Neurological

Predicting the recovery of patients with post-traumatic trigeminal neuropathy

Subjective well-being can be a contributing factor in neurosensory recovery after post-traumatic trigeminal neuropathy (PTN). These results from a prospective observational study were published in the Journal of Headache and Pain.

Patients (N = 36) were enrolled at Leuven University Hospital in Belgium between 2018 and 2020. Both objective (neurosensory tests) and subjective (EuroQol 5-dimensional scale). [EQ5D-5L], General Anxiety Disorder 7 [GAD-7], Patient health questionnaires [PHQ-9 and -15], Neuropathic pain 4 [DN4], and the Brief Pain Inventory [BPI]). PTN properties were evaluated. Based on this data, a predictive model for recovery after 6 months was formulated.

The patients included 23 women and 13 men with a mean age of 42 (range 23-68) years. The patients were attended by an oral and maxillofacial surgeon (89%) or an external dentist (11%).

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The PTN was left-sided and was determined by the removal of the third molar (47%), the implant placement (11%), the facial trauma (11%), the local anesthesia (8%), the extraction of the non-wisdom tooth (6%) and the Endodontics triggered treatment (6%). The affected nerves included the inferior alveolar nerve (64%), the lingual nerve (28%), the maxillary nerve (19%), and the ophthalmic nerve (3%).

Most of the objective measures were significantly correlated. The strongest positive correlations were stimulus localization and directional discrimination (r, 0.83) and 2-point discrimination with the Sunderland score (r, 0.75) and with the sensory code with loss of function (r, 0.72). The Medical Research Council Scale correlated negatively with the proportion of affected dermatomes (r, -0.71) and Sunderland scores with directional discrimination (r, -0.71) and with the stimulus localization (r, -0.71).

Most of the subjective measurements were significantly positively correlated. EQ5D quality of life was the only measure that negatively correlated with other subjective characteristics, suggesting that negative patient disposition may influence symptoms of PTN.

Some objective and subjective measurements were correlated. The EQ5D quality of life correlated significantly with the sensory function gain phenotype (r, -0.41), the Medical Research Council Scale (r, 0.36), the percentage of affected dermatoma (r, -0.35), allodynia of the brushstroke (r, -0.24) and Sunderland score (r, -0.21).

Based on this data, the researchers created a predictive model for the 6-month neurosensory recovery. Three variables predicted recovery and 27 variables predicted no recovery. The negative predictive value of the model was 87%, the positive predictive value 60%, the sensitivity 43% and the specificity 93%.

This model may have been limited by the small sample size and the ability to combine data from patients with differently affected nerve and facial regions.

Objective and subjective PTN readings were correlated and a baseline characteristics model strongly predicted no recovery after 6 months.

reference

Meewis J, Renton T, Jacobs R, Politis C, Van der Cruyssen F. Post-traumatic trigeminal neuropathy: Correlation between objective and subjective assessments and a predictive model for neurosensory recovery. J headache pain. 2021; 22 (1): 44. doi: 10.1186 / s10194-021-01261-3

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