Журнал клинических случаев

Buccal Fat Nerve Wrapping in Peripheral Trigeminal Nerve Repair Surgery: A Retrospective Case Series

Abstract

Van der Cruyssen F, De Poortere A, Verhelst PJ, Jacobs R and Politis C

Post-traumatic trigeminal neuropathy is a debilitating condition that may occur after dental, oral, and maxillofacial procedures. In this retrospective case series study, we describe the clinical and patient reported outcomes on 13 patients with trigeminal nerve injuries that occurred after various interventions who underwent surgical exploration and subsequent surgical treatment with buccal fat nerve wrapping. We observed both positive and negative neuropathic symptoms preoperatively. Postoperative pain and quality of life was measured with the Brief Pain Inventory. Medication use was recorded pre- and postoperatively. Surgical exploration of the inferior alveolar or lingual nerve was performed in all patients. The median time between the injury and the exploration surgery was 21 weeks. The actual treatment of the lesion depended on its nature. Upon closing the wound, buccal fat was wrapped around the damaged nerve to facilitate nerve regeneration and provide protection. Overall improvements in negative and/or positive symptoms was observed in 12 patients during a mean follow-up time of 36 months. All patients that experienced pain before surgery reported pain reduction, and 2 patients reported complete pain resolution. On the BPI questionnaire, six patients reported persistent pain. In conclusion, surgery and the use of buccal fat grafts successfully reduced positive and negative symptoms, including pain symptoms, after iatrogenic trigeminal nerve injuries. In addition, medication use was reduced postoperatively. Future research should evaluate whether the use of a fat graft might provide a more protective nerve regeneration environment, compared to conventional treatments.