patients and stratified for subdomains indicating degree of interference
FIGURE 5
FIGURE 5
Quality of life domains and self‐perceived health state measured by the EQ5D‐5L questionnaire. Comparison between transient and persistent nerve injuries (A) as well as non‐painful versus painful post‐traumatic trigeminal neuropathy (B). NS, not significant. Open‐ended boxes indicate a value of zero with standard deviation of zero. Standard deviations are indicated

References

    1. Caissie R, Goulet J, Fortin M, Morielli D. Iatrogenic paresthesia in the third division of the trigeminal nerve: 12 Years of clinical experience. J Can Dent Assoc (Tor). 2005;71(3):185‐190.
    1. Orofacial T, Classification P. International classification of orofacial pain. Cephalalgia. 2020;40(2):129‐221.
    1. Baad‐Hansen L, Benoliel R. Neuropathic orofacial pain: facts and fiction. Cephalalgia. 2017;37(7):670‐679.
    1. Nixdorf D, Moana‐Filho E. Persistent dento‐alveolar pain disorder (PDAP): working towards a better understanding. Rev Pain. 2011;5(4):18‐27.
    1. Macrae WA. Chronic post‐surgical pain: 10 years on. Br J Anaesth. 2008;101(1):77‐86.
    1. Klazen Y, Van der Cruyssen F, Vranckx M, et al. Iatrogenic trigeminal post‐traumatic neuropathy: a retrospective two‐year cohort study. Int J Oral Maxillofac Surg. 2018;47(6):789‐793.
    1. He P, Mah‐Ginn K, Karhade DS, et al. How often do OMSs lose malpractice cases and why? J Oral Maxillofac Surg. 2019;77 (12):2422‐2430. 10.1016/j.joms.2019.07.001
    1. Renton T, Yilmaz Z. Profiling of patients presenting with posttraumatic neuropathy of the trigeminal nerve. J Orofac Pain. 2011;25(4):333‐344.
    1. Demant DT, Lund K, Vollert J, et al. The effect of oxcarbazepine in peripheral neuropathic pain depends on pain phenotype: a randomised, double‐blind, placebo‐controlled phenotype‐stratified study. Pain. 2014;155(11):2263‐2273.
    1. Schug SA, Lavandʼhomme P, Barke A, Korwisi B, Rief W, Treede R‐D. The IASP classification of chronic pain for ICD‐11: chronic postsurgical or posttraumatic pain. Pain. 2019;160(1):45‐52.
    1. Miloro M. Trigeminal Nerve Injuries [Internet]. Vol. 71. Springer; 2015. 42 p.
    1. Renton T, Thexton A, Crean SJ, Hankins M. Simplifying the assessment of the recovery from surgical injury to the lingual nerve. Br Dent J. 2006;200(10):569‐573.
    1. Robinson PP, Smith KG, Johnson FP, Coppins DA. Equipment and methods for simple sensory testing. Br J Oral Maxillofac Surg. 1992;30(6):387‐389.
    1. Devine M, Hirani M, Durham J, Nixdorf DR, Renton T. Identifying criteria for diagnosis of post‐traumatic pain and altered sensation of the maxillary and mandibular branches of the trigeminal nerve: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018;125(6):526‐540.
    1. Suzuki K, Baad‐Hansen L, Pigg M, Svensson P. Assessment of mechanical pain thresholds in the orofacial region: a comparison between pinprick stimulators and electronic von Frey device. J Oral Facial Pain Headache. 2016;30(4):338‐345.
    1. Hillerup S. Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases. Clin Oral Investig. 2007;11(2):133‐142.
    1. Schug SA, Bruce J. Risk stratification for the development of chronic postsurgical pain. Schmerz. 2018;32(6):471‐476.
    1. Kushnerev E, Yates JM. Evidence‐based outcomes following inferior alveolar and lingual nerve injury and repair: a systematic review. J Oral Rehabil. 2015;42(10):786‐802.
    1. Bagheri SC, Meyer RA, Cho SH, Thoppay J, Khan HA, Steed MB. Microsurgical repair of the inferior alveolar nerve: success rate and factors that adversely affect outcome. J Oral Maxillofac Surg. 2012;70(8):1978‐1990.
    1. Zuniga JR, Yates DM. Factors determining outcome after trigeminal nerve surgery for neuropathic pain. J Oral Maxillofac Surg [Internet]. 2016;74(7):1323‐1329. 10.1016/j.joms.2016.02.005
    1. Teerijoki‐Oksa T, Forssell H, Jääskeläinen SK, et al. Validation of diagnostic methods for traumatic sensory neuropathy and neuropathic pain. Muscle Nerve. 2019;59(3):342‐347.
    1. Vollert J, Maier C, Attal N, et al. Stratifying patients with peripheral neuropathic pain based on sensory profiles. Pain. 2017;158(8):1446‐1455.
    1. Üçeyler N, Vollert J, Broll B, et al. Sensory profiles and skin innervation of patients with painful and painless neuropathies. Pain. 2018;159(9):1867‐1876.
    1. Forstenpointner J, Otto J, Baron R. Individualized neuropathic pain therapy based on phenotyping. Pain. 2017;159(3):569‐575.
    1. Teerijoki‐Oksa T, Jääskeläinen S, Forssell K, et al. An evaluation of clinical and electrophysiologic tests in nerve injury diagnosis after mandibular sagittal split osteotomy. Int J Oral Maxillofac Surg. 2003;32(1):15‐23.
    1. Agbaje J, De Laat A, Politis C, et al. Agreement between quantitative and qualitative sensory testing of changes in oro‐facial somatosensory sensitivity. J Oral Rehabil. 2017;44(1):30‐42.
    1. Castro M, Kraychete D, Daltro C, Lopes J, Menezes R, Oliveira I. Comorbid anxiety and depression disorders in patients with Chronic pain. Arq Neuropsiquiatr. 2009;67(4):982‐985.
    1. Selvarajah D, Cash T, Sankar A, et al. The contributors of emotional distress in painful diabetic neuropathy. Diabetes Vasc Dis Res. 2014;11(4):218‐225.
    1. Haviv Y, Zini A, Etzioni Y, et al. The impact of chronic orofacial pain on daily life: the vulnerable patient and disruptive pain. Oral Surg Oral Med Oral Pathol Oral Radiol. 2017;123(1):58‐66.
    1. Pigg M, Svensson P, Drangsholt M, List T. Seven‐year follow‐up of patients diagnosed with atypical odontalgia: a prospective study. J Orofac Pain. 2013;27(2):151‐164.
    1. Smith JG, Elias L‐A, Yilmaz Z, et al. The psychosocial and affective burden of posttraumatic neuropathy following injuries to the trigeminal nerve. J Orofac Pain. 2013;27(4):293‐303.

Source: PubMed

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