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创伤后三叉神经病理性疼痛:关于理解、管理及预后的叙述性综述

Post-Traumatic Trigeminal Neuropathic Pain: A Narrative Review of Understanding, Management, and Prognosis.

作者信息

Park Hyun-Jeong, Ahn Jong-Mo, Ryu Ji-Won

机构信息

Department of Oral Medicine, College of Dentistry, Chosun University, Gwangju 61452, Republic of Korea.

出版信息

Biomedicines. 2024 Sep 10;12(9):2058. doi: 10.3390/biomedicines12092058.

Abstract

This study provides an updated overview of the clinical characteristics of post-traumatic trigeminal neuropathic pain (PTNP) resulting from dental procedures or facial trauma, addressing its etiology, prevalence, evaluation, management, and prognosis. PTNP arises from injury to the trigeminal nerve, which governs sensory and motor functions in the maxillofacial region. The prevalence and characteristics of PTNP vary considerably across studies, with a reported prevalence ranging from 1.55% to 13%. The predominant causative factors are dental procedures, particularly third molar removal and implant placement. While gender distribution varies, a trend towards higher incidence in females is observed, particularly within the 40-60-year age group. Anatomically, the mandibular nerve is frequently involved. PTNP presents with a spectrum of symptoms ranging from tingling sensations to severe pain. Diagnostic challenges arise due to the lack of standardized criteria and potential overlap with focal neuralgia, necessitating comprehensive evaluation. Misdiagnosis can lead to prolonged patient suffering and unnecessary interventions. Successful management hinges on prompt diagnosis and interdisciplinary collaboration, with early intervention crucial in mitigating progression to chronic pain. Although nerve recovery post-trauma is challenging, preventive measures through accurate evaluation and treatment are paramount. Management strategies for PTNP include non-invasive and surgical interventions, with non-invasive approaches encompassing systemic and local pharmacological management. This narrative review aims to enhance uniformity in PTNP evaluation and treatment approaches, ultimately improving patient care and outcomes.

摘要

本研究提供了因牙科手术或面部创伤导致的创伤后三叉神经痛性疼痛(PTNP)临床特征的最新概述,涉及病因、患病率、评估、管理和预后。PTNP源于三叉神经损伤,该神经支配颌面部区域的感觉和运动功能。PTNP的患病率和特征在不同研究中差异很大,报告的患病率范围为1.55%至13%。主要致病因素是牙科手术,尤其是拔除第三磨牙和植入种植体。虽然性别分布有所不同,但观察到女性发病率有升高趋势,特别是在40至60岁年龄组。从解剖学角度来看,下颌神经常受累。PTNP表现出从刺痛感至剧痛等一系列症状。由于缺乏标准化标准以及与局灶性神经痛可能存在重叠,诊断存在挑战,需要进行全面评估。误诊会导致患者长期痛苦和不必要的干预。成功的管理取决于及时诊断和跨学科协作,早期干预对于减轻向慢性疼痛的进展至关重要。尽管创伤后神经恢复具有挑战性,但通过准确评估和治疗采取预防措施至关重要。PTNP的管理策略包括非侵入性和手术干预,非侵入性方法包括全身和局部药物管理。本叙述性综述旨在提高PTNP评估和治疗方法的一致性,最终改善患者护理和治疗结果。

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