Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Advanced Training Program in Oral and Maxillofacial Surgery, Parkland Hospital, Dallas, TX.
Robert V. Walker DDS Endowed Chair in Oral and Maxillofacial Surgery, Division of Oral and Maxillofacial Surgery, Professor, Departments of Surgery and Neurology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX.
J Oral Maxillofac Surg. 2023 Jul;81(7):806-812. doi: 10.1016/j.joms.2023.03.012. Epub 2023 Mar 31.
Post-traumatic trigeminal neuropathic pain (PTTNp) is a challenging condition to treat, and equally as challenging is the identification of surgical outcome variables to guide treatment. The study purpose was to determine if preoperative pain intensity was related to postoperative recurrence of PTTNp.
This retrospective cohort study assessed subjects at a single institution with preoperative PTTNp of either the lingual or inferior alveolar nerves who underwent elective microneurosurgery. Two cohorts were established as follows: No PTTNp at 6 months (group 1); presence of PTTNp at 6 months (group 2). The primary predictor variable was the preoperative visual analog scale (VAS) score. The primary outcome variable was PTTNp (recurrence or no recurrence at 6 months). The demographic and injury characteristics of the groups were compared to assess whether they were similar using Wilcoxon rank analysis. Two-tailed Student's t-test was performed to analyze the difference in preoperative mean VAS scores. Multivariate multiple linear regression models were used to determine the association between the covariates on the outcomes of the primary predictor variable and the primary outcome variable. A P value of <.05 was considered statistically significant.
Forty-eight patients were included in the final analysis. There were 20 patients with no pain at 6 months and 28 with recurrence at 6 months following surgery. There was a significant difference in mean preoperative pain intensity between the two groups (P value .04). The mean preoperative VAS score in group 1 was 6.31 (standard deviation, 2.65), while the mean preoperative VAS score in group 2 was 7.75 (standard deviation, 1.95). Regression analysis showed that one covariate, the type of nerve injured, explained some variability of preoperative VAS score, but by only 16% (P value .005). Regression analysis also showed that two covariates, Sunderland classification and time to surgery, explained some of the variability of PTTNp at 6 months, by approximately 30% (P value .001).
This study showed that presurgical pain intensity level was related to postoperative recurrence in the surgical treatment of PTTNp. In patients with recurrence, the preoperative pain intensity was higher. Other factors, including time interval from injury to surgery, were also related to recurrence.
创伤后三叉神经病理性疼痛（PTTNp）是一种具有挑战性的治疗病症，同样具有挑战性的是确定手术结果变量以指导治疗。本研究的目的是确定术前疼痛强度是否与 PTTNp 的术后复发有关。
本回顾性队列研究评估了在单一机构就诊的、患有术前舌神经或下牙槽神经 PTTNp 的患者，他们接受了选择性微创神经外科手术。建立了以下两个队列：术后 6 个月无 PTTNp（第 1 组）；术后 6 个月存在 PTTNp（第 2 组）。主要预测变量是术前视觉模拟量表（VAS）评分。主要结局变量是 PTTNp（术后 6 个月时是否复发）。使用 Wilcoxon 秩分析比较两组的人口统计学和损伤特征，以评估它们是否相似。采用双尾 Student's t 检验分析术前平均 VAS 评分的差异。使用多元多线性回归模型确定协变量对主要预测变量和主要结局变量的结果的关联。P 值<.05 被认为具有统计学意义。
最终分析纳入了 48 例患者。术后 6 个月时，20 例患者无疼痛，28 例患者疼痛复发。两组间术前平均疼痛强度存在显著差异（P 值<.05）。第 1 组的平均术前 VAS 评分为 6.31（标准差，2.65），而第 2 组的平均术前 VAS 评分为 7.75（标准差，1.95）。回归分析表明，一个协变量，即损伤的神经类型，仅能解释术前 VAS 评分的 16%（P 值<.05）。回归分析还表明，两个协变量，即 Sunderland 分类和手术时间，能解释大约 30%的 PTTNp 术后 6 个月的变异性（P 值<.001）。
本研究表明，术前疼痛强度水平与 PTTNp 手术治疗后的复发有关。在复发患者中，术前疼痛强度更高。其他因素，包括从损伤到手术的时间间隔，也与复发有关。
