Resection of the Posterior, Middle, and Anterior Superior Alveolar Nerves and Infraorbital Nerve Neurolysis for Refractory Maxillary Pain

Leila Musavi, Alexandra Macmillan, Rachel Pedriera, Joseph Lopez, Amir Dorafshar, A. Lee Dellon

Research output: Contribution to journalArticle

Abstract

Trigeminal injury can cause intractable facial pain. However, surgical approaches to the superior alveolar nerves have not been widely described. We report resection of the anterior superior alveolar nerve (ASAN), middle superior alveolar nerve (MSAN), and posterior superior alveolar nerve (PSAN) in a patient with refractory facial pain and outline an algorithmic approach to the treatment of trigeminal nerve injury. A 56-year-old woman presented with a 3-year history of refractory facial pain in the distribution of the right superior alveolar nerves after dental trauma. As a comorbidity, central sensitization developed in the patient, manifesting in the uninjured oral areas being painful. After several temporary nerve blocks and medical management, the patient underwent resection of the ASAN, MSAN, and PSAN, as well as neurolysis of the infraorbital nerve, through a Caldwell-Luc approach. One week postoperatively, she reported substantial improvement in pain symptoms, including burning and temperature sensitivity, in the right maxilla. These findings were maintained at 7 months, without any maxillary sinus complications. Central sensitization caused continued intraoral symptoms. The ASAN, MSAN, and PSAN can be surgically resected within the maxillary sinus to treat refractory neuropathic pain. An etiology-based approach can guide successful treatment of trigeminal neuropathy. Central sensitization as a comorbidity must be addressed medically.

Original languageEnglish (US)
JournalJournal of Oral and Maxillofacial Surgery
DOIs
StateAccepted/In press - Jan 1 2018

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Maxillary Nerve
Intractable Pain
Central Nervous System Sensitization
Facial Pain
Maxillary Sinus
Comorbidity
Trigeminal Nerve Injuries
Trigeminal Nerve Diseases
Nerve Block
Wounds and Injuries
Maxilla
Neuralgia

ASJC Scopus subject areas

  • Surgery
  • Oral Surgery
  • Otorhinolaryngology

Cite this

Resection of the Posterior, Middle, and Anterior Superior Alveolar Nerves and Infraorbital Nerve Neurolysis for Refractory Maxillary Pain. / Musavi, Leila; Macmillan, Alexandra; Pedriera, Rachel; Lopez, Joseph; Dorafshar, Amir; Dellon, A. Lee.

In: Journal of Oral and Maxillofacial Surgery, 01.01.2018.

Research output: Contribution to journalArticle

Musavi, Leila ; Macmillan, Alexandra ; Pedriera, Rachel ; Lopez, Joseph ; Dorafshar, Amir ; Dellon, A. Lee. / Resection of the Posterior, Middle, and Anterior Superior Alveolar Nerves and Infraorbital Nerve Neurolysis for Refractory Maxillary Pain. In: Journal of Oral and Maxillofacial Surgery. 2018.
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