Postoperative maxillary cyst (POMC) is relatively common complication among patients who underwent Caldwell-Luc surgery. Patients with POMC usually have no symptoms, although cyst extension can result in bone destruction or cystic infection with pain. The trigeminal nerve consists of the ophthalmic nerve, maxillary nerve, and mandibular nerve. Among these branches, the maxillary nerve runs to the lateral and frontal sides of the maxillary sinus wall. POMC can rarely lead to trigeminal neuropathy caused by cyst enlargement that compresses some branches of the trigeminal nerve. Recently, we experienced a case with trigeminal neuralgia due to POMC. The patient was successfully treated with inferior meatal antrostomy. We report this rare case with a literature review.
Humans ; Mandibular Nerve ; Maxillary Nerve ; Maxillary Sinus ; Ophthalmic Nerve ; Pro-Opiomelanocortin ; Trigeminal Nerve ; Trigeminal Nerve Diseases ; Trigeminal Neuralgia*

A morphometric study on the trigeminal ganglion and the intracranial portion of the ophthalmic, maxillary and mandibular nerves was done in 50 Korean adult cadavers. The shape of the ganglion was classified into 7 types and semicircular shape was most common (54%). Mean width of the trigeminal root at porus trieminus was 6.08mm. The length of the trigemnal root from porus to the trigeminal ganglion was 8.28mm at ophthalmic portion, 10.16mm at maxillary portion, and 8.90mm at mendibular portion. Maximum width of the ganglion was 15.48mm and the breadth of the ophthalmic, and maxillary portion were 5.25mm and 5.26mm, respectively, and that of the mandibular portion (4.92mm) was narrow than the other portion. Intracranial ophthalmic nerve was 4.30mm of width and 17.89mm of length, and this nerve inclined average 39.7。 (range 14.56。) from sagital plane. It was observed infrequently that the cavernous sinus extended to the lateral border of the maxillary nervw and the emissary sinus ran under the mandibular nerve.
Adult* ; Cadaver ; Cavernous Sinus ; Ganglion Cysts ; Humans ; Mandibular Nerve* ; Ophthalmic Nerve ; Trigeminal Ganglion*

Biplane fluoroscopy is usually used in angiography. Biplane fluoroscopy gives a biplane image with high resolution during the performance of operations. Trigeminal nerve blocks are effective treatment modalities for trigeminal neuralgia, and maxillary nerve block is the most dangerous procedure among them. The anatomic structures can change after head and neck surgery, so the trigeminal nerve block procedures cannot be done so easily. We used biplane fluoroscopy in these difficult cases. Our first case was a 60-year-old man who had undergone maxillary nerve block. The second case was of a 64-year-old man who had pulsed radiofrequency lesioning of mandibular nerve performed after head and neck surgery. With biplane fluoroscopy, we got good results without any complications.
Angiography ; Fluoroscopy* ; Head ; Humans ; Mandibular Nerve* ; Maxillary Nerve* ; Middle Aged ; Neck ; Trigeminal Nerve ; Trigeminal Neuralgia

BACKGROUND: Recently trigeminal nerve block with alcohol (TnbA) for the treatment of trigeminal neuralgia (TN) has come to be known as a procedure with a short-term effect and high complications. There has been none of report about long-term outcome of TnbA for TN. The objective of this prospective study for the long-term results of TnbA was to analyse the pain free duration and complication after the administration of blocks and compare them in the first block and subsequent blocks. METHODS: From March 1996 to May 2005, 304 consecutive patients with primary trigeminal neuralgia were treated with TnbA including supraorbital nerve block, infraorbital nerve block, maxillary nerve (V2) block, mandibular nerve (V3) block, and V2 and V3 at the same time and were prospectively followed up every two months for 10 years. RESULTS: The mean value of pain free duation of 1st, 2nd and 3rd TnbA were 43, 38 and 48 months, respectively using Kaplan-Meier analysis. The probability of pain recurrence in 1 and 3 years after the 1st, 2nd and 3rd blocks were 25%, 25%, 20% and 53%, 54%, 34%, respectively. The pain free durations of first and subsequent blocks were not statistically different. Complications were reported at 36 (11.8%), 5 (4.2%), and 0 in 1st, 2nd and 3rd blocks. CONCLUSIONS: TnbA showed the relatively long duration of pain free and low incidence of complications. Repeated TnbA has pain free duration as long as the 1st block and less complications as well. TnbA is a valuable treatment of TN as a percutaneous procedure.
Humans ; Incidence ; Kaplan-Meier Estimate ; Mandibular Nerve ; Maxillary Nerve ; Nerve Block ; Prospective Studies ; Recurrence ; Trigeminal Nerve* ; Trigeminal Neuralgia*

