OBLITERATING FORAMINA FOLLOWING PERIPHERAL NEURECTOMIES CAN PROLONG
REMISSION OF NEURALGIA UP TO 10 YEARS
placed into the foramen without the need of
tapping or preparing the foramen.10 Lastly, this case
also illustrates the elusive nature of the trigeminal
neuralgia that can mimic toothache. While dental
extraction has been reported to provide pain
relief when there is a pure odontogenic cause46,
the difficulty in differentiating between neuralgia
and odontalgia may result in patients receiving
inappropriate treatment, such as root canal
therapy.44 As seen in this case, such a procedure
only managed to provide pain relief over the
region supplied by the right long buccal nerve.
Conclusion
This case has been managed with various means
of treatment since the 1970s when different modes
of periphery treatment were still in use. In time, she
has been in the care of several oral surgeons, at
the time when neurosurgical procedure was still
not easily available in the country. She might have
been managed differently if she had succumbed
to the same diagnosis nowadays. Having said so,
this report suggests that the insertion of a titanium
screw into a bony foramen can obstruct peripheral
nerve regeneration, hence delaying trigeminal
neuralgia from recurring.
Because of this, she is believed to be the patient
with the longest duration of having a foreign
body inserted into a bony foramen without any
adverse effect. Perhaps in cases where peripheral
neurectomies need to be done e.g. for debilitating
patients etc, it may be advisable to obliterate the
foramen with a metal screw.
Acknowledgement
Grateful thanks for retired professor, Dato’ Dr. CB
Lian for expert involvement in managing this case
as well as permission to report it.
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