Trigeminal neuralgia-like pain is often

seen in the mental nerve region of the

mandible, but frequently, there is no

radiographic evidence for the source of

such pain.

A common cause of pain in the middle and anterior portion of the mandible is an injury or abnormality of the inferior alveolar nerve or its largest terminal branch, the mental nerve. Procedures such as implant placement, simple and complex oral surgical procedures, or improper retraction of a tissue flap containing the mental nerve are all known causes for injury to the mental nerve.

In addition, crushing injuries, producing permanent nerve injury, is another recognized cause of mental nerve pain.

Publication:01/01/2009

Name: CRANIO: The Journal of Craniom

andibular Practice Publisher: Chroma

Subject: Science and

technology

This irritation may be severe enough to

produce a chronic, atypical type of

trigeminal neuralgia, which is not

amenable to treatment with

medications. Such was the situation in

the current case report Published in 2009

as well as

EXCRUCIATING

ELECTRIC SHOCK LIKE

PAIN !!...

An 88-year-old Caucasian married female was

seen in a craniofacial pain practice with the chief

complaint of left jaw pain. The pain had been

present for about a year with no known etiology

nor a prior history of any type of trigeminal pain.

Teeth numbers 17 through 22 had been removed

years earlier without any post-operative

complications.

Ten years earlier, she had been successfully

surgically treated for a bony lesion in the posterior

portion of the left side of her mandible, but until

the onset of this current problem, she had

experienced no additional mandibular pain.

The pathological diagnosis was ischemic

osteonecrosis and for nine years, she had been

pain-free.

With the onset of her current pain, she consulted her primary care physician who referred her to a neurologist.

Neurological evaluation, which included MRI evaluation, was negative. Cranial nerve examination was normal. with the exception of elicitation of pain in the mental nerve origin only. The patient was placed on a trial dose of gabapentin with no success.

She described her pain as sharp, shooting, and at times, electrical, which affected the normal distribution of the mental nerve.

Panoramic radiographic evaluation demonstrated

what appeared to be a normally formed mental

foramen.

A diagnostic anesthetic injection of the mental

nerve with one cubic centimeter of Citanest

(Prilocaine HCl 4% without vasoconstrictor. Dentsply

International, York, PA) alleviated all pain

complaints with any movement of her face or lip.

When the anesthetic effects were gone, her pain

returned just as before the injection.

A diagnosis of atypical trigeminal neuralgia of the

mental nerve of unknown etiology was

determined.

NAME = M.ABBAS

AGE=50

DOA=13/8/2014

SHARP SHOOTING,LANCINATING PAIN IN

THE RT SIDED MENTAL REGION SINCE 1

YEAR 2 DAYS AFTER EXTRACTION OF

MAXILLARY TOOTH…

PT UNDER different Rx since 1 year at

various settings

(Hyderabad,Dadu,Karachi)

NO RELIEF IN PAIN WHATSOEVER!...

The mental foramen is the structure which

conveys the mental nerve, artery and vein.

Research locates the foramen as most

commonly being situated directly below

the apex of the second premolar. (3-11)

When reviewing the literature, it is clear that

the position of the mental foramen varies,

but the most common location is below the

second mandibular premolar tooth.

Article presents a case of trigeminal neuralgia-like pain of the mental nerve

. An 88-year-old female presented with trigeminal neuralgia-like pain in the distribution of the mental nerve due to no known etiology. Conservative therapy using the appropriate medication by her neurologist was not beneficial and she could not tolerate the side effects of the medication.

Her pain was immediately and totally eliminated with a diagnostic anesthetic block of the painful mental nerve.

Successful treatment was provided by carefully

smoothing of the osseous edge or rim of the mental foramen.

NOTE THE DIFFERENCE IN SIZE

The first line of treatment for patients with

trigeminal neuralgia is always

medication. Even minimally invasive

surgery carries risks and should be

considered a last resort.

ANTICONVULSANTS

ANTIDEPRESSANTS

CARBAMEZAPINE,GABAPENTIN,PHENYTOIN etcCommonly experienced side effects of drug therapy for TN include dizziness, drowsiness, forgetfulness, unsteadiness, and nausea.

In addition, carbamazepine and other drugs prescribed for TN do not always remain effective over time, requiring high doses each time.

Surgical evaluation for trigeminal neuralgia includes confirming the diagnosis of trigeminal neuralgia, reviewing a brain magnetic resonance imaging (MRI) scan to exclude other treatable causes of face pain, and evaluating the severity of the pain, the general medical condition of the patient, and the patient's preference for treatment goals versus risk aversion.

NO ABNORMALITY

OR EVIDENCE OF

PRINCIPLE

VASCULAR

COMPRESSION

SEEN WITHIN THE

BRAIN.

BOTH MIDDLE

AND ANT

CEREBRAL

ARTERIES

PATENT.

CENTRAL CAUSE NOT FOUND

Trigeminal neuralgia surgery is reserved

for people who still experience

debilitating pain despite best medical

management

MVD

GAMMA

KNIFE

1-

MENTAL FORAMEN

CONTOURING/RESHAPING???....