30. TRIGEMINAL NEURALGIA

what is pain?

pain is an unpleasant sensory and emotional experience which is connected to damage of tissues

what is trigeminal neuralgia?

Neuropathic facial pain arising from the trigeminal nerve that has specific inclusion criteria. Pain is intense lasting brief periods seconds to minutes attacks can happen up to 300 times a day

what is the cause of trigeminal neuralgia?

1. pressure on root entry zone of cn 5 by vascular loop

2. demyelination

3. ectopic/hyperactive discharge of nerve

what diseases procude similar pain to trigemonal neuralgia?

MS

Tumors

Lyme disease

what are the features of trigeminal neuralgia?

intense pain for seconds to minutes

background aching/burning

severe paroxysmal pain with unilateral location

mostly the maxillary and mandibular branches are affected

local anaesthesia will stop the pain

what are the trigger points for trigeminal neuralgia?

the corner of the lips

cheeks

ala of nose

lateral brow

also intraoral triggers point that include teeth, gingiva and tongue

how is trigeminal neuralgia diagnosed?

usually on history and clinical examination

- pain triggered by stimuli

- intervals with no pain

- no dentoalveolar causes

- temporary pain relief from anaesthesia

what is the differential diagnoses for trigeminal neuralgia?

- pain of neuropathic origin

- acute pulpitis

- acute periodontitis

- multiple sclerosis

- glossopharyngeal neuralgia

what is the treatment for trigeminal neuralgia?

1. medical

2. surgical

3. oral surgery

what is the medical treatment for trigeminal neuralgia?

1. anticonvulsants

- carbamazepine 400-1200mg daily

- gabapentin 600-3200mg daily

2. tricyclic antidepressants

- amitryptiline 10-300mg daily

3. antispactic dd

• baclofen 15-80 mg daily

what is the surgical treatment for trigeminal neuralgia?

1. microvascular decompression

2. gamma knife therapy

3. balloon compression of the root of the trigeminal nerve

oral surgery methods include

neurotomy

neuroectomy

neuroexcersis

neurotomy refers to

cutting of the nerve after its exit from foramen of the facial skeleton

neurectomy refers

cutting of the nerve with removal of a part of nerve‘s tissue after its exit from foramen of the facial skeleton

neuroexercis

after surgical exposure of the area of the foramen of the facial skeleton, thenerve was grabbed with hemostat, twisted and pulled for removing as major part as possible