Subjective well-being may be a contributing factor for neurosensory recovery following post-traumatic trigeminal neuropathy (PTN). These findings from a prospective observational study were published in The Journal of Headache and Pain.
Patients (N=36) were recruited at the University Hospital Leuven in Belgium between 2018 and 2020. Both objective (neurosensory testing) and subjective (EuroQol 5-dimension scale [EQ5D-5L], General Anxiety Disorder 7 [GAD-7], Patient Health Questionnaires [PHQ-9 and -15], Douleur Neuropathique 4 [DN4], and the Brief Pain Inventory [BPI]). PTN characteristics were assessed. On the basis of these data, a predictive model for recovery at 6 months was formulated.
The patients included 23 women and 13 men who had a mean age of 42 (range, 23-68) years. Patients were referred by an oral and maxillofacial surgeon (89%) or external dentist (11%).
The PTN was left-sided and triggered by third molar removal (47%), implant placement (11%), facial trauma (11%), local anesthesia (8%), non-wisdom tooth extraction (6%), and endodontic treatment (6%). Affected nerves included the inferior alveolar nerve (64%), lingual nerve (28%), maxillary nerve (19%), and ophthalmic nerve (3%).
Most objective measures were significantly correlated. The most strongly positive correlations were stimulus localization and directional discrimination (r, 0.83) and 2-point discrimination with Sunderland score (r, 0.75) and with loss-of-function sensory code (r, 0.72). Medical Research Council Scale negatively correlated with proportion of affected dermatome (r, -0.71) and Sunderland scores with directional discrimination (r, -0.71) and with stimulus localization (r, -0.71).
Most subjective measures were significantly positively correlated. EQ5D quality of life was the only measure that was negatively correlated with other subjective features, indicating negative patient disposition may be impacting symptoms of PTN.
Some objective and subjective measurements were correlated. EQ5D quality of life was significantly correlated with gain-of-function sensory phenotype (r, -0.41), Medical Research Council Scale (r, 0.36), percentage of affected dermatome (r, -0.35), brush stroke allodynia (r, -0.24), and Sunderland score (r, -0.21).
On the basis of these data, the investigators built a prediction model for 6-month neurosensory recovery. Three variables predicted recovery and 27 variables predicted no recovery. The model’s negative predictive value was 87%, positive predictive value was 60%, sensitivity was 43%, and specificity was 93%.
This model may have been limited by the low sample size and by the choice to combine data from patients who had differently affected nerves and facial regions.
Objective and subjective measures of PTN were correlated, and a model of baseline characteristics strongly predicted no recovery at 6 months.
Meewis J, Renton T, Jacobs R, Politis C, Van der Cruyssen F. Post-traumatic trigeminal neuropathy: correlation between objective and subjective assessments and a prediction model for neurosensory recovery. J Headache Pain. 2021;22(1):44. doi:10.1186/s10194-021-01261-3