Minimally Invasive Trigeminal Ablation: Long Buccal Nerve

Aims: To describe a technique of minimally invasive trigeminal nerve ablation of the long buccal nerve that was performed at a tertiary care academic medical center. Methods: This case describes a 44-year-old woman with refractory left long buccal nerve neuropathy following a dental procedure. After failing medical management, she was taken for nerve exploration, which revealed no nerve discontinuity or neuroma formation. She was therefore counseled regarding the risks and possible benefits of a novel minimally invasive trigeminal nerve thermoablation of the long buccal nerve technique. Results: Postoperatively, the patient experienced mild anesthesia along the long buccal nerve division and no longer experiences any allodynia or hypersensitivity. Additionally, she no longer requires any additional medical therapy or interventions. Conclusion: Minimally invasive trigeminal nerve ablation of the long buccal nerve may be effective surgical intervention in treating refractory neuropathic pain in cases of no structural nerve defects. However, long-term well-designed studies are required to fully define its role.

long buccal nerve;minimally invasive;posttraumatic trigeminal neuropathy;thermoablation

1. Hillerup S. Iatrogenic injury to oral branches of the trigem- inal nerve: Records of 449 cases Clin Oral Investig 2007; 11:133–142.

2. Benoliel R, Kahn J, Eliav E. Peripheral painful traumatic trigem- inal neuropathies. Oral Dis 2012;18:317–332.

3. Sandstedt P, Sörensen S. Neurosensory disturbances of the trigeminal nerve: A long-term follow-up of traumatic injuries. J Oral Maxillofac Surg 1995;53:498–505.

4. Hillerup S, Stoltze K. Lingual nerve injury in third molar surgeryI. Observations on recovery of sensation with spontaneous healing. Int J Oral Maxillofac Surg 2007;36:884–889.

5. Heir GM, Karolchek S, Kalladka M, et al. Use of topical med- ication in orofacial neuropathic pain: A retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008; 105:466–469.

6. Nasri-Heir C, Khan J, Heir GM. Topical medications as treat- ment of neuropathic orofacial pain. Dent Clin North Am 2013; 57:541–553.

7. Renton T, Yilmaz Z. Managing iatrogenic trigeminal nerve injury: A case series and review of the literature. Int J Oral Maxillofac Surg 2012;41:629–637.

8. Hendy CW, Smith KG, Robinson PP. Surgical anatomy of the buccal nerve. Br J Oral Maxillofac Surg 1996;34:457–460.

9. Merrill RG. Prevention, treatment, and prognosis for nerve injury related to the difficult impaction. Dent Clin North Am 1979;23:471-488

10. Leung YY, Fung PP, Cheung LK. Treatment modalities of neu- rosensory deficit after lower third molar surgery: A systematic review. J Oral Maxillofac Surg 2012;70:768–778.

11. Carter E, Yilmaz Z, Devine M, Renton T. An update on the causes, assessment and management of third division sensory trigeminal neuropathies. Br Dent J 2016;220:627–635.

12. Hillerup S. Iatrogenic injury to the inferior alveolar nerve: Etiology, signs and symptoms, and observations on recovery. Int J Oral Maxillofac Surg 2008;37:704–709.

13. Cheung LK, Leung YY, Chow LK, Wong MC, Chan EK, Fok YH. Incidence of neurosensory deficits and recovery after lower third molar surgery: A prospective clinical study of 4338 cases. Int J Oral Maxillofac Surg 2010;39:320–326.

14. Greenwood M, Corbett I. Observations on the exploration and external neurolysis of injured inferior alveolar nerves. Int J Oral Maxillofac Surg 2005;34:252–256.

15. Xu D, Pollock M. Experimental nerve thermal injury. Brain 1994;117:375–384.

16. Sessirisombat S. Carbon-dioxide laser in the treatment of trigeminal neuralgia: A preliminary study. J Interdiscipl Med Dent Sci 2017;5:1.