Chemical destruction of Gasserian ganglion by either alcohol or phenol has remained a popular form of treatment for tic pain. However, control of the lesion size is inaccurate and various complications have often resulted. With advent of radiofrequency generator, percutaneous coagulation of the Gasserian ganglion is now possible, and the need for open surgery or chemical destruction have been drastically reduced. We treated 3 cases of trigeminal neuralgia with the radiofrequency current. Modified Hartel's anterior appaorch for the injection of the Gasserian ganglion is utilized and the radiofrequency lesions were made in the second branches of the trigeminal nerve selectively preserving the touch sensation in our patients. We reviewed the literature and described the technical procedures.
Humans ; Phenol ; Sensation ; Tics ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Neuralgia*

The deleted in colorectal cancer (DCC) protein mediates attractant responses to netrin during axonogenesis. In the rat trigeminal ganglia (TG), axons must extend toward and grow into the trigeminal nerve to innervate target tissues such as dental pulp. Our present study aimed to investigate the expression of DCC in the TG. Four developmental timepoints were assessed in the experiments: postnatal days 0, 7 and 10 and adulthood. RT-PCR and western blotting revealed that the expression of DCC mRNA and protein does not significantly change throughout development. Immunohistochemistry demonstrated that DCC expression in the TG was detectable in the perikarya region of the ganglion cells during development. Nerve injury at 3 and 5 days after the mandibular nerve had been cut did not induce altered expression of DCC mRNA in the TG. Moreover, DCC-positive cell bodies also showed similar immunoreactive patterns after a nerve cut injury. The results of this study suggest that DCC constitutively participates in an axonogenesis attractant in ways other than expression regulation.
Animals ; Axons ; Blotting, Western ; Colorectal Neoplasms ; Dental Pulp ; Ganglion Cysts ; Immunohistochemistry ; Mandibular Nerve ; Rats ; RNA, Messenger ; Trigeminal Ganglion ; Trigeminal Nerve

Orofacial neuropathic pain is initiated by extraction of teeth or nerve injury from trauma in the trigeminal nerve that innervates the facial area. In the experiment, orofacial neuropathic pain usually occurred following injury of peripheral trigeminal nerve including infra-orbital nerve, inferior alveolar nerve, or mental nerve. In addition, pathology from trigeminal nerve root or ganglion is involved in orofacial neuropathic pain. This study introduced various animal models that help us study the underlying mechanisms of development or maintenance of orofacial neuropathic pain. One of the most typical symptoms of orofacial neuropathic pain is hypersensitivity to the innocuous mechanical stimuli. Our study presents a novel method to evaluate mechanical allodynia in rats with orofacial neuropathic pain. Recently, accumulate evidence support participation of central glial cells in the development or maintenance of orofacial neuropathic pain. Signaling molecules in glial cells also play an important role in neuropathic pain in the orofacial area.
Animals ; Facial Pain ; Ganglion Cysts ; Hyperalgesia ; Hypersensitivity ; Mandibular Nerve ; Models, Animal ; Neuralgia ; Neuroglia ; Rats ; Tooth ; Trigeminal Nerve ; Trigeminal Neuralgia

