gms | German Medical Science

Objective: Trigeminal neuralgia (TN) is characterized by paroxysmal and lancinating pain in the facial area innervated by the trigeminal nerve. It is often triggered by speech, chewing, headcolds and toothbrushing. In the case of craniomandibular dysfunction (CMD) patients suffering from pain are not necessarily triggered by chewing, speaking or yawning. The pain affects the face – especially the area around the ear. In our patients we wanted to examine how frequently both pathologies occur together.

Method: 153 patients with TN were operated in our hospital between January 2007 and December 2013. The preoperative status, including magnetic resonance imaging (MRI) was collected, follow-up examinations were performed immediately postoperatively, at discharge, after 3 and 6 months. Further follow-up will be done. Nearly all patients underwent dental and/or oral-maxillofacial-surgery treatment prior to surgery.

Results: Postoperatively 8 (5.2%) patients complained of continued pain when chewing, speaking and / or pain in the ear, with partially changed pain intensity and pain character. In 3 cases a co-treatment by an oral and maxillofacial surgeon occured successfully. In one young woman the pain around the ear and jaw resolved completely, but she continued to suffer from severe pain in the eye area. After surgical revision of the microvascular decompression (MVD) these complaints improved too.

Conclusions: Before MVD nearly all patients with TN underwent dental and/or oral-maxillofacial-surgery treatment with removal of several teeth and insertion of dental implants. These procedures in themselves can subsequently lead to problems in the jaw joint area. Another aspect is the pain-related changes in mastication in patients with trigeminal neuralgia. Ultimately, we recommend a co-treatment by an oral and maxillofacial surgeon when residual symptoms after MVD remain.