Botulinum toxin-A injections as therapy for chronic painful post-traumatic trigeminal neuropathy: case report

Authors

  • Giancarlo De la Torre Canales Department of Prosthodontics – Bauru School of Dentistry – University of São Paulo – Bauru – Brazil. http://orcid.org/0000-0002-0921-342X
  • Rodrigo Lorenzi Poluha Department of Prosthodontics – Bauru School of Dentistry – University of São Paulo – Bauru – Brazil. https://orcid.org/0000-0001-7180-6448
  • Dyna Mara Ferreira Department of Prosthodontics – Bauru School of Dentistry – University of São Paulo – Bauru – Brazil.
  • Juliana Stuginski-Barbosa Department of Prosthodontics – Bauru School of Dentistry – University of São Paulo – Bauru – Brazil. https://orcid.org/0000-0002-7805-5672
  • Paulo Cesar Rodrigues Conti Department of Prosthodontics – Bauru School of Dentistry – University of São Paulo – Bauru – Brazil. https://orcid.org/0000-0003-0413-4658

DOI:

https://doi.org/10.14295/bds.2020.v23i1.1800

Abstract

Painful post-traumatic trigeminal neuropathy (PTTN) involves spontaneous and evoked pain, of moderate to severe intensity, continuous and described as burning or shooting. The first line treatment is pharmacological. However, botulinum toxin - A (BoNT-A) can be used when medications cannot control pain. This article describes the use of BoNT-A in a case of PTTN refractory to conventional pharmacological treatment. A 44-year-old male patient presented with an 8-years history of pain in the lower left second molar region. Pain was burning, lasting for seconds, with multiple pain episodes per day. Diagnosis hypothesis was PTTN. After no improvement with conventional pharmacological treatment, injections of BoNT-A were elected. Somatosensory assessment showed a significant reduction in visual analog scale for touch, cold and pinprick sensitivity. Likewise, patient's impression of change in pain significantly improved after BoNT-A injections. Our results suggest that BoNT-A could be used as a treatment for PTTN refractory to conventional treatments.

Keywords

Post-traumatic trigeminal neuropathy; Trigeminal neuropathic pain; Botulinum toxin.

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Published

2020-01-31

Issue

Vol. 23 No. 1 (2020): Jan. - Mar. - Published Jan. 2020

Section

Case Report or Clinical Technique