Prognosis after surgical treatment of trigeminal neuropathy with a
Prognosis after surgical treatment of trigeminal neuropathy with a
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三叉神经病手术治疗后的预后
DOI：
10.1093/pm/pnw088
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发表时间：
2016
期刊：
影响因子：
3.1
通讯作者：
Tanaka Y
中科院分区：
文献类型：
--
作者：
Seo K ;Terumitsu M ;Inada Y ;Nakamura T ;Shigeno K ;Tanaka Y
目的：虽然使用聚乙醇酸-胶原(PGA-c)管的手术对于周围神经损伤引起的慢性手痛是有效的，但由于手术入路困难，它还没有被应用于三叉神经损伤。我们在三叉神经病的手术中使用了PGA-C管，并根据结果评估了其预后。设计、病例报告、设置和患者。在一所大学医院的牙科麻醉科，11例严重感觉障碍的患者接受了舌神经(LN)或下牙槽神经(IAN)损伤的手术修复。一名患者失去了随访。比较10例患者手术前后定量感觉测试(QST)的变化和感觉障碍的存在情况。采用桥接或环扎周围神经两种手术方法。当检测到神经收缩或术中神经撕裂时，选择双侧残端桥接(N = 4)。否则，使用纵向PGA-c管包裹病变(N = 6)。结果两种方法均可改善患者的QST结果(刷击知觉、机械触摸阈值、对冷/热刺激的敏感性)。6例患者术前痛觉异常或感觉障碍缓解，4例患者疼痛或感觉障碍明显减轻。2例患者(1例为炎症性疼痛，1例为植入物相关疼痛)术后长期疼痛，需要止痛药物治疗。结论：使用PGA-c管行手术治疗LN或Ian神经病引起的顽固性疼痛有助于减轻感觉障碍。然而，应该注意到术后出现新的痛经的可能性。
Objective.Although surgery using a polyglycolic acid–collagen (PGA-c) tube is effective for peripheral nerve injury-induced chronic hand pain, it has not been applied to trigeminal nerve lesions because of the difficult approach. We used a PGA-c tube during surgery for trigeminal neuropathy and evaluated its prognosis based on the outcomes.Design.Case report.Setting and Patients.In the dental anesthesia division of a university hospital, 11 patients with severe dysesthesia underwent surgical repair of a damaged lingual nerve (LN) or inferior alveolar nerve (IAN). One patient was lost to follow-up. Changes in quantitative sensory testing (QST) and the presence of dysesthesia as a treatment outcome were compared preoperatively and postoperatively in 10 patients. Two surgical treatments, bridging or encircling peripheral nerves, were applied. Bridging of both stumps was selected when neurotmesis was detected or the nerve was lacerated during surgery (N = 4). Otherwise, a longitudinal PGA-c tube was used to encircle the lesion (N = 6). Outcomes were evaluated 2 months to 8 years postoperatively.Results.Both methods improved the patients’ condition based on QST results (brush stroke perception, mechanical touch threshold, sensitivity to cold/hot stimuli). Preoperative allodynia or dysesthesia was resolved in six patients and greatly reduced in four. Two patients (one with inflammation-induced pain, one with implant-related pain) developed prolonged postoperative allodynia requiring pain-relief medication.Conclusions.Use of a PGA-c tube for surgical treatment of intractable pain due to LN or IAN neuropathy helps alleviate sensory impairment. The possibility of new dysesthesias emerging postoperatively, however, should be noted.