Painful Post-traumatic Trigeminal Neuropathy Research Articles

The Comparative Efficacy of Palmitoylethanolamide (PEA) With the Combination of Pregabalin and Nortriptyline on Post-extraction Trigeminal Neuropathy by Using Magnetic Resonance (MR) Neurography: A Randomized Clinical Trial.

Aim The aim of this randomized clinical trial is to compare the efficacy of palmitoylethanolamide (PEA) with the combination of pregabalin and nortriptyline in treating post-extraction trigeminal neuropathy using magnetic resonance neurography (MRN). Methods The present prospective, randomized controlled trial was conducted on 60 patients (20 in each group). In group I (positive control group), a combination of 75 mg of pregabalin and 10 mg of nortriptyline was administered once daily for the duration of 12 weeks. In group II, 600 mg of palmitoylethanolamide was given twice a day. In group III, a combination therapy of the abovementioned drugs was given. The efficacy of the drug was assessed by measuring pain intensity in terms of the numeric rating scale (NRS) (primary outcome)and changes (signal intensity and nerve thickness) in magnetic resonance neurography (secondary outcome) at various intervals of time. The data was collected and subjected to statistical analysis using the Statistical Package for Social Sciences (SPSS)version 25(IBM SPSS Statistics, Armonk, NY)at the significance level of P<0.05. Results A significant decrease in post-drug mean NRS scores was observed in all three groups. In terms of reduction in the mean NRS, the combination group showed the highest reduction. Palmitoylethanolamide significantly reduces pain scores with negligible side effects. Conclusion Palmitoylethanolamide helps in the reduction of mild to moderate pain of painful post-traumatic trigeminal neuropathy (PTTN) with minimal side effects, suggesting that it may be used where the use of the conventional drug is either contraindicated or not feasible.

Treatments For Painful Post-Traumatic Trigeminal Neuropathy: A Literature Review and Clinical Case Report

Treatments For Painful Post-Traumatic Trigeminal Neuropathy: A Literature Review and Clinical Case Report

Post-Traumatic Trigeminal Neuropathic Pain after Dental Implant Surgery and the Injustice Experience Questionnaire

Painful post-traumatic trigeminal neuropathy (PTTN) is a known complication of dental implant therapy. Patients with PTTN develop sensory abnormalities in the orofacial region, which may be a psychosocial aspect, and dentists should assess somatosensory testing and psychosocial factors. The patients were assessed using quantitative sensory testing (QST). A 64-year-old female presented with allodynia of the left lower lip that occurred after a surgical implant procedure. Persistent pain started 4 months after the placement of two dental implants in the mandible. Sensory testing of these areas revealed warm hyposensitivity and mechanical hypersensitivity of the mandibular region. We also assessed PTTN-related perceived injustice using the Injustice Experience Questionnaire. The patient refused medication therapy such as pregabalin; therefore, autogenic training was adopted as an alternative management strategy. We conclude that for expensive dental procedures, such as implant placement, sufficient consensus should be obtained preoperatively before proceeding with surgery.

Post-traumatic Trigeminal Neuropathy Associated With Endodontic Therapy: A Systematic Review.

A painful or non-painful trigeminal nerve lesion brought on by trauma that exhibits symptoms and/or clinical evidence of trigeminal nerve dysfunction is known as painful post-traumatic trigeminal neuropathy (PTTN). In relation to this, the term post-traumatic persistent dentoalveolar pain (PDAP) is an idiopathic condition of chronic neuropathic origin that manifests as a diagnostic challenge for dental practitioners. Neuropathic pain is defined by the International Association for the Study of Pain (IASP) as "pain initiated or caused by a primary lesion or dysfunction in the nervous system." PDAP is located primarily in the teeth and jaws. This study systematically reviews how likely it is to get painful PTTNif the patient receivedendodontic therapy and the duration between doing root canal therapy (RCT) and getting PTTN. A systematic review was carried out using key search terms from PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) with English as the only permitted language. There were strict inclusion requirements. The 10 articles that were included showed a prevalence of an endodontic procedure anywhere from three to 48 months following post-endodontic treatment, and it mainly affects females in their mid-40s with no variation regarding the areas, whether it is in the maxilla or mandible. The lack of information about the association between RCT and PTTN led practitioners to make wrong diagnoses, which made the patient unwilling to seek further help. So, in this review, we identified some visible characteristics that can help in that process.

Persistent, neuropathic-like trigeminal pain after dental implant loading.

