A neurosurgery expert witness opines on a case involving a patient who was left with chronic pain following a dental procedures and linear accelerator radiation therapy for trigeminal neuralgia. This case involves a fifty-eight-year-old female patient with no significant past medical history who presented to her dentist complaining of pain in the right jaw line and cheek bone region. The pain was originally thought to be from an infected tooth which prompted an extraction by a dentist.When the extraction failed to relieve the patient’s pain she was referred to an oral surgeon by the treating dentist for the removal of a second tooth which was now believed to be the source of the pain. Before the procedure a CT head was performed and read as normal with no masses or lesions present.
Following the second extraction, the patient’s pain became exponentially worse necessitating a neurology consultation. After many visits the patient was finally diagnosed with trigeminal neuralgia. A neurologist recommended that a trigeminal nerve block be performed. The treatment had limited success and the patient continued to experience breakthrough pain despite the nerve block. The patient was then referred to a neurosurgeon who suggested that the patient receive LINAC (linear accelerator) radiation therapy to ablate the trigeminal nerve root. Following surgery the symptoms only worsened further and the patient decompensated neurologically due to radiation necrosis. The patient now displays continued facial pain, stroke-like drooping of the left side of her face, and difficulty walking; she has needed numerous costly additional procedures, and has needed to undergo locomotor training in an attempt to regain her balance and full ability to walk.
