R.D.GARDI MEDICAL COLLEGE & HOSPITAL

DEPARTMENT OF ANATOMY

Trigeminal Neuralgia

By:- Guided by:-Dr. Saurabh Thawrani Dr. Manish Patil

Trigeminal Neuralgia

By;

Dr. Saurabh Anand ThawraniB.D.S,

Diploma Laser Dentistry (Italy),Diploma Infection Control (U.S.A),

Diploma Advanced Oral Implantology (Pune), Member Infection Control Committee (Egypt),Fellow Royal Society of Public Health (U.K.),

M.Sc. Medical Anatomy,…

TRIGEMINAL NERVE (At a Glance)

•The fifth cranial nerve, or simply CN V•Nerve responsible for sensation in the face and motor functions such as biting and chewing.•The largest of the cranial nerves.•Trigeminal L. Trigeminus = Triplet•Three major branches: the ophthalmic nerve (V1),(superior orbital fissure)

the maxillary nerve (V2),(foramen rotundum)

the mandibular nerve (V3). (foramen ovale)

•The ophthalmic and maxillary nerves are purely sensory & the mandibular nerve has sensory (or "cutaneous") and motor functions•The three converge on the trigeminal ganglion also called the semilunar ganglion or gasserian ganglion, located within Meckel's cave

TRIGEMINAL NEURALGIAOr

TIC DOULOUREUXOr

TRIFACIAL NEURALGIAOr

FOTHERGILL’S NEURALGIA

INTRODUCTION• It is the most debilitating form of neuralgia that

affects the sensory branches of the Vth cranial nerve.

• It is a disorder of the peripheral or central fibres of the trigeminal nerve in which the dominant symptom is pain in the anterior half of the head and face

• TN has been called "suicide disease" in the past.

• One of India's biggest film stars, Salman Khan, was diagnosed with TN in 2011. He underwent surgery in the US.

DEFINITIONNeuralgia (Greek neuron, "nerve" + algos, "pain")

is pain in the distribution of a nerve or nerves, as in intercostal neuralgia, trigeminal neuralgia, and glossopharyngeal neuralgia.

Trigeminal neuralgia:- Sudden, usually unilateral, severe, brief, stabbing, lancinating, recurring pain in the distribution of one or more branches of the Vth cranial nerve

TiC DOULOUREUX(A French word)

• Painful jerking.

• It is a truly agonizing condition, in which the patient may clunch the hand over the face & experience severe, lancinating pain associated with spasmodic contractions of the facial muscles during attacks

• A feature that led to use of this term

ETIOLOGY

• Usually idiopathic• Demylination of the nerve• Multiple sclerosis• Petrous ridge compression• Post – traumatic neuralgia• Intracranial tumors• Intracranial vascular abnormalities• Viral etiology

PATHOGENESIS

GENERAL CHARACTERISTICS

• INCIDENCE- 8:100000• AGE- 5th-6th decade of life• SEX- female> male• AFFLICTION FOR SIDE- right> left• DIVISION OF TRIGEMINAL NERVE

INVOLVEMENT- V2>V3>V1

CLINICAL CHARACTERISTICS• Sudden, unilateral, intermittent paroxysmal, sharp,

shooting, lancinating , shock like pain, elicited by slight touching superficial ‘trigger points’ which radiates from that point, across the distribution of one or more branches of the trigeminal nerve

• Pain is usually confined to one part of one division of trigeminal nerve

• Pain rarely crosses the midline• Attacks do not occur during sleep• Pain is of short duration, but may recur with variable

frequency.• In extreme cases, the patient will have a motionless

face – the ‘frozen or mask like face’.

Common Trigger Zone• Cutaneous corner of the lips, cheek, ala of the nose,

lateral brow• Intraoral teeth, gingivae, tongue.• Trigger area on the face are so sensitive that touching or

even air currents can trigger an episode.• 10-12% of cases are bilateral, or occurring on both sides.

This mainly seen in cases with systemic involvement include multiple sclerosis or expanding cranial tumor

TRIGGERING ZONES

DIFERENTIAL DIAGNOSIS

• MIGRAINE- severe type of periodic headache is persistent, at least over a period of hours and it has no trigger zone.

• SINUSITIS- pain is not paroxysmal, in this pain is persistent, associated nasal symptoms.

• DENTAL PAIN- localized, related to biting or hot or cold foods, visible abnormalities on oral examination.

• Post herpetic neuralgia- pain is usually involved in ophthalmic division. The history of skin lesion prior to onset of neuralgia, pain is persistent, associated nasal symptoms.

MANAGEMENT Medical

Anticonvulsant medicines - used to block nerve firing - These drugs include carbamazepine, oxcarbazepine, topiramate, gabapentin, pregabalin, clonazepam, phenytoin, lamotrigine, and valproic acid.

• First line of treatment : CARBAMAZIPINE

• Second line of treatment : BACLOFEN, LAMOTRIGINE, OXCARBAZEPINE, PHENYTOIN, GABAPENTIN, PREGABALIN, SODIUM VALPROATE

• Low dose of Antidepressants such as AMITRYPTILINE are thought to be effective in treating neuropathic pain.

• Intramuscular morphine (not usually helpful in treating the sharp, recurring pain )

• Eventually, if medication fails to relieve pain or produces intolerable side effects such as cognitive disturbances, memory loss, excess fatigue, bone marrow suppression, or allergy, then surgical treatment may be indicated.

SurgicalRhizotomy (rhizolysis) is a procedure in which nerve fibers are

damaged to block pain. A rhizotomy for TN always causes some degree of sensory loss and facial numbness. Several forms of rhizotomy are available to treat trigeminal neuralgia.

• Balloon compression Relief usually lasts one to two years.

• Glycerol injection Relief usually lasts one to two years.

• Radiofrequency thermal lesioning (also known as "RF Ablation" or “RF Lesion”) Relief usually last three to four years

• Stereotactic radiosurgery (Gamma Knife, Cyber Knife) Recurrence of pain within three years

• Microvascular decompression (MVD) is the most invasive of all surgeries for TN, but also offers the lowest probability that pain will return. Relief usually lasts 12 to 15 years

7th of October is the International Trigeminal

Neuralgia Awareness Day.

Thank you