Magnetic resonance neurography in the management of peripheral trigeminal neuropathy: experience in a tertiary care centre
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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
The scientific guarantor of this publication is Avneesh Chhabra. The authors of this manuscript declare relationships with the following companies: Avneesh Chhabra serves as a consultant with Siemens for the MSK CAD group. He also receives royalties from the Jaypee, Wolters and Elsevier groups of publishers. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study performed at one institution.
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