Kudo Yoko, Asoda Seiji, Muraoka Wataru, Wajima Koichi, Nakagawa Taneaki
Department of Dental Anesthesiology, Faculty of Dental Medicine and Graduate School of Dental Medicine, Hokkaido University, Sapporo, JPN.
Department of Dentistry and Oral Surgery, Keio University School of Medicine, Tokyo, JPN.
Cureus. 2025 May 17;17(5):e84308. doi: 10.7759/cureus.84308. eCollection 2025 May.
We report a case of neuropathic pain affecting the third branch of the trigeminal nerve caused by periodontitis associated with a low-level impacted mandibular third molar on the left side. The patient also experienced neuropathic pain in the second branch, which may have resulted from sensitization of the third branch. A 57-year-old woman presented with percussion and contact pain in the left maxillary second molar, along with burning pain extending from the left buccal region to the mandible. Pus discharge was noted from the periodontal pocket, and she was treated with anti-inflammatory medication and antibiotics. Although the pus discharge resolved, the pain persisted. The percussion and contact pain in the left maxillary second molar, as well as the burning pain from the left buccal area to the mandible, were diagnosed as neuropathic pain involving the left third branch of the trigeminal nerve, originating from inflammation of the left mandibular third molar. Persistent pain and allodynia in the second branch region were attributed to sensitization of the third branch. Pregabalin was added to her treatment, resulting in symptom relief. Imaging showed that the left mandibular third molar was low-level impacted and in close proximity to the inferior alveolar canal, which was identified as the source of the initial pain. The tooth was extracted under general anesthesia after pain symptoms improved. One month post-extraction, the patient experienced a flare-up of burning pain in the left maxillary second molar region and allodynia in the gingiva, as well as burning pain from the left buccal region to the mandible. Pregabalin was restarted but did not provide analgesic effects. Amitriptyline was then added, leading to pain relief. This case highlights the complex pathophysiology of neuropathic pain, which remains incompletely understood. Early intervention to relieve pain may be crucial to prevent chronic symptoms.
我们报告一例由左侧下颌低位阻生第三磨牙相关的牙周炎引起的三叉神经第三支神经性疼痛病例。患者还在第二支出现神经性疼痛，这可能是第三支致敏所致。一名57岁女性，左侧上颌第二磨牙出现叩击痛和接触痛，伴有从左侧颊部延伸至下颌的灼痛。牙周袋有脓性分泌物，给予抗炎药物和抗生素治疗。尽管脓性分泌物消失，但疼痛持续存在。左侧上颌第二磨牙的叩击痛和接触痛，以及从左侧颊部到下颌的灼痛，被诊断为涉及三叉神经左侧第三支的神经性疼痛，源于左侧下颌第三磨牙的炎症。第二支区域的持续性疼痛和痛觉过敏归因于第三支的致敏。加用普瑞巴林治疗后症状缓解。影像学检查显示左侧下颌第三磨牙低位阻生，紧邻下牙槽神经管，被确定为初始疼痛的来源。疼痛症状改善后，在全身麻醉下拔除该牙。拔牙后1个月，患者左侧上颌第二磨牙区域出现灼痛发作，牙龈出现痛觉过敏，以及从左侧颊部到下颌的灼痛。重新使用普瑞巴林但未产生镇痛效果。随后加用阿米替林，疼痛缓解。该病例突出了神经性疼痛复杂的病理生理学机制，目前仍未完全了解。早期干预缓解疼痛对于预防慢性症状可能至关重要。
