Investigation and medical management of trigeminal neuralgia byconsultant oral and maxillofacial surgeons in the British Isles

Trigeminal neuralgia is an extremely painful affliction of the face that is treated by various specialists including oral and maxillofacial surgeons. Some aspects of its management remain controversial, including screening for secondary trigeminal neura lgia, and the monitoring of treatment with carbamazepine. There is, however, little information available about current practice. A postal questionnaire was sent to 254 fellows of the British Association of Oral and Maxillofacial Surgeons (BAOMS) about v arious aspects of the management of trigeminal neuralgia. One hundred and seventy nine replies (70%) were received. Orofacial and cranial nerve examinations were undertaken by the majority of surgeons, but most did not routinely arrange computed tomograp hy or magnetic resonance imaging for all patients, nor did they refer the patient to a neurologist. In contrast with current recommendations, warnings about the adverse effects of carbamazepine were given by only a few surgeons, while most routinely moni tored full blood counts.