Abstrato

Efficacy of Peripheral Neurectomy in the Management of Refractory Cases of Trigeminal Neuralgia

Priya Jeyaraj*

The treatment modalities to afford a cure from the intractable pain associated with Trigeminal neuralgia have been wide and varied. Six cases of Trigeminal neuralgia, three affecting the Infraorbital branch of the Maxillary division and three involving the Inferior Alveolar branch of the Mandibular division are presented. The neuralgia in all these cases had become refractory to increasing doses of medication. All six patients were thereafter successfully treated by Peripheral Neurectomy of the involved nerve trunks, which resulted in a complete resolution of all symptoms with no recurrence even after a follow up period of three to five years. Histopathological and immunohistochemical examination of the extirpated nerve fibers revealed varying degrees of axonal degeneration and demyelination of the nerve sheaths at different locations, which could be a contributory or even an etiological factor of the condition, thus corroborating and confirming the relevance and efficacy of the mildly invasive surgical procedure of Peripheral Neurectomy in affording a permanent cure of the refractory neuralgic pain. In addition, an adjunctive measure has been proposed and elucidated, which comprises of electrocauterisation of the nerve canal and foramen following the nerve extirpation, which could prevent possible regeneration of remnants of the nerve fibers, in this way, further ensuring a permanent resolution and cure, with nil recurrence.