Post-operative orofacial pain, temporomandibular dysfunction and trigeminal sensitivity after recent pterional craniotomy: preliminary study

• Published in: Acta neurochirurgica 2017-05, Vol.159 (5), p.799-805
• Main Authors: Brazoloto, Thiago Medina, de Siqueira, Silvia Regina Dowgan Tesseroli, Rocha-Filho, Pedro Augusto Sampaio, Figueiredo, Eberval Gadelha, Teixeira, Manoel Jacobsen, de Siqueira, José Tadeu Tesseroli
• Format: Article
• Language: English
• Subjects: Adult; Aneurysm, Ruptured - surgery; Clinical Article - Functional; Craniotomy - adverse effects; Facial Pain - etiology; Female; Headache Disorders, Secondary - etiology; Humans; Interventional Radiology; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Skull Base - surgery; Surgical Orthopedics; Temporomandibular Joint Disorders - etiology; Trigeminal Nerve Diseases - etiology
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-017-3137-9

Background Surgical trauma at the temporalis muscle is a potential cause of post-craniotomy headache and temporomandibular disorders (TMD). The aim of this study was to evaluate the prevalence of pain, masticatory dysfunction and trigeminal somatosensory abnormalities in patients who acquired aneurysms following pterional craniotomy. Methods Fifteen patients were evaluated before and after the surgical procedure by a trained dentist. The evaluation consisted of the (1) research diagnostic criteria for TMD, (2) a standardized orofacial pain questionnaire and (3) a systematic protocol for quantitative sensory testing (QST) for the trigeminal nerve. Results After pterional craniotomy, 80% of the subjects, 12 patients, developed orofacial pain triggered by mandibular function. The pain intensity was measured by using the visual analog scale (VAS), and the mean pain intensity was 3.7. The prevalence of masticatory dysfunction was 86.7%, and there was a significant reduction of the maximum mouth opening. The sensory evaluation showed tactile and thermal hypoesthesia in the area of pterional access in all patients. Conclusions There was a high frequency of temporomandibular dysfunction, postoperative orofacial pain and trigeminal sensory abnormalities. These findings can help to understand several abnormalities that can contribute to postoperative headache or orofacial pain complaints after pterional surgeries.