Later or delayed management of nerve injuries will depend upon the mechanism and the duration of the event (Table 12.1) [16]. The patient’s ability to cope with the neuropathy and pain, functional problems, and their overall psychological status will drive the need for therapeutic intervention. Considering that the majority of these patients present with neuropathic pain, most are managed with reassurance and medications; however, psychological techniques are being developed for these patients. Many injuries have limited benefit from surgical intervention and should be managed symptomatically using medication or counseling. In order to manage the patient appropriately, you must assess what is causing the patient’s problems. It is important to identify key symptoms including pain or altered sensory perception that may be impairing the patient’s functional abilities. Secondly, it is critical to inquire about functional problems (Fig. 12.2) in order to identify what specifically is most responsible for the patient’s distress. Symptoms like numbness with pain with light touch (mechanical allodynia) or pain with cold stimuli (cold allodynia) often confuses and distresses the patient. An explanation of these symptoms by the clinician often alleviates the patient’s anxiety in most cases. Therapeutic interventions may include the following:

The surgical management for trigeminal nerve injuries is discussed in the other chapters of this book, and this chapter addresses several nonsurgical strategies that can be used to assist the practitioner in preventing and managing complications related to some common dental surgical procedures. In a recent study, surgery with no other form of treatment was a management option for only 22 % of all patients presenting with trigeminal nerve injuries [16].

The planned treatment must address the patient’s concerns appropriately, and the aims of treatment would ideally include the reduction of pain and discomfort and ultimately provide improved neurosensory function. It is important to stress that treatment may not completely restore function, such as eating, drinking, speaking, and sleeping; in addition, any treatment will not restore normal sensation in the neuropathic area, including general sensory (i.e., mechanosensory function) or special sensory function (i.e., taste). Escalation of a patient’s symptoms from intermittent pain to persistent pain would be a significant negative outcome, as would causing a patient to have discomfort or pain when previously they only reported anesthesia. Therefore, particularly with surgery, each patient must be warned of the potential risk of escalating their neuropathic symptoms, which in this study [16] resulted in 40 % of patients declining offered reparative nerve surgery.

The strategy for selecting the mode and timing of intervention must be based upon the etiology of the injury, the patient’s current symptoms, the extent and permanency of the injury, and ­ultimately the patients’ choice of treatment following informed consent and education by the clinician. The key management strategies include counseling and reassurance, medication, and surgery.

In order to successfully manage patients with nerve injuries, the clinician must consult with the patient in an in-depth fashion, provide realistic expectations by reaffirming the nerve injury is permanent if the patient has had their symptoms for more than 3 months, and provide reassurance that these injuries do not predispose them to other disease processes (e.g., cancer), and indeed will likely not worsen. Such reassurance can successfully manage patients who can manage their pain but cannot cope with the consequences of their nerve injury and have associated functional chronic neuropathic pain and resultant psychological difficulties that significantly impact upon their social life or professional life, or usual activities of daily living.