Various Presentations Associated with Enhancement of the V2 Branch of the Trigeminal Nerve

Abstract

The two patients discussed in this case report presented with radiologic enhancement of the V2 segment of the trigeminal nerve. The first patient discussed in this case report is a 78-year-old female with a history of squamous cell carcinoma of the face who presented with paresthesias involving the left V2 segment of the trigeminal nerve. A maxillofacial MRI was performed that showed subtle, thin enhancement along the outer margin of the left maxilla, and enhancement along the anterior course of V2. These findings suggested the possibility of V2 perineural spread of a tumor secondary to squamous eccrine duct carcinoma. The second case discusses a 71-year-old female who presented with symptoms of trigeminal neuralgia. An MRI was performed and showed thickening and enhancement of the right infraorbital nerve within the maxillary sinus with no significant neurovascular contact at the root entry zone. Further assessment by neurosurgery suggested this patient likely had isolated neuritis of the right infraorbital nerve, causing severe classic neuralgic symptoms. The third case presents a 28 year old male with MRI findings showing bilateral V2 enhancement within the anterior maxillary infraorbital foramina bilaterally. These three cases emphasize the importance of understanding the anatomy of the trigeminal nerve and maintaining a comprehensive knowledge of the common pathologies that affect cranial nerves. This awareness is critical in appropriately recognizing and diagnosing V2 pathologies and identifying their unique characteristics on various imaging modalities.