Maxillary Branch Of Trigeminal Nerve Research Articles

Cavernous sinus syndrome: a case report

Background: Cavernous sinus syndrome (CSS) is a rare, but potentially life- and sight-threatening condition. We report a case of multiple cranial neuropathies with CSS.Case presentation: A 70-year-old woman presented with unilateral complete ptosis, ophthalmoplegia, and diplopia. Examination showed left-sided multiple cranial nerve palsies, with the involvement of cranial nerve III (oculomotor nerve), IV (trochlear nerve), V1 and V2 (ophthalmic and maxillary branches of trigeminal nerve), and VI (abducens nerve). A clinical diagnosis of CSS was made. Neuroimaging revealed a left-sided cavernous sinus mass for further investigation.Conclusion: In this case report, we highlight the clinical and radiological features of CSS to raise clinical suspicion for similar diagnosis in the future.

Unilateral Nevus of Ota with Palatal and Optic Disc Pigmentation with Coincidental Preauricular Tag- A Case Report

Nevus of Ota also known as oculodermal melanosis presents as hyperpigmentation of face involving ophthalmic and maxillary branches of trigeminal nerve associated with ocular hyperpigmentation. It is due to confinement of melanocytes in the dermis. Most commonly it is unilateral but sometimes it may have bilateral presentation. Typically, it presents at birth but can also be an acquired condition. Frequently seen in Japanese and rarely in Indian subcontinent. It has more predilection towards females. Less frequently, hyperpigmentation is seen in other sites like oral mucosa, tympanum and nasal mucosa. These patients are at high risk of developing glaucoma and malignancy. The author reported a case of 12-year-old male child with unilateral pigmentation of left side face involving forehead, periorbital and cheek, along with ocular pigmentation. Hyperpigmentation of conjunctiva, iris and angles is present in left eye with intraocular pressure being normal in both eyes. Fundus showing optic disc pigmentation in the left eye with cup disc asymmetry in both eyes. Child has coexistent preauricular tag on the left side.

Dopamine receptor D2, but not D1, mediates descending dopaminergic pathway-produced analgesic effect in a trigeminal neuropathic pain mouse model.

Neuropathic pain represents a challenge to clinicians because it is resistant to commonly prescribed analgesics due to its largely unknown mechanisms. Here, we investigated a descending dopaminergic pathway-mediated modulation of trigeminal neuropathic pain. We performed chronic constriction injury of the infraorbital nerve from the maxillary branch of trigeminal nerve to induce trigeminal neuropathic pain in mice. Our retrograde tracing showed that the descending dopaminergic projection from hypothalamic A11 nucleus to spinal trigeminal nucleus caudalis is bilateral. Optogenetic/chemogenetic manipulation of dopamine receptors D1 and D2 in the spinal trigeminal nucleus caudalis produced opposite effects on the nerve injury-induced trigeminal neuropathic pain. Specific excitation of dopaminergic neurons in the A11 nucleus attenuated the trigeminal neuropathic pain through the activation of D2 receptors in the spinal trigeminal nucleus caudalis. Conversely, specific ablation of the A11 dopaminergic neurons exacerbated such pain. Our results suggest that the descending A11-spinal trigeminal nucleus caudalis dopaminergic projection is critical for the modulation of trigeminal neuropathic pain and could be manipulated to treat such pain.

An Open Study of Botulinum-A Toxin Treatment of Idiopathic Trigeminal Neuralgia

Introduction: Trigeminal Neuralgia (TN) is a unilateral, recurrent, sharp facial pain disorder that is limited to the distribution of divisions of the trigeminal nerve. The aim of this study was to evaluate the efficacy of Botulinum neurotoxin type A (BTX-A) for alleviating the frequency and severity of TN pain. Materials and Methods: This trial was performed as a before and after study. We treated 31 patients (15 male and 16 female) with mean age of 52 year old that their diagnosis was made at least 4.5 years before. We injected BTX-A in various parts of face and particularly in the origin of mandibular and maxillary branches of trigeminal nerve. Injection volume was determined by the necessity and pain intensity measured with visual analog scale up to 100U. Patients were evaluated before and after the injection and were followed after week, and each month, for a three months period. Other related variables were recorded such as: toxin complications, pain status variations by brushing, chewing, cold weather and patient’s satisfaction with their therapy. Results: showed that after injection, pain intensity and frequency decreased after tooth brushing, chewing and cold weather (P<0.0001). Median of pain intensity decreased from 10 to 2 in all cases. Only 6% of patients affected to transient asymmetry and other complications were not observed. After 3 months of injection 71% of patients were inclined to reinjection. Conclusion: BTX-A could be used as an effective and safe treatment method for drug resistant TN. Also it can be used in patients who are not satisfied with oral anticonvulsants.

Mucormycotic skull base osteomyelitis: A case report

Mucormycotic skull base osteomyelitis in immunocompetent individuals is extremely rare clinical entity, with only 8 cases reported in literature till date. It is the most acute, fulminant and deadly infection most commonly seen arising from sinonasal tract and middle ear infections. The involvement of the bone is lately seen due to angioinvasiness nature of this opportunistic fungi infection. When seen in immunosuppressed individuals it can be more aggressive and can spread extensively to the deep facial structures, orbits and intracranially with erosion of the skull base and cervical vertebrae.Early diagnosis and prompt treatment planning for this malignant behavior type of infection is to reduce the mortality rate. We report a rare case of 61-year-old male patient complaining of cranial neuropathy of maxillary branch of trigeminal nerve from 22 days. Magnetic resonance imaging revealed radiodense lining of the right sphenoidal sinus with a lesion in infratemporal region provisionally diagnosed as meningioma. We performed surgical excision of the lesion with zygomatic arch access osteotomy. Histopathological examination revealed mucormycotic skull base osteomyelitis. Patient was started on amphotericin B therapy immediately.

Pterygopalatine fossa segment neurectomy of maxillary nerve through maxillary sinus route in treating trigeminal neuralgia

PurposeTo explore an effective surgical treatment for pain in the distribution area of the maxillary branch of trigeminal nerve (TN). Materials and methodsTwenty-six patients with pain in the distribution of the maxillary branch of TN were followed up after they had undergone pterygopalatine fossa segment neurectomy of maxillary nerve through maxillary sinus route. ResultsIn all cases, the pain initially resolved after operation, with anaesthesia or paraesthesia in the operated side of the maxillary nerve-distributed area. After a mean follow-up period of 24 (range 3–36) months, 19 (73.08%) of the 26 patients had an excellent response, 5 (19.23%) had a good response, 2 (7.69%) had a fair response, and none (0%) had a poor response. One patient had a recurrence with palatal pain 3 months after the operation. ConclusionsThe maxillary sinus route can provide a clear vision for sectioning of the maxillary nerve. This new surgical technique has proven to be safe and effective. It provides another option for the weak elderly who are intolerant of craniotomy or patients who have contraindications for craniotomy when radiofrequency thermocoagulation (RFT) and percutaneous glycerol neurolysis (PGR) treatment is not possible.