Magnetic resonance neurography in the management of peripheral trigeminal neuropathy

experience in a tertiary care centre

Brian Cox, John R Zuniga, Neeraj Panchal, Jonathan J Cheng, Avneesh Chhabra

Research output: Contribution to journalArticle

10 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalEuropean Radiology
DOIs
StateAccepted/In press - Jan 21 2016

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Trigeminal Nerve Diseases
Peripheral Nervous System Diseases
Tertiary Care Centers
Magnetic Resonance Spectroscopy
Neuroma
Lingual Nerve
Sublingual Gland
Mandibular Nerve
Trigeminal Nerve
Submandibular Gland
Skull Base
Wounds and Injuries
Tertiary Healthcare
Granuloma
Cicatrix
Edema
Tooth
Inflammation
Pain

Keywords

  • Inferior alveolar nerve
  • Lingual nerve
  • MRN
  • Neurography
  • Trigeminal nerve

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

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title = "Magnetic resonance neurography in the management of peripheral trigeminal neuropathy: experience in a tertiary care centre",
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 = "Inferior alveolar nerve, Lingual nerve, MRN, Neurography, Trigeminal nerve",
author = "Brian Cox and Zuniga, {John R} and Neeraj Panchal and Cheng, {Jonathan J} and Avneesh Chhabra",
year = "2016",
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doi = "10.1007/s00330-015-4182-5",
language = "English (US)",
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T1 - Magnetic resonance neurography in the management of peripheral trigeminal neuropathy

T2 - experience in a tertiary care centre

AU - Cox, Brian

AU - Zuniga, John R

AU - Panchal, Neeraj

AU - Cheng, Jonathan J

AU - Chhabra, Avneesh

PY - 2016/1/21

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N2 - 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.

AB - 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.

KW - Inferior alveolar nerve

KW - Lingual nerve

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KW - Neurography

KW - Trigeminal nerve

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