BackgroundPainful post-traumatic trigeminal neuropathy (PTTN) is a known complication of dental implant therapy. Besides cases resulting of nerve damage during surgery or implant placement, some patients report delayed neuropathic-like symptoms only after implant loading i.e. crown placement. The present retrospective study aimed at describing the clinical features of pain experienced by these patients. Material and MethodsThe cohort of patients consulting for chronic orofacial pain at the Groupe Hospitalier Pitié-Salpêtrière (Paris, France) between 2015 and 2020 (ABCD study, IRB # TPS 1106180), was screened for patients with history of dental implant placement and persistent pain. Patients with no pain after surgery for 6 months and pain resulting from the loading of the implant, were included. ResultsAmong 675 files of patients screened, 5 fulfilled inclusion criteria. All patients were women, mean age 62.4 ± 9.8 y.o, and reported trigeminal neuropathic-like persistent pain. Intensity of pain was described as moderate to severe, with pin and needles, burning and tingling, and electric shocks as main symptoms. ConclusionsThese results suggest that implant loading can trigger trigeminal neuropathy, in a previously sensitized nerve. Putative neurophysiological basis of the phenomenon is discussed. Key words:Neuropathic pain, trigeminal nerve, lesion, dental implant, implant loading, allodynia.

Capsaicin-induced depolymerization of axonal microtubules mediates analgesia for trigeminal neuropathic pain

Pain management in craniofacial neuropathy is a major clinical challenge. Trigeminal neuralgia and painful post-traumatic trigeminal neuropathy are two major trigeminal neuropathic pain that need to be addressed. Capsaicin a specific agonist of transient receptor potential vanilloid 1 (TRPV1), a Ca2+-permeable ion channel, that is enriched in nociceptors. The capacity of capsaicin to ablate TRPV1-expressing nociceptive terminals has led to an FDA-approved therapy treat neuropathic pain conditions. We showed that capsaicin induces ablation of nociceptive nerve terminals through TRPV1/Ca2+/calpain-mediated mechanisms, which is necessary for long-lasting analgesia for neuropathic pain. However, the mechanisms underlying capsaicin-induced ablation and analgesia to achieve pain control are not fully understood. In this study, we hypothesize that capsaicin increases depolymerization of microtubules, which induces axonal ablation and analgesia for trigeminal neuropathic pain. To test the hypothesis, we determined the effects of microtubule stabilizer; paclitaxel, which binds to microtubules and stabilizes microtubules against depolymerization, on capsaicin-induced axonal ablation and analgesia for trigeminal neuropathic pain in mice. Paclitaxel decreased capsaicin-induced ablation of axonal terminals in-vitro in time-lapse imaging of axonal terminals from microfluidic chamber. Capsaicin increases the proportion of free tubulin in dissociated sensory neurons, which was inhibited by paclitaxel treatment, suggesting capsaicin increases depolymerization of microtubules. Subcutaneous injection of capsaicin to facial skin attenuated mechanical allodynia in mice with chronic constriction injury of the infraorbital nerve (ION-CCI). In contrast, co-administration of paclitaxel and capsaicin did not produce analgesic effects. Results from the present study supports that TRPV1-microtubule interactions can determine capsaicin-induced ablation of nociceptive terminals and the extent of capsaicin-induced analgesia, which further supports that capsaicin-induced ablation of nociceptive terminals is necessary for analgesia. Further understanding of TRPV1/Ca2+-dependent mechanisms of capsaicin-induced ablation and analgesia may help to improve the efficacy of this treatment. Support/grant information: NIH R01 DE027731 and R35 DE030045 Support/grant information: NIH R01 DE027731 and R35 DE030045.

Oral appliances in the management of neuropathic orofacial pain: A retrospective case series.

Neuropathic orofacial pain disorders are frequently managed with topical or systemic medications that carry a risk of dangerous side effects such as drowsiness, disorientation, and/or physical addiction. The aim of this paper is to report the use of neurosensory oral appliances as a safe means of providing symptomatic relief for neuropathic orofacial pain. This is a retrospective chart review of patients with diagnoses of persistent idiopathic facial pain (PIFP), painful post-traumatic trigeminal neuropathy (PTTN), or an oral dysesthesia, who utilized neurosensory appliances with or without the use of topical anesthetic gel. Eleven patients were identified. Eight patients (62.5%) found benefit with the neurosensory appliance alone, and three patients (37.5%) found relief with the addition of lidocaine 2% gel. All patients reported >50% resolution of their symptoms, with three (37.5%) reporting complete resolution. Seven patients maintained follow-up ≥3months, with efficacy lasting for a range of at least 3-8months. Oral neurosensory appliances, whether used alone as a physical barrier or as a vehicle to deliver topical anesthetic, represent a safe and effective modality for the management of neuropathic orofacial pain disorders. Additional studies are needed to assess long-term efficacy.

