Trigeminal neuralgia originating in the tongue: From misdiagnosis to clarity.

BACKGROUND: Trigeminal neuralgia originating primarily in the anterior two-thirds of the tongue is a rare type of neuropathic pain condition predominantly involving the lingual branch of the mandibular (V3) component after pathologic changes in the lingual nerve. Diagnosis involves meticulous evaluation of patient history, symptoms, and clinical signs; investigations ranging from combinations of topical anesthetics to different types of nerve blocks; and varying imaging modalities, such as conventional radiography and magnetic resonance imaging.

CASE DESCRIPTION: The authors describe a case of neuralgia predominantly involving the lingual nerve. A detailed timeline, including misdiagnosis of the condition and complete management and follow-up, is also described, along with a discussion of the literature. The authors also highlight the importance of the basic diagnostic skill sets required for a dentist in such cases, without which a patient may receive unnecessary treatment.

PRACTICAL IMPLICATIONS: Clinical examination, anesthetic nerve blocks, and magnetic resonance imaging play roles in diagnosing and differentiating nonodontogenic orofacial pain, especially neuropathic and musculoskeletal pain and headache. However, for odontogenic and osteogenic pathologies, cone-beam computed tomography remains the reference standard. Pharmacotherapy has its own obstacles in long-term prognosis due to potential adverse effects, decreased quality of life, and limitations in alleviating the pain. A decompression surgery may be imperative, as in this case, in which pharmacotherapy failed to produce long-term beneficial results.