Trigeminal Neuralgia Treatment via Piezosurgical Enlargement of the Mental Foramen

Background: This article and the novel surgical approach described here were inspired by the ideas and observations of the late professors T. Pawela and J. Wnukiewicz. The authors present the medical history and unique surgical treatment of four patients with trigeminal neuralgia, who, despite pharmacological treatment and numerous specialists being involved in the treatment process, continued suffering. Our belief is that the direct cause of the symptoms is a narrow mental foramen, which compresses the mental nerve. It can be easily verified by local anesthesia administration to verify the trigger point, and by analyzing CBCT scans with a special emphasis on the diameter of both mental foramina. Methods: Surgical decompression by narrow mental foramen enlargement was conducted with a piezosurgical device. In this procedure, a rectangle of cortical bone is gently and precisely cut around the mental foramen and then into smaller pieces. This technique enables its easy and safe removal. Then, the mental nerve is left loose, uncompressed. Results: All four patients reported immediate recovery, their pain attacks stopped, and their quality of life improved significantly. One patient reported temporal hypoesthesia that lasted 5 months post-op. About 2 years post-op, another patient reported rare recurrences of pain, although much less severe than before surgery. Conclusions: This type of treatment may be considered when trigeminal neuralgia cannot be classified as classic or as secondary and is unresponsive to pharmacological treatment. A piezosurgical device seems to be the safest option in terms of potential damage to the nerve. Further research should include a larger sample of patients and focus on analyzing the mental foramina diameter of patients with idiopathic trigeminal neuralgia.