PURPOSE: To describe the MRI findings of trigeminal neurinoma. MATERIALS AND METHODS: We retrospectively analyzed the MRI findings of 19 patients with trigeminal neurinomas proven by surgery and pathologic examination. Axial T1-and T2-weighted MR images in all patients and gadolinium-enhanced T1-weighted images in 14 patients were obtained at 2.0T (8 cases), 1.5T (6 cases) or 0.5T (5 cases). These were analyzed in terms of tumor size, signal intensity, degree of contrast enhancement, the presence or absence of cystic change and denervation atrophy of the masticator muscles. RESULTS: Clinical manifestations included sensory abnormality or pain (n=12), headache (n=10), impaired visual acuity or diplopia (n=6), hearing loss or tinnitus (n=3), weakness of masticator muscles (n=2), and mass or nasal obstruction (n=2). On MR images, tumor size was seen to average 4.2 (range 1.5-6)cm; tumors were located in the posterior cranial fossa (n=8), middle cranial fossa (n=4), ophthalmic nerve (n=2), maxillarynerve (n=1), and mandibular nerve (n=1), and in three cases were dumb bell-shaped and extended into both the middle and posterior cranial fossa. On T1-weighted images, signals were isointense with cortical grey matter, in ten cases (53%), and of low intensity in nine (47%); on T2-weighted images, signals were of high intensity in 15 cases (79%) and were isointense in four (21%). Cystic change was seen in 12 cases (63%). After enhancement, all (14/14) the tumors enhanced. Denervation atrophy was seen in nine cases (47%) and all of these involved the trigeminal ganglion or mandibular nerve. CONCLUSION: A trigeminal neurinoma shows similar signal intensity and enhancement to other cranial neurinomas with a higher incidence of cystic degneration. Its location and shape are characteristic, and where there is involvement of the trigeminal ganglion or mandibular nerve, denervation atrophy may be seen.
Atrophy ; Cranial Fossa, Middle ; Cranial Fossa, Posterior ; Denervation ; Diplopia ; Headache ; Hearing Loss ; Humans ; Incidence ; Magnetic Resonance Imaging ; Mandibular Nerve ; Muscles ; Nasal Obstruction ; Neurilemmoma* ; Neuroma ; Ophthalmic Nerve ; Retrospective Studies ; Tinnitus ; Trigeminal Ganglion ; Visual Acuity

The lingual nerve (LN) is a branch of the mandibular division of the trigeminal nerve, and its injury is one of the major complications during oral surgery. This study aims to investigate the anatomy of the LN in the lower third molar area. Twenty sides from ten fresh-frozen adult cadaveric Caucasian heads were examined to measure the diameter of the LN. The mean diameter of the LN was 2.20±0.37 mm (range, 1.61–2.95 mm). There were no statistically significant differences in the measurements between sexes, sides, or tooth status (dentulous or edentulous). Understanding the anatomical features of the LN is essential for performing any surgical procedure in the oral region.
Adult ; Cadaver ; Head ; Humans ; Lingual Nerve ; Mandibular Nerve ; Molar, Third ; Surgery, Oral ; Tooth ; Trigeminal Nerve

It is well known that trigeminal nerve injury causes hyperexcitability in trigeminal ganglion neurons, which become sensitized. Long after trigeminal nerve damage, trigeminal spinal subnucleus caudalis and upper cervical spinal cord (C1/C2) nociceptive neurons become hyperactive and are sensitized, resulting in persistent orofacial pain. Communication between neurons and non-neuronal cells is believed to be involved in these mechanisms. In this article, the authors highlight several lines of evidence that neuron-glial cell and neuron macrophage communication have essential roles in persistent orofacial pain mechanisms associated with trigeminal nerve injury and/or orofacial inflammation.
Cell Communication ; Cervical Cord ; Facial Pain ; Inflammation ; Macrophages ; Neurons ; Nociceptors ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Nerve Injuries ; Trigeminal Nucleus, Spinal