Resection of the Posterior, Middle, and Anterior Superior Alveolar Nerves and Infraorbital Nerve Neurolysis for Refractory Maxillary Pain

Publication date: Available online 8 January 2018
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Leila Musavi, Alexandra Macmillan, Rachel Pedriera, Joseph Lopez, Amir H. Dorafshar, A. Lee Dellon
PurposeTrigeminal injury can cause intractable facial pain. However, surgical approaches to the superior alveolar nerves have not been widely described. Here, we present the resection of the anterior, middle, and posterior superior alveolar nerves (ASAN, MSAN, and PSAN) for a patient with refractory facial pain, and outline an algorithmic approach to the treatment of trigeminal nerve injury.MethodsA 56-year-old female presented with a three-year history of refractory facial pain in the distribution of her right superior alveolar nerves following dental trauma. As a co-morbidity, the patient developed central sensitization, manifested in the non-injured oral areas being painful. Following several temporary nerve blocks and medical management, she underwent resection of the ASAN, MSAN, and PSAN, as well as neurolysis of the infraorbital nerve through a Caldwell-Luc approach.ResultsOne week post-operatively, the patient reported significant improvement in pain symptoms, including burning and temperature sensitivity, in the right maxilla. These findings were maintained at 7 months, without any maxillary sinus complications. Her central sensitization caused continued intra-oral symptoms.ConclusionThe ASAN, MSAN, and PSAN can be surgically resected within the maxillary sinus to treat refractory neuropathic pain. An etiology-based approach can guide successful treatment of trigeminal neuropathy. Central sensitization as a co-morbidity must be addressed medically.



http://ift.tt/2m8iUpC