A Case of Painful Post-Traumatic Trigeminal Neuropathy after Endoscopic Sinus Surgery

Painful post-traumatic trigeminal neuropathy (PPTTN) is a distinctive facial pain syndrome characterized by facial and/or oral pain along the sensory distribution of the fifth cranial nerve with a clear history of a traumatic event. To our knowledge, PPTTN after endoscopic sinus surgery (ESS) has not been reported in the literature. We present a case of an elderly woman who experienced unilateral neuralgic pain after undergoing ESS. Following ESS of the left sphenoid sinus to remove suspicious fungus balls, the patient complained of intermittent facial pain occurring in the left periorbital and forehead area. Clinical diagnosis of PPTTN was established after a comprehensive multidisciplinary assessment. The pain disappeared completely after a 5-week medical treatment with gabapentin. Since PPTTN cases associated with ESS are extremely rare, our case demonstrates that PPTTN should be considered in the differential diagnosis of facial pain developing after ESS and can be successfully treated with medical therapy.

Signs and symptoms, quality of life and psychosocial data in 1331 post-traumatic trigeminal neuropathy patients seen in two tertiary referral centres in two countries.

BackgroundPost‐traumatic trigeminal neuropathy (PTN) is a disturbance of function or pathological change of the trigeminal nerve branches following trauma and has an important impact on patient's quality of life (QoL).ObjectivesTo provide diagnostic data on PTN and illustrate differences in aetiology, injured nerve, pain distribution, sensory profile and QoL between PTN subgroups.Methods1331 patients with painful or non‐painful PTN were retrospectively reviewed in two centres, extracting demographic data, time and cause of trauma, clinical findings including signs and symptoms, basic neurosensory testing, imaging modalities, treatments, and QoL or psychosocial assessment.ResultsMore females were represented (70%) than males. The inferior alveolar nerve was most frequently damaged (60%) followed by the lingual nerve (28%). Wisdom teeth removal was considered the main cause (48%). Pain was reported in 63% of patients and pain frequency increased with age without clinically significant gender differences. Numbness was reported in 50% of PTN patients. Neurosensory testing showed larger affected dermatome involvement in persistent injuries, with no differences between the non‐painful and painful PTN groups. Patient clustering indicated different sensory profile distributions when stratified according to aetiology or affected nerve branch. High interference with lifestyle was reported (78%), and patients suffering from painful PTN had worse QoL and psychosocial outcomes.ConclusionPatients with painful PTN had different clinical profiles and lower QoL scores than those with non‐painful PTN. Sensory profiles may provide important prognostic and therapeutic information; however, more research is needed to assess the clustering procedure and link these clusters to therapeutic guidelines.

Botulinum toxin-A injections as therapy for chronic painful post-traumatic trigeminal neuropathy: case report

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.KeywordsPost-traumatic trigeminal neuropathy; Trigeminal neuropathic pain; Botulinum toxin.

Exploring the time course of painful post-traumatic trigeminal neuropathy: a pilot study

Patients suffering from painful post-traumatic trigeminal neuropathy (PTTN) often report circadian variations in pain. This pilot study aimed to assess the daily evolution of pain in patients fulfilling the following criteria: PTTN diagnosed based on ICHD-3 criteria; &gt;18 years of age; no impairment in communication and signed informed consent. Primary study outcome was a self-declared quantitative assessment of pain intensity using an 11-point numerical scale (0–10) for 8 consecutive days. Impact on oral function and quality of life was also assessed, using psychometric questionnaires GOHAI and HADS. Eleven patients with PTTN were recruited (mean age: 66.1 ± 6.8 years old). Mean pain intensity was 3.6 ± 0.99. Mean pain intensity increased progressively and significantly during the day, from 1.8 ± 1.3 to 4.6 ± 2.3 (p &lt; 0.0001). Mean HADS score was 7.8 ± 2.7. Mean GOHAI score was weak (35/60). In conclusion, PTTN seems to follow a circadian rhythm.

