Résumé
Painful post-traumatic trigeminal neuropathy (PTTN) involves spontaneous and evoked pain, of moderate to severe intensity, continuous and described as burning or shooting. The first line treatment is pharmacological. However, botulinum toxin - A (BoNT-A) can be used when medications cannot control pain. This article describes the use of BoNT-A in a case of PTTN refractory to conventional pharmacological treatment. A 44-year-old male patient presented with an 8-years history of pain in the lower left second molar region. Pain was burning, lasting for seconds, with multiple pain episodes per day. Diagnosis hypothesis was PTTN. After no improvement with conventional pharmacological treatment, injections of BoNT-A were elected. Somatosensory assessment showed a significant reduction in visual analog scale for touch, cold and pinprick sensitivity. Likewise, patient's impression of change in pain significantly improved after BoNT-A injections. Our results suggest that BoNT-A could be used as a treatment for PTTN refractory to conventional treatments. (AU)
A neuropatia trigeminal pós-traumática dolorosa (PTTN) envolve dor espontânea e evocada, de intensidade moderada a grave, contínua e descrita como queimante ou lascinante. O tratamento de primeira linha é farmacológico. No entanto, a toxina botulínica - A (BoNT-A) pode ser usada quando os medicamentos não conseguem controlar a dor. Este artigo descreve o uso da BoNT-A em um caso de PTTN refratário ao tratamento farmacológico convencional. Paciente de sexo masculino, 44 anos, com 8 anos de dor na região do segundo molar inferior esquerdo. A dor foi descrita como queimante, com duração de segundos e com vários episódios por dia. A hipótese de diagnóstico foi PTTN. Após nenhuma melhora com o tratamento farmacológico convencional, as injeções de BoNT-A foram eleitas. A avaliação somatossensorial mostrou uma redução significativa na escala visual analógica para sensibilidade ao toque, frio e picada após BoNT-A. Da mesma forma, a impressão de mudança do paciente na dor melhorou significativamente após as injeções de BoNT-A. Nossos resultados sugerem que o BoNT-A poderia ser usada como tratamento para PTTN refratário a tratamentos convencionais. (AU)
Sujets)
Humains , Mâle , Adulte d'âge moyen , Névralgie essentielle du trijumeau , Toxines botuliniques de type A , Atteintes du nerf facialRésumé
We present a case of painful trigeminal neuropathy that was successfully treated with hangebyakujutsutenmato (HBT) extract, a traditional Japanese medicine. A 76-year-old woman experienced severe left facial pain caused by a large basilar artery aneurysm compressing the brainstem. Administration of gabapentin (GPT) reduced facial pain slightly. However, attempts to increase the GPT dose aggravated dizziness and gait disorder. GPT combined with HBT relieved both facial pain and dizziness, enabling dose reduction of GPT. The classical text “Hiiron,” the original literature on HBT, recommends this medicine for headaches and/or dizziness secondary to gastrointestinal dysfunction caused by inappropriate treatment. Many different medicines can cause dizziness, and HBT may be useful for the treatment of this side effect.
Résumé
Most postoperative maxillary cysts develop more than 10 years after a Caldwell-Luc operation. They can manifest with cheek pain, swelling and dental and visual symptoms. Brain imaging should be performed to distinguish trigeminal nerve compression from various other possible causes. It should be treated by surgical intervention to relieve the above-mentioned symptoms. We report a patient who presented with compressive trigeminal neuropathy caused by a postoperative maxillary cyst.
Sujets)
Humains , Joue , Neuroimagerie , Nerf trijumeau , Atteintes du nerf trijumeauRésumé
Most postoperative maxillary cysts develop more than 10 years after a Caldwell-Luc operation. They can manifest with cheek pain, swelling and dental and visual symptoms. Brain imaging should be performed to distinguish trigeminal nerve compression from various other possible causes. It should be treated by surgical intervention to relieve the above-mentioned symptoms. We report a patient who presented with compressive trigeminal neuropathy caused by a postoperative maxillary cyst.
Sujets)
Humains , Joue , Neuroimagerie , Nerf trijumeau , Atteintes du nerf trijumeauRésumé
The occurrence of a trigeminal neuropathy associated with connective tissue disease is rare. Trigeminal neuropathy in connective tissue disease is predominantly sensory and it is characterized by numbness, hypesthesia, slurred speech, and touch pain. Although the pathogenesis of trigeminal neuropathy associated with connective tissue disease remains obscure, the main pathologic findings are vasculitis and neuritis. A case of trigeminal neuropathy associated with mixed connective tissue disease is described, and the incidence, symptoms, pathophysiology, treatment of the disease is discussed.
Sujets)
Maladies du tissu conjonctif , Hypoesthésie , Incidence , Connectivite mixte , Névrite , Atteintes du nerf trijumeau , VasculariteRésumé
Microsurgical tumor removal is the treatment of choice to relieve the mass effect for the treatment of acoustic neurinoma patients. Gamma knife radiosurgery is another treatment option for patients with tumor size of less than approximately 4cm. Between May, 1990 and March, 1994, 55 tumor lesions from 50 patients were treated with gamma knife radiosurgery at Asan Medical Center. Following microsurgery, 20 patients underwent gamma knife radiosurgery for tumors not removed surgically. The remaining 30 patients underwent gamma knife radiosurgery alone. For an average follow-up period of 26 months(ranging from 6 to 45 months), 37 lesions out of 39 lesions responded, giving a tumor growth control rate of 94.9%. Facial neuropathy and trigeminal neuropathy were noted in 8% and 6%, respectively. According to these results, it is suggested that gamma knife radiosurgery in an effective altrnative therapeutic modality for the management of small to moderate sized acoustic neurinomas.
Sujets)
Humains , Acoustique , Atteintes du nerf facial , Études de suivi , Microchirurgie , Neurinome de l'acoustique , Radiochirurgie , Atteintes du nerf trijumeauRésumé
Trigeminal neuropathy os characterized by unremitting facial pain, no evident trigger point and facial sensory change. According to Jannetta, in trigeminal neuropathy, the offending artery is not necessarily in contact with the root entry zone(REZ) but any site of the nerve. We have recently experienced a 48-year-old woman with symptoms and signs compatible with trigeminal neuropathy and explored the CP angle. SCA was crossing just anterior to the trigeminal root and one small arterial loop was lying on the pons close to the root entry zone(REZ) but neither of them was in diirect contact with the nerve. Teflon felt was inserted between the arteries and nerve and secured with silk and beriplast for fear that they should contact by changing position. Immediately after the operation the facial pain and pre-existing facial sensory change were completely gone.