Psychological Assessment of Patients with Iatrogenic Trigeminal Nerve Injury Using Symptom Checklist-90-Revised

  • Park, Mi-Sun ;
  • Roh, Byung-Yoon ;
  • Ahn, Jong-Mo ;
  • Yoon, Chang-Lyuk ;
  • Ryu, Ji-Won
  • Received : 2015.02.02
  • Accepted : 2015.02.17
  • Published : 2015.03.30


Purpose: This study aims to assess the psychological characteristics of patients with iatrogenic damage of the trigeminal nerve using Symptom Checklist-90-Revised (SCL-90-R). Methods: A total of 22 patients who visited the clinic of Department of Oral Medicine, School of Dentistry, Chosun University were evaluated in the months from December 2012 to December 2014. Patients were included in the study if they presented with reported sensory changes due to iatrogenic trigeminal nerve injury. A total of 37 control group who has no symptoms of pain and sensory change were included in the study. All participants filled out the SCL-90-R instrument to assess psychosocial symptoms. Results: The T-scores of most of the SCL-90-R symptom dimensions were within normal range (less than 55) in the patients and the control group. The patients group showed higher T-scores of SCL-90-R than those of the control group, with statistically significance of somatization, anxiety, psychoticism, and positive symptoms distress. Female patients group had higher Tscores of SCL-90-R than those of male patients group, but there was no statistical difference, except for the positive symptom global index. The chronic patients group showed higher Tscores of SCL-90-R than those of the acute patients group, but there was no statistical difference, except for the Positive symptom global index. Conclusions: According to the psychological assessment of iatrogenic trigeminal nerve injury patients using SCL-90-R, the patients group, as compared to the control group shows a significantly higher score for somatization, anxiety, and psychoticism. Therefore, assessment of psychological state would be considered to treat patients with iatrogenic trigeminal nerve injury.


Iatrogenic;Psychological tests;Symptom Checklist-90-Revised;Trigeminal nerve injuries