Pulsed radiofrequency of superior cervical ganglion for treatment of painful post-traumatic trigeminal neuropathy (PTTN): A case series report

ABSTRACT Objective: Painful post-traumatic trigeminal neuropathy (PTTN) is a clinical pain syndrome that occurs due to injuries to the peripheral branches of the trigeminal nerve and is characterized by a deep burning pain and accompanied by positive and negative neurological signs. In patients with recalcitrant PTTN, the sympathetic nervous system is a potential therapeutic target. The aim of this study was to investigate the therapeutic response of PTTN patients to pulsed radiofrequency treatment (PRF) of the superior cervical sympathetic ganglion (SCG). Methods: Thirty-five patients with PTTN who had a history of severe disabling facial neuropathic pain underwent PRF of the SCG under a new lateral fluoroscopic approach. Results: The patients’ pain intensity post-PRF was 3.94 (± 3.11), compared with 8.82 (± 1.27) pre-PRF (p < 0.001). Conclusion: PRF of the SCG could be an effective method to treat chronic PTTN.

Tooth-Related Pain or Not?

Dental pain is the most common acute pain presenting in the orofacial region; however, chronic pain conditions are also frequent and include; temporomandibular joint disorders (TMDs), primary headaches (neurovascular pain), painful post-traumatic trigeminal neuropathy (PPTTN) and less commonly referred pain and idiopathic or centralized pain conditions. All of these conditions can mimic toothache and vice versa. Many of these conditions are comorbid with high levels of tension headache and migraine reported in patients with TMD; however, dentists remain unfamiliar with headaches and medics unfamiliar with toothache's multiple presentations. The anatomical complexity of the region, the potential exhaustive differential diagnoses and the multiple siloed training of specialties, leads to incorrect and delayed diagnosis and often results in patients undergoing inappropriate surgical and medical treatments. The continued inappropriate interventions may also complicate the later presentation of the patient with pain, by changing its phenotype, preventing a timely and correct diagnosis. Due to the variable presentation of toothache, which can mimic many different chronic pains including; episodic throbbing pain of migraine, the dull continuous pain of myofascial and arthrogenous TMDs or centralized facial pain, diagnosis can be complex. Neuralgic pain occurs in the dentition in health and with disease, mimicking conditions like PPTTN, trigeminal neuralgia (TN), and trigeminal autonomic cephalalgias (TACs), many patients are inappropriately diagnosed and treated, either by general medical practitioners assuming that the neuralgia is due to TN rather than more commonly presenting toothache or by a dentists or other surgeons continuing to treat TN or TACs with routine surgical care. Many patients are prescribed countless courses of antibiotics and undergo multiple surgical interventions simply as a result of poor education due to siloed specialty training. This must be addressed to improve patient safety.

Sleep Disorders and Chronic Orofacial Pain

Sleep disturbances have been linked to chronic pain disorders and it has been suggested that they affect each other in a circular fashion. However, with the exception of sleep bruxism and temporomandibular disorders, very little is known about the interaction between sleep and specific orofacial pain disorders. We aimed to review and evaluate the existing knowledge about the relationship between orofacial pain and sleep disorders. Furthermore, to elaborate on management options for patients with orofacial pain and sleep disorders. Orofacial pain disorders such as temporomandibular disorders, burning mouth syndrome, and painful post-traumatic trigeminal neuropathy are reciprocally related to disturbances in sleep quality. Furthermore, in the case of temporomandibular disorders, it has been shown that sleep quality disturbances occur before pain onset. Regarding sleep bruxism, the recent literature seems to indicate that when sleep bruxism is assessed objectively (i.e., polysomnography), most sleep bruxism parameters do not seem to be able to explain temporomandibular disorder occurrence. Finally, very few studies have assessed the effect sleep quality improvement has on chronic orofacial pain parameters such as intensity and frequency. In general, there is a lack of studies assessing the relationship between sleep disturbances and orofacial pain disorders, the exception being the relationship between sleep bruxism and TMD. The few studies that exist suggest an association between orofacial pain disorders and decreased sleep quality. As such, it is important that the orofacial pain clinician be aware of comorbid sleep disorders and a multidisciplinary and integrative approach should be used to manage these patients.

