Magnetic resonance neurography in the management of peripheral trigeminal neuropathy: experience in a tertiary care centre
This tertiary care experience examines the utility of magnetic resonance neurography (MRN) in the management of peripheral trigeminal neuropathies.
Materials and methods
Seventeen patients with clinically suspected peripheral trigeminal neuropathies (inferior alveolar nerve and lingual nerve) were imaged uniformly with 1.5-T examinations. MRN results were correlated with clinical and surgical findings in operated patients and the impact on clinical management was assessed.
Clinical findings included pain (14/17), sensory changes (15/17), motor changes (2/17) and palpable masses (3/17). Inciting events included prior dental surgery (12/17), trauma (1/17) and idiopathic incidents (4/17). Non-affected side nerves and trigeminal nerves in the intracranial and skull base course were normal in all cases. Final diagnoses on affected sides were nerve inflammation (4/17), neuroma in continuity (2/17), LN transection (1/17), scar entrapment (3/17), infectious granuloma (1/17), low-grade injuries (3/17) and no abnormality (3/17). Associated submandibular gland and sublingual gland oedema-like changes were seen in 3/17 cases because of parasympathetic effects. Moderate-to-excellent MRN-surgical correlation was seen in operated (8/17) patients, and neuroma and nerve transection were prospectively identified in all cases.
MRN is useful for the diagnostic work-up of suspected peripheral trigeminal neuropathy patients with significant impact on clinical management and moderate-to-excellent correlation with intra-operative findings.
• MRN substantially impacts diagnostic thinking and management in peripheral trigeminal neuropathy.
• MRN has moderate-to-excellent correlation with intra-operative findings.
• MRN should be considered in pre-surgical planning of peripheral trigeminal neuropathy subjects.
KeywordsTrigeminal nerve Inferior alveolar nerve Lingual nerve MRN Neurography
- 2.Tay AB, Lai JB, Lye KW, Wong WY, Nadkarni NV, Li W, Bautista D (2015) Inferior alveolar nerve injury in trauma-induced mandible fractures. J Oral Maxillofac SurgGoogle Scholar
- 8.Liu W, Yin W, Zhang R, Li J, Zheng Y (2015) Diagnostic value of panoramic radiography in predicting inferior alveolar nerve injury after mandibular third molar extraction: a meta-analysis. Aust Dent JGoogle Scholar
- 12.Fujii H, Fujita A, Yang A, Kanazawa H, Buch K, Sakai O, Sugimoto H (2015) Visualization of the peripheral branches of the mandibular division of the trigeminal nerve on 3D double-echo steady-state with water excitation sequence. AJNR Am J NeuroradiolGoogle Scholar
- 13.Terumitsu M, Seo K, Matsuzawa H, Yamazaki M, Kwee IL, Nakada T (2011) Morphologic evaluation of the inferior alveolar nerve in patients with sensory disorders by high-resolution 3D volume rendering magnetic resonance neurography on a 3.0-T system. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 111(1):95–102CrossRefPubMedGoogle Scholar
- 14.Chhabra A, Soldatos T, Subhawong TK, Machado AJ, Thawait SK, Wang KC, Padua A Jr, Flammang AJ, Williams EH, Carrino JA (2011) The application of three-dimensional diffusion-weighted PSIF technique in peripheral nerve imaging of the distal extremities. J Magn Reson Imaging 34(4):962–967CrossRefPubMedGoogle Scholar
- 23.Miloro M, Ruckman P 3rd, Kolokythas A (2015) Lingual nerve repair: to graft or not to graft? J Oral Maxillofac SurgGoogle Scholar
- 24.Chhabra A, Belzberg AJ, Rosson GD, Thawait GK, Chalian M, Farahani SJ, Shores JT, Deune G, Hashemi S, Thawait SK, Subhawong TK, Carrino JA. Impact of high resolution 3 tesla MR neurography (MRN) on diagnostic thinking and therapeutic patient management. Eur Radiol. 2015 Sep 22. doi:10.1007/s00330-015-3958-y