SURGICAL NEURECTOMY OF INFERIOR ALVEOLAR NERVE IN REFRACTORY TRIGEMINAL NEURALGIA: A REPORT OF CASE SERIES

Background: Trigeminal neuralgia is a commonly diagnosed neurosensory disease of head, neck and face region, involving 5th cranial nerve. “Tic Douloureux‟ and “Fothergill”s disease are the synonyms used to describe the same disease. Peripheral neurectomy is one of the oldest surgical procedures for refractory trigeminal neuralgia (RTN). Moreover, Carbamazepine is usually the preferred first line of treatment for Trigeminal neuralgia, followed by some choice of drugs like Lamotrigine and Baclofen and anti-epileptics like Phenytoin, Gabapentin, Topiramate, Tocainide and Valproate. If there is a decrease in efficacy or development of tolerance to the drugs, some surgical modality needs to be considered. The purpose of this study was to present case reports of sixteen patients with the case of refractory trigeminal neuralgia who were suffering from chronic, debilitating trigeminal neuralgia and severe throbbing pain for 2-3 years and treated with Carbamazepine with no significant effect. The patients were treated and cured with neurectomy of Inferior Alveolar Nerve under general anaesthesia. The visual analogue scale (VAS) was used for pain assessment preoperatively and during the follow-up period. The outcome of surgery was graded as a marked, moderate, or mild improvement. Kaplan–Meier analysis was used for the time to recurrence to predict the probability of recurrence at any given time following the procedure. Fourteen patients had marked improvement of pain. There was recurrence of pain in 2 patients (12.5%) in an 18 month follow-up period in this study. The mean preoperative Hospital Anxiety and Depression Scale Anxiety and Depression scores significantly improved on the last follow-up visit following the procedure (P < 0.001). Conclusion:  Neurectomy of Inferior Alveolar Nerve is thus a safe and effective procedure for elderly patients, for those patients living in remote and rural places that cannot avail major neurosurgical facilities, and for those patients who are reluctant for major neurosurgical procedures. The preoperative severity of pain, anxiety, and depression levels also improved markedly after the procedure.