IADR Abstract Archives
Management of Trigeminal Neuralgia: a Non-Traditional Treatment Approach
Objectives: Trigeminal neuralgia is a chronic pain condition associated with sharp, shock-like pain in one or more divisions of the trigeminal nerve. For patients who do not respond well to pharmacotherapy, there is growing evidence that Botulinum toxin type A injections into the trigeminal ganglion provide pain relief for several months at a time. These injections are administered into the trigeminal ganglion in Meckel’s cave by inserting a needle through the Pterygopalatine Fossa using fluoroscopy to guide and confirm proper needle placement. However, there is evidence that Botulinum toxin travels across nerve synapses; thus, injecting directly into the trigeminal ganglion may not be necessary. This case report aims to explore the possibility of managing Trigeminal Neuralgia with Botulinum toxin type A injections into a more easily-accessible site.
Methods: We present two patients with a confirmed diagnosis of trigeminal neuralgia who were treated by injecting Botulinum toxin type A intraorally into the mental foramen. The patients returned as needed for additional rounds of injections to manage their pain and the frequency of their electric-shock-like attacks. The patients' pain levels were measured using the Visual Analog Scale (VAS) at each appointment and any quality of life changes documented.
Results: Treatment in this manner resulted in 6 months or longer of pain relief for both patients with no adverse health effects, consistent with expected results from fluoroscopy-guided injections into the trigeminal ganglion.
Conclusions: While additional studies are needed before wide-scale adoption of this treatment is recommended, the current literature and our experience indicate that this treatment modality is safe and effective with no local or systemic adverse effects. Injections into the mental foramen are much less-invasive than those administered directly into the trigeminal ganglion and both patients we treated experienced comparable results to what can be expected from traditional fluoroscopy-guided Botulinum toxin injections.
Methods: We present two patients with a confirmed diagnosis of trigeminal neuralgia who were treated by injecting Botulinum toxin type A intraorally into the mental foramen. The patients returned as needed for additional rounds of injections to manage their pain and the frequency of their electric-shock-like attacks. The patients' pain levels were measured using the Visual Analog Scale (VAS) at each appointment and any quality of life changes documented.
Results: Treatment in this manner resulted in 6 months or longer of pain relief for both patients with no adverse health effects, consistent with expected results from fluoroscopy-guided injections into the trigeminal ganglion.
Conclusions: While additional studies are needed before wide-scale adoption of this treatment is recommended, the current literature and our experience indicate that this treatment modality is safe and effective with no local or systemic adverse effects. Injections into the mental foramen are much less-invasive than those administered directly into the trigeminal ganglion and both patients we treated experienced comparable results to what can be expected from traditional fluoroscopy-guided Botulinum toxin injections.