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Research ArticleHEAD AND NECK IMAGING

Utility of MR Neurography for the Evaluation of Peripheral Trigeminal Neuropathies in the Postoperative Period

Tyler Thornton, Shuda Xia, John R. Zuniga and Avneesh Chhabra
American Journal of Neuroradiology February 2024, DOI: https://doi.org/10.3174/ajnr.A8152
Tyler Thornton
aFrom the University of North Texas Health Science Center (T.T.), Fort Worth, Texas
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Shuda Xia
bUniversity of Texas Southwestern Medical Center (S.X.), Dallas, Texas
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John R. Zuniga
cDepartment of Oral and Maxillofacial Surgery (J.R.Z.), University of Texas Southwestern Medical Center, Dallas, Texas
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Avneesh Chhabra
dDepartment Radiology (A.C.), University of Texas Southwestern Medical Center, Dallas, Texas
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Article Figures & Data

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  • FIG 1.
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    FIG 1.

    Patient population in this study.

  • FIG 2.
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    FIG 2.

    NS-RADS PI-1. A 54-year-old woman, status post third molar removal with decreased sensation, burning pain, and dysgeusia. A, Presurgical coronal MRN MIP image 89 days status post inciting event shows a neuroma in continuity of the right lingual nerve (NS- RADS I-4, arrow). B, Postsurgical coronal corresponding MRN 351 days following right lingual nerve neuroma excision and neurorrhaphy with allograft and Axoguard placement demonstrates the expected postsurgical appearance of the nerve (NS-RADS PI-1) with no loss of continuity, neuroma reformation, or substantial nerve-caliber changes (arrow).

  • FIG 3.
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    FIG 3.

    NS-RADS PI-3. A 64-year-old man with a history of multiple nerve-repair procedures of the inferior alveolar nerve and mental nerve with a history of burning pain, lip biting, and speech difficulties. A and B, Presurgical coronal and sagittal MRN MIP images demonstrate a right mental nerve lateral neuroma in continuity (NS-RADS I-4, arrows). C and D, Postsurgical coronal and sagittal MRN MIP images 353 days following neuroma excision and neurorrhaphy with allograft and Axoguard placement show a recurrent right mental nerve neuroma in continuity (arrows).

  • FIG 4.
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    FIG 4.

    NS-RADS PI-2. A 27-year-old woman 214 days status post third molar removal with decreased sensation, burning pain, and hypogeusia. A, Presurgical coronal MRN MIP image shows the right lingual nerve demonstrating nerve-caliber focal thickening and increased signal instead of uniformly distally decreasing nerve caliber, consistent with a neuroma in continuity (NS-RADS I-4, arrow). B, Postsurgical coronal MRN MIP image 98 days status post right lingual nerve neuroma excision and neurorrhaphy with allograft and Axoguard placement demonstrates incomplete regeneration, ie, minimal increased residual signal of the nerve without a new neuroma with minor caliber change compared with preoperative MRN, consistent with NS-RADS PI-2 findings (arrow).

  • FIG 5.
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    FIG 5.

    NS-RADS PI-3. A 21-year-old woman status post third molar removal experiencing decreased sensation, burning pain, and hypogeusia. A, Presurgical sagittal MRN MIP 55 days status post third molar removal shows right lingual nerve neuroma (NS-RADS I-4, arrow). B, Postsurgical sagittal MRN MIP 166 days status post neuroma excision and neurorrhaphy with allograft and Axoguard placement demonstrates the re-formation of multiple neuromas (arrows).

  • FIG 6.
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    FIG 6.

    NS-RADS PI-2. A 31-year-old man status post third molar removal experiencing decreased sensation and ageusia. A and B, Presurgical coronal MRN MIP 54 days status post third molar removal shows a right lingual nerve end-bulb neuroma with complete transection with no distal continuity (NS-RADS I-5, arrows). C, Postsurgical coronal MRN MIP 238 days status post neuroma excision and neurorrhaphy with allograft and Axoguard placement demonstrates partial regeneration (arrows).

Tables

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    Table 1:

    MRN protocol on 3T scanner (Ingenia, Achieva)

    SequenceTR/TE (ms)Section Thickness (mm)MatrixFOV (cm)CommentsAcquisition Time (min:sec)
    Axial T2-weighted SPAIR2000/603.0268 × 24816Corpus callosum to chin5:20
    Axial T1-weighted580/93.0320 × 31016Corpus callosum to chin5:10
    Axial 3D balanced FFE5.32/2.660.65270 × 27016Corpus callosum to chin6:00
    Axial DTI14,000/705.0196 × 19218Skull base to chin; b-values = 0 and 600 s/mm2; 12 directions7:00
    Coronal 3D STIR (optional)1500/781.5 (Isotropic Voxel)…20Corpus callosum to chin7:15
    Coronal 3D PSIF12/2.50.9 (Isotropic Voxel)…20Corpus callosum to chin7:30
    • Note:—FFE indicates fast-field echo; SPAIR, spectral attenuated inversion recovery; STIR, short tau inversion recovery; PSIF, diffusion-weighted reversed fast imaging with steady-state precession.

    • View popup
    Table 2:

    Postsurgical MRN NS-RADS PI distribution among 10 patients with the number of patients experiencing clinical improvement in specified neuropathic symptoms and overall clinical outcome

    NS-RADS PIPatient CountPatients with Postsurgical Clinical ImprovementNerve-Repair PTN Outcome
    PainSensationTasteLip Biting-SpeechComplete ResolutionPartial ImprovementNo Change
    NS-RADS PI-133323120
    NS-RADS PI-230002012
    NS-RADS PI-340003013
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Utility of MR Neurography for the Evaluation of Peripheral Trigeminal Neuropathies in the Postoperative Period
Tyler Thornton, Shuda Xia, John R. Zuniga, Avneesh Chhabra
American Journal of Neuroradiology Feb 2024, DOI: 10.3174/ajnr.A8152
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Cite this article
Tyler Thornton, Shuda Xia, John R. Zuniga, Avneesh Chhabra
Utility of MR Neurography for the Evaluation of Peripheral Trigeminal Neuropathies in the Postoperative Period
American Journal of Neuroradiology Feb 2024, DOI: 10.3174/ajnr.A8152

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