Trigeminal autonomic cephalalgias presenting in a multidisciplinary tertiary orofacial pain clinic

Orofacial pain may have a variety of causes and offers a significant clinical challenge for its diagnosis and management.ObjectiveTo assess the headache disorders presenting in a tertiary multidisciplinary orofacial pain clinic, after dental causes have been excluded.MethodsClinic letters from the initial consultation and subsequent follow up reviews of the 142 patients, who were seen in the tertiary Multidisciplinary Orofacial Pain clinic between January 2015 until January 2018 were reviewed as a clinical audit.ResultsThe most common diagnoses were possible trigeminal autonomic cephalalgia (n = 62, 44%), migraine (n = 38, 27%) and painful post-traumatic trigeminal neuropathy (n = 17, 12%). The most common trigeminal autonomic cephalalgia diagnosis was hemicrania continua (n = 13, 9%), which is higher than the reported prevalence in neurology and headache clinics.ConclusionThis study demonstrates the importance of a multidisciplinary approach to diagnosing complex orofacial pain patients and the importance of awareness of primary headache disorders, in particular trigeminal autonomic cephalalgias, thereby reducing unnecessary diagnostic delays or procedures.

Comparison of the Neuropathic Pain Symptoms and Psychosocial Impacts of Trigeminal Neuralgia and Painful Posttraumatic Trigeminal Neuropathy.

To compare the impacts of trigeminal neuralgia (TN) and painful posttraumatic trigeminal neuropathy (PPTTN) on psychologic function and health-related quality of life (HRQoL) using a comprehensive quantitative assessment. This was a comparative cross-sectional study. A total of 97 patients diagnosed with PPTTN and 40 patients diagnosed with TN who sought treatment at an orofacial pain clinic completed standardized self-report measures of pain intensity, neuropathic symptoms, pain self-efficacy, mood, and indicators of general and oral HRQoL. Differences between the PPTTN and TN groups were tested, and associations of each condition with pain severity, psychologic function, and HRQoL were examined. The majority of PPTTN (66%) and TN patients (80%) were affected by orofacial pain. Pain attacks were more frequent in TN (71%) than PPTTN (28%) patients, while numbness was more common in PPTTN (51%) than TN (12%) patients. Pain intensity was higher in TN for intermittent and affective pain dimensions. Both PPTTN and TN had a significant, but comparable, impact on patients' oral HRQoL. The burden of condition on overall health was significantly more pronounced in patients with TN than PPTTN, with evident differences in the mobility and self-care domains. There was a trend showing that more TN (54%) than PPTTN (36%) patients reported signs of depression, but clinically significant anxiety was comparably high in both groups (34% to 39%). Anxiety and pain self-efficacy were closely related to oral and general health statuses in both groups. Both TN and PPTTN are associated with significant psychosocial burden and reduced HRQoL, indicating a need to develop effective treatments for neuropathic orofacial pain that target functional restoration.

Lipopolysaccharide-mediated inflammatory priming potentiates painful post-traumatic trigeminal neuropathy.

We explored the molecular and behavioral effects of a perineural Lipopolysaccharide (LPS)-mediated inflammatory priming on the development and maintenance of painful post-traumatic trigeminal neuropathy (PPTTN) following infra-orbital nerve chronic constriction injury (CCI-IoN) in rats. Rats were pretreated with repetitive perineural injections in the vicinity of the IoN of either LPS or vehicle (Vhcl) before being submitted to CCI-IoN. Orofacial pain-like behaviors (response to Von Frey Filament testing and spontaneous isolated face grooming) were measured during the period of LPS injections (three weeks) and following CCI-IoN surgery (two weeks). Local LPS administration induced an early pain-like behavior (i.e. an increase in spontaneous pain [SP] or mechanical static allodynia [MSA]) in both conditions, and following CCI-IoN, MSA and SP developed earlier and more severely in LPS-pretreated rats than in the control group. Ipsilateral increases of key neuropathic pain mRNA markers in the IoN parenchyma, trigeminal ganglia (TG) and spinal trigeminal nucleus caudalis (Sp5C) were observed in CCI-IoN injured animals as compared to controls. Although no significant molecular differences could be observed within the IoN parenchyma between LPS and Vhcl-pretreated animals, a significant increase of key inflammatory cytokine Interleukin 1 beta (IL - 1β) could be found in the TG of LPS-pretreated CCI-injured animals versus controls. Finally, a higher increase of inducible nitric oxide synthase (iNOS) in ipsilateral Sp5C of LPS-pretreated animals was observed as compared to Sp5C of Vhcl-pretreated animals. These results suggest a key role of inflammatory priming in the development and maintenance of PPTTN implicating IL-1β/iNOS-dependent central sensitization mechanisms.

