Vipul Garg, Ankit Aggarwal, Anik Sarkar*, Vanshikha Sharma, Marvi Bhopal, Megha Dhadwal, Shruti and Dakshanya Chatterjee

Department of Oral and Maxillofacial Surgery, Himachal Institute of Dental Sciences, India

*Corresponding Author: Anik Sarkar, Department of Oral and Maxillofacial Surgery, Himachal Institute of Dental Sciences, India.

Received: July 15, 2024; Published: October 18, 2024

Abstract

Introduction: Carbamazepine is usually the preferred first line of treatment for Trigeminal neuralgia, followed by some choice of drugs like Lamotrigine and Baclofen and anti-epileptics like Phenytoin, Gabapentin, Topiramate, Tocainide and Valproate. If there is a decrease in efficacy or development of tolerance to the drugs, some surgical modality needs to be considered. Factors such as pain relief, recurrence rate, morbidity, and mortality rates should be kept in mind while going through the treatment plan. A minimally invasive procedure for the treatment of Trigeminal Neuralgia is Peripheral neurectomy, a safe and efficient procedure for elderly patients, in rural and remote centers where neurosurgical facilities and the choice of drugs are not readily available. It is also effective in those patients who are reluctant to wait long enough for the pharmacotherapeutics to be efficient and also elect for any elaborate and extravagant neurosurgical procedures. Although loss of sensation along the branches of the trigeminal nerve and recurrence rate are associated trade-offs with peripheral neurectomy, all in all, it is considered a fairly safe and logical procedure in rural practice, which can be done even under local anesthesia. The purpose of this study is to evaluate the difference in recurrence outcomes of obturating the exposed nerve foramina using a titanium screw vs bone wax vs leaving the foramen open.

Materials and methods: 3 patients reporting to the Department of Oral and Maxillofacial Surgery, Himachal Institute of Dental Sciences, Paonta Sahib with complaints of sharp, stabbing paroxysmal pain responding to certain trigger points on whom previous medication of Carbamazepine was ineffective were prepared for peripheral neurectomy. On one patient, a titanium screw and on another, bone wax was used to obturate the exposed foramen post-operatively. In the third patient, the foramen was left as it is.

Results: The method of using a Titanium screw to obturate the foramen showed promising results when compared with both bone wax and leaving the foramen open.

Conclusion: Peripheral neurectomy is an efficient and cheap way to provide relief to patients living in rural areas with little healthcare facilities for trigeminal neuralgia. The decision to obturate the foramen with a titanium screw is still a viable option when compared with other methods of obturation.

 Keywords: Neurovascular Compression; Multiple Sclerosis; Ganglionic Local Opioid Analgesia; Repetitive Transcranial Magnetic Stimulation; Microvascular Decompression; Gamma Knife

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Citation

Citation: Anik Sarkar., et al. “Peripheral Neurectomy for Trigeminal Neuralgia Followed by a Choice of Two Different Means of Obturating the Nerve Foramina”. Acta Scientific Neurology 7.11 (2024): 01-09.

Copyright

Copyright: © 2024 Anik Sarkar., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.