Yuvaraj V, Krishnan B, Therese Beena Agnes, Balaji T S
Department of Oral and Maxillofacial Surgery, Sri Venkateshwaraa Dental College and Hospital, Pondicherry, India.
2Department of Dentistry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), 74, 4th Cross, Thanthai Periyar Nagar, Pondicherry, 605005 India.
J Maxillofac Oral Surg. 2019 Mar;18(1):15-22. doi: 10.1007/s12663-018-1108-1. Epub 2018 Apr 4.
Of the many chronic painful conditions, trigeminal neuralgia (TN) affecting the orofacial region needs the particular attention of physicians and surgeons, especially those specialising in the maxillofacial region. Treatment protocols for the management of classic TN include pharmacology and surgical intervention. Oral and maxillofacial surgeons have traditionally employed the peripheral neurectomy in the surgical management of TN. This review aims to evaluate the efficacy of peripheral neurectomy in the management of TN with regard to (a) the relief of symptoms in comparison with standard neurosurgical procedures and (b) the duration of pain relief and complications observed compared to standard neurosurgical procedures.
The review of the literature was done according to PRISMA guidelines and included randomised controlled trials, reviews and prospective clinical studies involving surgical procedures for the management of TN. The primary outcomes evaluated were (a) initial relief of pain, (b) duration of relief of pain, (c) complications observed with ablative procedures and (d) recurrence of symptoms. A total of 43 studies fulfilled the inclusion criteria.
In a total of 7913 patients from the 43 studies, central procedures were found to have best results for both quality and duration of pain relief. Percutaneous and peripheral procedures were associated with increased recurrence rates. The consolidated rates of complication for peripheral, percutaneous and central procedures were 39.46, 65.42 and 10.41%, respectively. The use of peripheral neurectomy alone in the management of classic TN was observed in 10 studies.
Peripheral neurectomy in TN is associated with lesser quality of pain relief in comparison with central neurosurgical procedures. It also provides only short- to medium-term pain relief. Most studies with the use of peripheral neurectomy involved only a small group of patients with short follow-up periods. Oral and maxillofacial surgeons must not consider the peripheral neurectomy as the first surgical option in the management of classic TN. Long-term results can be achieved better with appropriate central neurosurgical procedures and pharmacotherapy.
在众多慢性疼痛病症中，影响口面部区域的三叉神经痛（TN）需要内科医生和外科医生，尤其是颌面外科专科医生的特别关注。经典三叉神经痛的治疗方案包括药物治疗和手术干预。口腔颌面外科医生传统上采用周围神经切除术来治疗三叉神经痛。本综述旨在评估周围神经切除术在治疗三叉神经痛方面的疗效，具体涉及：（a）与标准神经外科手术相比，症状缓解情况；（b）与标准神经外科手术相比，疼痛缓解的持续时间及观察到的并发症。
根据PRISMA指南对文献进行综述，纳入了涉及三叉神经痛手术治疗的随机对照试验、综述和前瞻性临床研究。评估的主要结局包括：（a）疼痛的初始缓解情况；（b）疼痛缓解的持续时间；（c）观察到的消融手术并发症；（d）症状复发情况。共有43项研究符合纳入标准。
在这43项研究的总共7913例患者中，发现中枢手术在疼痛缓解的质量和持续时间方面效果最佳。经皮和周围手术的复发率较高。周围、经皮和中枢手术的综合并发症发生率分别为39.46%、65.42%和10.41%。有10项研究观察了单独使用周围神经切除术治疗经典三叉神经痛的情况。
与中枢神经外科手术相比，三叉神经痛的周围神经切除术在疼痛缓解质量方面较差。它也仅能提供短期至中期的疼痛缓解。大多数使用周围神经切除术的研究仅涉及一小部分患者且随访期较短。口腔颌面外科医生在治疗经典三叉神经痛时，不应将周围神经切除术视为首选手术方式。采用适当的中枢神经外科手术和药物治疗可更好地实现长期效果。