Sleep quality and psychosocial characteristics of patients with painful post-traumatic trigeminal neuropathies

The aim of this study was to explore how pain and psychological distress influence the sleep quality of patients with painful post-traumatic trigeminal neuropathy (PPTN). Thirty-two patients with a diagnosis of PPTN according to the International Classification for Headache Disorders of the International Headache Society were enrolled. All patients completed a number of questionnaires that examined sleep quality, psychological distress, and quality of life. The global Pittsburg Sleep Quality Index (PSQI) score was "5" or greater in 75% of the patients. Additionally, the Symptom Check List-90-Revised (SCL-90-R) global severity index (GSI) revealed that 71.9% of the study sample reported values of psychological distress over the level of clinical significance. Sleep quality was analyzed through a linear regression model of global PSQI (dependent variable) that included gender, age, pain intensity, and pain duration (independent variables). This model revealed a significant positive association between the PSQI global score and the SCL-90-R GSI that was independent of age, gender, pain intensity, and duration. Patients with PPTN present higher levels of sleep disturbance and psychological distress compared with the general population. Sleep quality disturbances and levels of psychological distress are strongly associated and seem to be independent of age, gender, medication use, pain intensity and duration.

Prevalence of neuropathic pain and sensory alterations after dental implant placement in a university-based oral surgery department: A retrospective cohort study.

To determine the prevalence and the clinical features of patients with neuropathic pain and sensory alterations after dental implant placement. Literature is very scarce concerning the prevalence of neuropathic pain after dental implant placement. A retrospective cohort study was made in patients submitted to dental implant placement in the Dental Hospital of the University of Barcelona. A descriptive analysis of the data was made, and the 95% confidence intervals (95% CI) were calculated for the prevalences. The study sample was composed of 1156 subjects of whom, 1012 patients (3743 dental implants) met the study inclusion criteria. Four hundred and seventeen patients (41.2%) were male and 595 (58.8%) were female, with a mean age of 60.7years (range 16-90years). Three patients were diagnosed as having painful post-traumatic trigeminal neuropathy (PPTN), which corresponds to a prevalence of 0.3% (95% CI: 0%-0.6%). Additionally, 5 patients (0.5%; 95% CI: 0%-1.07%) presented trigeminal neuropathy without pain (TNWP). The combined prevalence of both disorders was 0.8% (95% CI: 0.02%-1.3%). All patients with PPTN and TNWP were 60years old or older, with a total combined prevalence of 1.48% (95% CI: 0.46%-2.5%) in this age group. Additionally, the prevalence in this age group for women was 1.85% (95%CI: 0.38%-3.31%). Neuropathic pain after dental implant placement is very infrequent (0.3%) in a University Oral Surgery department. However, the presence of trigeminal neuropathies can be slightly higher and can affect up to 0.5% of patients. Older female patients seem to be more prone to this rare and disabling complication.

Intraoral Sensory Abnormalities Caused by Tooth Extraction in a Patient with Chronic Inflammatory Demyelinating Polyneuropathy

Background: Chronic inflammatory demyelinating polyneuropathy (CIDP) is considered to be an immunemediated, acquired disease of the peripheral nerves. CIDP patients infrequently develop neuropathy with various clinical forms, such as blink reflex and trigeminal neuropathy. However, to our knowledge, there is no information about intraoral somatosensory changes associated with CIDP. Here, we report the case of a patient with CIDP who exhibited somatosensory changes investigated by quantitative sensory testing (QST). Case Report: A 77-year-old Japanese man was referred to our institution with symptoms of intraoral pain and swollen gingiva. The patient had been diagnosed with CIDP 8 years earlier. The second premolar of the right mandible was diagnosed with apical periodontitis, and tooth extraction was performed to control his pain and inflammation. Following the tooth extraction, local inflammation and pain subsided, however, the patient reported spontaneous dysesthesia on the adjacent gingiva of the extracted tooth. Intraoral qualitative sensory testing of the gingiva showed gingival mechanical allodynia and cold hypoalgesia at the extraction site. We diagnosed the patient with painful post-traumatic trigeminal neuropathy related to tooth extraction. Conclusion: Because of the lack of evidence for peripheral, organic changes in the oral mucosa, the sensory changes may be best explained by peripheral disturbance, an association may exist between these reported somatosensory changes and CIDP.