Diagnosis and management of traumatic neuropathy

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Introduction. Traumatic trigeminal neuropathy in neurological practice occurs relatively rarely.
Objectives. To study clinical and neurophysiological features of traumatic trigeminal neuropathy caused by orthognathic surgeries.
Materials and methods. Patients (n=24; aged 23–56 years) undergone orthognathic surgery, in short-term postoperative period (no more than 1 month since the surgery) received a therapeutic course of rhythmic magnetic stimulation. Stimulation pulse was 1–1.5 T, pulsing frequency 1 Hz, duration of the treatment 15–20 minutes daily, the course of treatment 10 days. Acoustic brainstem and trigeminal evoked potentials were recorded.
Results. The clinical picture of post-operative trigeminal neuropathy is dominated by hypoesthesia of varying severity, and the trigger zone of the face and in the mouth are not determined. Tenderness of trigeminal nerve exit point was observed in 2nd, 3rd as well as in all three branches of the trigeminal nerve. In the study of acoustic brainstem evoked potentials there were identified changes at the medulla-pontine level more evident on one side (usually on the right), shortening of the latent periods of three peaks, I–III–V peaks amplitudes increase on both sides, and confluence of II–III peaks, mostly on one side. Reduction of latency and increase of amplitude of trigeminal evoked potentials components indicate dysfunction of the trigeminal system on both sides. Clinical effect expressed in improvement of sensitive disturbanses after the course of rhythmic magnetic stimulation was observed in 83% of patients; at the same time there was observed some delay of improvement of neurophysiological symptoms.
Conclusion. Clinical-neurophysiological dissociation after the course of rhythmic magnetic stimulation can be explained by the short term of the course, incomplete recovery of functions of the structures involved in the stimuli conduction, as well as by the lack of adequate medical support.

About the authors

Marine M. Tanashyan

Research Center of Neurology

Email: ncnmaximova@mail.ru
ORCID iD: 0000-0002-5883-8119

D. Sci. (Med.), Prof., Corresponding member of RAS, Deputy Director for science, Head, 1st Neurological department

Russian Federation, Moscow

Marina Yu. Maksimova

Research Center of Neurology

Author for correspondence.
Email: ncnmaximova@mail.ru
ORCID iD: 0000-0002-7682-6672

D. Sci. (Med), Prof., Head, 2nd Neurology department; professor, Division of diseases of the nervous system, Department of dentistry

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80; Moscow

Pavel A. Fedin

Research Center of Neurology

Email: ncnmaximova@mail.ru
Russian Federation, Moscow

Olga V. Lagoda

Research Center of Neurology

Email: ncnmaximova@mail.ru
Russian Federation, Moscow

Elvira M. Musaeva

Peoples' Friendship University of Russia

Email: ncnmaximova@mail.ru
Russian Federation, Moscow


  1. Agbaje J.O., Salem A.S., Lambrichts I. et al. Systematic review of the incidence of inferior alveolar nerve injury in bilateral sagittal split osteotomy and the assessment of neurosensory disturbances. Int J Oral Maxillofac Surg 2015; 44(4): 447–451. doi: 10.1016/j.ijom.2014.11.010. PMID: 25496848.
  2. Politis C., Lambrichts I., Agbaje J.O. Neuropathic pain after orthognathic surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117(2): e102–e107. doi: 10.1016/j.oooo.2013.08.001. PMID: 24120908.
  3. Robert R.C., Bacchetti P., Pogrel M.A. Frequency of trigeminal nerve injuries following third molar removal. J Oral Maxillofac Surg 2005; 63(6): 732–735. doi: 10.1016/j.joms.2005.02.006. PMID: 15944965.
  4. Wijbenga J.G., Verlinden C.R., Jansma J. et al. Long-lasting neurosensory disturbance following advancement of the retrognathic mandible: distraction osteogenesis versus bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2009; 38(7): 719–725. doi: 10.1016/j.ijom.2009.03.714. PMID: 19394196
  5. Politis C., Sun Y., Lambrichts I., Agbaje J.O. Self-reported hypoesthesia of the lower lip after sagittal split osteotomy. Int J Oral Maxillofac Surg 2013; 42(7): 823–829. doi: 10.1016/j.ijom.2013.03.020. PMID: 23639585.
  6. Yoshioka I., Tanaka T., Khanal A. et al. Relationship between inferior alveolar nerve canal position at mandibular second molar in patients with prognathism and possible occurrence of neurosensory disturbance after sagittal split ramus osteotomy. J Oral Maxillofac Surg 2010; 68(12): 3022–3027. doi: 10.1016/j.joms.2009.09.046. PMID: 20739116.
  7. Yamauchi K., Takahashi T., Kaneuji T. et al. Risk factors for neurosensory disturbance after bilateral sagittal split osteotomy based on position of mandibular canal and morphology of mandibular angle. J Oral Maxillofac Surg 2011; 70(2): 401–406. doi: 10.1016/j.joms.2011.01.040. PMID: 21549489.
  8. Bagheri S.C., Meyer R.A., Khan H.A., Steed M.B. Microsurgical repair of peripheral trigeminal nerve injuries from maxillofacial trauma. J Oral Maxillofac Surg 2009; 67(9): 1791–1799. doi: 10.1016/j.joms.2009.04.115. PMID: 19686912.
  9. D’Agostino A., Trevisiol L., Gugole F. et al. Complications of orthognathic surgery: the inferior alveolar nerve. J Craniofac Surg 2010; 21(4): 1189–1195. doi: 10.1097/SCS.0b013e3181e1b5ff. PMID: 20613608.
  10. Degala S., Shetty S.K., Bhanumathi M. Evaluation of neurosensory disturbance following orthognathic surgery: a prospective study. J Maxillofac Oral Surg 2015; 14(1): 24–31. doi: 10.1007/s12663-013-0577-5. PMID: 25729223.
  11. Ponomarenko G.N. Electromagnetotherapy and phototherapy. St. Peterburg: Mir i sem'ya-95; 1995: 248 p. (In Russ.).
  12. Maksimova M.Yu., Fedin P.A., Suanova E.T., Tyurnikov V.M. Neurophysiological features of atypical facial pain. Annals of clinical and experimental neurology. 2013; 7(3): 9–16. (In Russ.).

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Copyright (c) 2018 Tanashyan M.M., Maksimova M.Y., Fedin P.A., Lagoda O.V., Musaeva E.M.

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