Painful-Post Traumatic Trigeminal
Neuropathy after Periodontal Surgery: A Case Report

Author(s): Yanez-Regonesi, F, Mishra, P, Moreno-Hay, I Affiliations: University of Kentucky, Lexington, USA.

Aim of Investigation: This report describes the case of a 41-year old female patient with a chief complaint of pain at the donor site following gingival graft surgery 5 years ago. She reported constant discomfort and numbness located in the anterior third of the palate, with intermittent episodes of 5/10 burning pain, approximately 10 times a day lasting for 30 minutes. She also indicated slight relief with gabapentin 100mg qd.

Methods: Comprehensive cranial nerve and physical examination of the masticatory and cervical muscles along with an intraoral examination was performed. Hypoesthesia was noted at the donor site. The remaining physical examination was unremarkable.

Results: Diagnosis of painful post-traumatic trigeminal neuropathy (PTTN) was given. Initially, it was recommended increasing the dose of gabapentin but the patient could not tolerate it due to severe side effects. Combination therapy was then recommended adding a low dose of duloxetine along with topical neurogel (6% benzocaine, 5% carbamazepine and 2% amitriptyline) which she retained in the affected area with the help of a stent. Patient reported 90% improvement in her symptoms with 100mg of gabapentin, 20mg of duloxetine and occasional use of topical medication.

Conclusions: To the best of our knowledge, no other cases of PTTN following gingival graft surgery have been previously reported in the literature. Since PTTN is often underdiagnosed, it is important for dentists to recognize this condition in order to avoid any further unnecessary dental or surgical treatment that could lead to symptom aggravation.

Acknowledgements and/or Funding Source: None