Trigeminal neuralgia due to vertebrobasilar dolichoectasia: three case reports

We report here 3 cases of trigeminal neuralgia (TN) due to vertebrobasilar dolichoectasia (VBD) and discuss the clinician's role in such cases. All cases presented at our clinic with paroxysmal, electric shock-like pain over their maxillary or mandibular gingiva. To confirm a diagnosis of TN, magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) were performed, and contact of the trigeminal nerve with a tortuous vertebrobasilar artery (VBA) was detected. Patients were informed about the therapeutic algorithm of TN before starting treatment. When medication became ineffective, the patients were referred to a neurosurgeon, and microvascular decompression (MVD) was consequently performed in 1 patient and radiofrequency thermocoagulation (RFTC) in the other 2 cases. VBD is associated with the risk of serious complications during follow-up and some limitations regarding second-line treatment. Dentists have a significant role in controlling orofacial pain and must be aware of this specific etiopathology of TN.