Longstanding trigeminal sensory neuropathy of nontraumatic cause

Abstract

Objective. Trigeminal sensory neuropathy is an uncommon but often significant orofacial symptom. There are few detailed descriptions of the problem in the dental literature. The aim of this study was to evaluate the clinical presentation and management of a cohort of patients presenting with anesthesia/paresthesia affecting one or more divisions of the trigeminal nerve unrelated to any identifiable traumatic cause. Study Design. Nine patients with trigeminal neuropathy were examined. Each patient underwent a standard protocol of examination and hematologic, serologic, radiologic, and histopathologic investigations, as appropriate. Results. Trigeminal neuropathy was found to be secondary to distant malignancy in 4 patients and to connective tissue disease in 2 patients. In each of 3 other patients, there was no obvious cause for the neuropathy. Patients with malignancy as the cause of their neuropathy tended to have involvement of more than one division of the trigeminal nerve and/or other neurologic features. Conclusions. Trigeminal sensory neuropathy may herald underlying distant malignancy or connective tissue disease. Anesthesia and paresthesia of the orofacial region are therefore serious clinical symptoms that must be carefully investigated before a diagnosis of idiopathic disease is made. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:572-6)