  1. Chaushu G, Taicher S, Halamish-Shani T, Givol N. Medicolegal aspects of altered sensation following implant placement in the mandible. Int J Oral Maxillofac Implants 2002;17:413-415.
  2. Lydiatt DD. Litigation and the lingual nerve. J Oral Maxillofac Surg 2003;61:197-200.
  3. Venta I, Lindqvist C, Ylipaavalniemi P. Malpractice claims for permanent nerve injuries related to third molar removals. Acta Odontol Scand 1998;56:193-196.
  4. Renton T. Prevention of iatrogenic inferior alveolar nerve injuries in relation to dental procedures. Dent Update 2010;37:350-352, 354-356, 358-360 passim.
  5. Gregg JM. Neuropathic complications of mandibular implant surgery: review and case presentations. Ann R Australas Coll Dent Surg 2000;15:176-180.
  6. Walton JN. Altered sensation associated with implants in the anterior mandible: a prospective study. J Prosthet Dent 2000;83:443-449.
  7. Walter JM Jr, Gregg JM. Analysis of postsurgical neurologic alteration in the trigeminal nerve. J Oral Surg 1979;37:410-414.
  8. Zaytoun HS Jr, Phillips C, Terry BC. Long-term neurosensory deficits following transoral vertical ramus and sagittal split osteotomies for mandibular prognathism. J Oral Maxillofac Surg 1986;44:193-196.
  9. Cheung LK, Lo J. The long-term clinical morbidity of mandibular step osteotomy. Int J Adult Orthodon Orthognath Surg 2002;17:283-290.
  10. Carmichael FA, McGowan DA. Incidence of nerve damage following third molar removal: a West of Scotland Oral Surgery Research Group study. Br J Oral Maxillofac Surg 1992;30:78-82.
  11. Robinson PP, Smith KG. Lingual nerve damage during lower third molar removal: a comparison of two surgical methods. Br Dent J 1996;180:456-461.
  12. Valmaseda-Castellon E, Berini-Aytes L, Gay-Escoda C. Inferior alveolar nerve damage after lower third molar surgical extraction: a prospective study of 1117 surgical extractions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:377-383.
  13. Marbach JJ, Hulbrock J, Hohn C, Segal AG. Incidence of phantom tooth pain: an atypical facial neuralgia. Oral Surg Oral Med Oral Pathol 1982;53:190-193.
  14. Lobb WK, Zakariasen KL, McGrath PJ. Endodontic treatment outcomes: do patients perceive problems? J Am Dent Assoc 1996;127:597-600.
  15. Polycarpou N, Ng YL, Canavan D, Moles DR, Gulabivala K. Prevalence of persistent pain after endodontic treatment and factors affecting its occurrence in cases with complete radiographic healing. Int Endod J 2005;38:169-178.
  16. Pogrel MA, Thamby S. Permanent nerve involvement resulting from inferior alveolar nerve blocks. J Am Dent Assoc 2000;131:901-907.
  17. Renton T, Yilmaz Z. Profiling of patients presenting with posttraumatic neuropathy of the trigeminal nerve. J Orofac Pain 2011;25:333-344.
  18. Pogrel MA, Jergensen R, Burgon E, Hulme D. Long-term outcome of trigeminal nerve injuries related to dental treatment. J Oral Maxillofac Surg 2011;69:2284-2288.
  19. Sandstedt P, Sorensen S. Neurosensory disturbances of the trigeminal nerve: a long-term follow-up of traumatic injuries. J Oral Maxillofac Surg 1995;53:498-505.
  20. Campbell RL, Shamaskin RG, Harkins SW. Assessment of recovery from injury to inferior alveolar and mental nerves. Oral Surg Oral Med Oral Pathol 1987;64:519-526.
  21. Tolle T, Dukes E, Sadosky A. Patient burden of trigeminal neuralgia: results from a cross-sectional survey of health state impairment and treatment patterns in six European countries. Pain Pract 2006;6:153-160.
  22. Gustin SM, Wilcox SL, Peck CC, Murray GM, Henderson LA. Similarity of suffering: equivalence of psychological and psychosocial factors in neuropathic and non-neuropathic orofacial pain patients. Pain 2011;152:825-832.
  23. Porto F, de Leeuw R, Evans DR, et al. Differences in psychosocial functioning and sleep quality between idiopathic continuous orofacial neuropathic pain patients and chronic masticatory muscle pain patients. J Orofac Pain 2011;25:117-124.
  24. Han KH, Lim JY, Min BB, Lee JH, Moon KJ, Kim ZS. Korean MMPI-2 standardization study. Korean J Clin Psychol 2006;25:533-564.
  25. Kim KI, Won HT, Lee JH, Kim KY. Standardization study of Symptom Check List-90 in Korea I: characteristics of normal responses. J Korean Neuropsychiatr Assoc 1978;17:449-458.
  26. Hong KE, Jeong DU. Construction of Korean social readjustment rating scale: a methodological study. J Korean Neuropsychiatr Assoc 1982;21:123-136.
  27. Kim KI, Kim JH, Won HT. Korean manual of Symptom Checklist-90-Revision. Seoul: Chungang Attitude Publishing Co.; 1984. pp. 7-37.
  28. Caumo W, Schmidt AP, Schneider CN, et al. Preoperative predictors of moderate to intense acute postoperative pain in patients undergoing abdominal surgery. Acta Anaesthesiol Scand 2002;46:1265-1271.
  29. Katz J, Poleshuck EL, Andrus CH, et al. Risk factors for acute pain and its persistence following breast cancer surgery. Pain 2005;119:16-25.
  30. Sullivan K, King J. Detecting faked psychopathology: a comparison of two tests to detect malingered psychopathology using a simulation design. Psychiatry Res 2010;176:75-81.
  31. Zarb GA, Speck JE. The treatment of temporomandibular joint dysfunction: a retrospective study. J Prosthet Dent 1977;38:420-432.
  32. Tarescavage AM, Ben-Porath YS. Psychotherapeutic outcomes measures: a critical review for practitioners. J Clin Psychol 2014;70:808-830.
  33. Benoliel R, Zadik Y, Eliav E, Sharav Y. Peripheral painful traumatic trigeminal neuropathy: clinical features in 91 cases and proposal of novel diagnostic criteria. J Orofac Pain 2012;26:49-58.
  34. Ziccardi VB, Steinberg MJ. Timing of trigeminal nerve microsurgery: a review of the literature. J Oral Maxillofac Surg 2007;65:1341-1345.
  35. Susarla SM, Kaban LB, Donoff RB, Dodson TB. Does early repair of lingual nerve injuries improve functional sensory recovery? J Oral Maxillofac Surg 2007;65:1070-1076.
  36. Susarla SM, Kaban LB, Donoff RB, Dodson TB. Functional sensory recovery after trigeminal nerve repair. J Oral Maxillofac Surg 2007;65:60-65.
  37. Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain 2005;118:289-305.
  38. van Seventer R, Bach FW, Toth CC, et al. Pregabalin in the treatment of post-traumatic peripheral neuropathic pain: a randomized double-blind trial. Eur J Neurol 2010;17:1082-1089.
  39. Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol 2007;26:1-9.


Supported by : Chosun University