## 4 Discussion
### Treatment Considerations
#### 4.4.1 Pharmacokine and Topical Treatment  
Pharmacologic therapy remains the mainstay and first-line strategy for PTTNP. Commonly used agents include gabapentin, pregablalin, tricyclic antidepressants (e.g., amitripty  
\begin{table}
\begin{tabular}{l l} \hline \hline
**Phase** & **Recommendation** \\ \hline Diagnosis & Evaluate within one week of symptom onset. \\  & Perform detailed history and neurosensory testing (QST, brush test, pinpick, thermal). \\  & Use Sunderland classification to grade nerve injury. \\ \hline Imaging &
\begin{tabular}{l} Obtain panoramic radiograph and/or CBCT to assess for foreign body, implant impingement, or bony \\ compression. \\ \end{tabular} \\ \hline \multirow{7}{*}{Pharmacologic Treatment} & Acute Phase (first few days to weeks): \\  & -Tagered corticosteroids (e.g., prednisone 40-60 mg/day for 5–7 days, then taper) \\  & -NSAIDs for inflammation and pain control \\  & Chronic Phase (>3 months): \\  & -Gabapentin 300–1800 mg/day \\  & -Pregabalin 75–300 mg/day \\  & -Amitriptyline 10–50 mg/day \\  & -Clonazepam 0.25-1.5 mg/day \\  & -Topical Agents (adjunctive): \\  & -Lidocaine 5% patch \\  & -Capsaicin 0.025-0.075% cream \\ \hline \multirow{7}{*}{Physical Therapy} & Adjunctive modalities: \\  & -Low-Level Laser Therapy (LLIT) \\ \cline{1-1}  & -Transcutaneous Electrical Nerve Stimulation (TENS) \\ \cline{1-1}  & -Desensitization techniques (e.g., cotton, cold/warm stimulation) \\ \hline \multirow{7}{*}{Surgical Consideration} & If symptoms persist beyond 3–6 months or progressive worsening, consider the following: \\ \cline{1-1}  & -Surgical decompression (if mechanical cause) \\ \cline{1-1}  & -Neuorrhraphy or microsurgical repair (if laceration) \\ \hline Referral & Refer to an orofacial pain specialist or oral/maxillofacial surgeon within one month if no improvement or \\ \cline{1-1}  & diagnosis uncertain. \\ \hline \multirow{7}{*}{Monitoring \& Follow-up} & Reassess symptoms monthly using VAS, QualST/QST \\ \cline{1-1}  & Monitor for changes in pain quality, spread, or new sensory deficits \\ \cline{1-1}  & Adjust therapy based on response \\ \hline \hline \end{tabular} Note: This table is based on the clinical recommendations from the American Academy of Orofacial Pain (AAOP), 7 th Edition Guidelines.  
\end{table}
Table 6: Clinical management of PTTNP (post-traumatic trigeminal neuropathic pain).  
line), and benzodiazepepines (e.g., clonazepam) [30; 31; 34]. Pharmacologic agents used in PTTNP target the aberrant neuronal excitability and aim to reduce the central and peripheral sensitization. Gabapentin (300-3600 mg/day) and pregabalin (150-600 mg/day) act on the \(\alpha 28\) subunit of the voltage-gated calcium channels, inhibiting excitatory neurotransmitter release. Amitriptyline (10-75 mg/day) exerts its effects via norepinephrine and serotonin reuptake inhibition and sodium channel blockade. Clonazepam (0.25-1.5 mg/day) may be beneficial for comorbid anxiety or insomnia but should be used cautiously due to the risk of dependence and cognitive side effects. Dose titration and adverse effect profiles must be considered, especially in elderly patients or those with renal or cardiovascular comorbidities [31; 35].  
In addition to the systemic agents, topical medications offer localized pain relief with minimal systemic burden. Lidocaine patches (5%) can be applied for 12 h/day and are useful for focal neuropathic pain. Capsaicin cream (0.025-0.075%) works by depleting substance P and desensitizing TRPV1 receptors, though it may cause an initial burning sensation. These topical agents are particularly beneficial in patients who are intolerant to systemic medications or for those with well-demarcated pain areas [31; 36].  
Careful monitoring of the treatment response, side effects, and comorbidities (e.g., renal or hepatic dysfunction) is critical in all cases. Patients should be educated on the gradual onset of therapeutic effects, the importance of adherence, and the need to avoid the self-adjustment of medications [30; 31].