European Radiology

, Volume 26, Issue 10, pp 3392–3400

Magnetic resonance neurography in the management of peripheral trigeminal neuropathy: experience in a tertiary care centre

  • Brian Cox
  • John R. Zuniga
  • Neeraj Panchal
  • Jonathan Cheng
  • Avneesh Chhabra
Musculoskeletal

Abstract

Objective

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.

Results

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.

Conclusion

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.

Key Points

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.

Keywords

Trigeminal nerve Inferior alveolar nerve Lingual nerve MRN Neurography 

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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Brian Cox
    • 1
  • John R. Zuniga
    • 2
  • Neeraj Panchal
    • 3
  • Jonathan Cheng
    • 4
  • Avneesh Chhabra
    • 1
  1. 1.Department of RadiologyUT Southwestern Medical CenterDallasUSA
  2. 2.Department of Oral & Maxillofacial Surgery, Surgery, Neurology & NeurotherapeuticsUT Southwestern Medical CenterDallasUSA
  3. 3.Department of Oral Maxillofacial SurgeryUniversity of PennsylvaniaPhiladelphiaUSA
  4. 4.Department of Plastic SurgeryUT Southwestern Medical CenterDallasUSA

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