Painful traumatic trigeminal neurpathy; diagnosis and treatment: about two clinical cases

Abstract

Neuropathic pain is originated as a direct consequence of an injury or disease that affects the somatosensory system, which is a chronic, debilitating condition that affects a significant number of patients. The causes of neuropathic pain are diverse, and trauma is one of them. In this article the Painful Traumatic Trigeminal Neuropathy (PTTN) is reviewed. Two clinical cases are presented. The first is a 43-year-old female with PTTN, who was diagnosed nine months after reduction and osteosynthesis of a left zygomatomaxillary fracture. The second case corresponds to a 62-year-old male who presented with a left suborbital PTTN also after a zygomatomaxillary fracture and its reduction and osteosynthesis surgery. In the first case, the patient achieved a 70 % of reduction in pain after 6 months of treatment using multimodal analgesia with pregabalin, carbamazepine and amitriptyline. The second patient achieved complete resolution of pain with multimodal therapy using carbamazepine, amitriptyline, and lidocaine patches after two months of treatment. Therapy through multimodal analgesic scheme provides a favorable prognosis, however achieving a total resolution of the patient’s pain is a difficult objective to achieve, and a significant reduction of 30% or more in the patient´s VAS is considered a success of the effectiveness of the therapy.