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Cryoneurotomy in the management of intractable trigeminal neuralgia
Affiliation:1. Oral & Maxillofacial Surgery Unit, The University of Adelaide, South Australia;2. Chronic Pain Unit, Royal Adelaide Hospital, South Australia;3. Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Saitama Medical University, Saitama, Japan;1. Professor and Head, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL;2. Chief Resident, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL;3. Associate Professor and Program Director, Department of Oral and Maxillofacial Surgery, University of Illinois at Chicago College of Dentistry, Chicago, IL;1. Assistant Professor, Department of Oral and Maxillofacial Surgery, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China;2. Attending Physician, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China;3. Professor and Director, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China;4. Attending Physician, Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China;1. Professor and Robert V. Walker DDS Chair, Division of Oral and Maxillofacial Surgery, Department of Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, TX;1. Associate Professor, Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea and School of Dentistry, Seoul National University, Seoul, Republic of Korea;2. Associate Professor, Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul National University Bundang Hospital, Seongnam, Republic of Korea and School of Dentistry, Seoul National University, Seoul, Republic of Korea;3. Resident, Department of Oral and Maxillofacial Surgery, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea and School of Dentistry, Seoul National University, Seoul, Republic of Korea;1. Professor of Medicine, Director of Clinical Research, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio;2. Professor of Medicine, Pediatrics and Public Health, Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla;3. Professor of Medicine, Department of Internal Medicine, Division of General Internal Medicine, University of Cincinnati, Cincinnati, Ohio;5. Distinguished University Health Professor, Professor of Medicine, Pediatrics and Public Health, Director, Division of Allergy and Immunology, Joy McCann Culverhouse Chair in Allergy and Immunology, Morsani University of South Florida College of Medicine, Tampa, Fla
Abstract:In this paper we describe the effects of peripheral cryoneurotomy on a consecutive series of patients with intractable trigeminal neuralgia (TN) who had been treated by a single surgeon over a ten-year period. The results of 55 patients who underwent a total of 102 cryoneurotomies were documented. The age at first cryofreeze was 64 (30-92) years with 24 males and 31 females. Thirty-five had primary TN and 20 secondary TN. The first cryofreeze resulted in 28.2 (5-144) pain free months. Twenty-nine had a second freeze which lasted 34 (2-100) pain-free months and 13 had a third cryofreeze which lasted 26 (1-108) pain free months. Two patients had further freezes. Thirty-four of the primary TN patients had prolonged freedom from pain with one dying perioperatively. The 20 patients with secondary TN had shorter period of pain relief (p < 0.05) and one committed suicide. The procedure of peripheral cryoneurotomy is recommended for older, unwell patients with primary TN that is refractory to medical or neurosurgical treatments. It is less effective for dysaesthesia secondary to traumatic nerve injuries.
Keywords:Trigeminal neuralgia  cryoneurotomy  multidisciplinary pain management
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