Trigeminal Neuralgia

What causes trigeminal neuralgia?

Introduction | Types | Symptoms | Causes | Diagnosis | Treatments

Introduction

•The brain is connected to the body by the spinal cord with spinal nerves sending and receiving impulses and messages to and from the brain.

•However, twelve cranial nerves directly connect to the body. These nerves are involved with the muscle and sensory function of the head and neck.

 

•Trigeminal Nerve, also known as the 5th cranial nerve.

•Primarily provides sensation to the face.

•Smaller role in muscle for chewing and biting.

•The trigeminal nerve is so named because it has three (tri) branches responsible for facial sensation.

1- Ophthalmic (V1) 

2- Maxillary (V2) 

3- Mandibular (V3)

•Fothergill’s Disease (FD) also known as Trigeminal Neuralgia is characterized by paroxysmal attacks of severe, sharp, stabbing, electric shock-like pain affecting one side of the face mainly the second and third divisions of it.

 

•Trigeminal neuralgia is a chronic pain disorder that affects the trigeminal nerve.

•The pain of trigeminal neuralgia is may occur every few hours, minutes, or seconds, but in some patients whose pain is not well controlled affecting activities of daily life and cause depression.

 

Types

There are two main types:

1- Typical

2- Atypical trigeminal neuralgia.

 

Typical Trigeminal Neuralgia

•The typical form results in episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to a few minutes.

 

Atypical Trigeminal Neuralgia

•The atypical form results in a constant burning pain that is less severe

 

 

Symptoms

•Sever shooting pain may feel like ha electric shock at the nerve root.

•Sudden attack of pain and get worsen by touching the face, chewing.

•Duration of pain lasts from a few seconds to several minutes.

•Pain in the areas where trigeminal nerve supplies go, cheek, jaws, teeth, gums, lips.

•Pain occurs one side of the face at a time.

 

Causes

•Multiple Sclerosis.

•Tumors on the nerve.

•Compression of the nerve by the small artery or vein.

•Old age. 

•Diabetes.

 

Most Common cause:

•Vascular Compression of the nerve by a small leaves the brainstem.

 

Diagnosis

•From a well-taken history 

•CT- scan

•MRI

 

Medical Treatment

Carbamazepine:-

•This medicine slows the nerve firing and can quiet an overaction nerve. Other Solutions:

•Injection of glycerol into the nerve.

 

Physical therapy Treatment

•Patients were given continuous Transcutaneous Electrical Nerve Stimulation (TENS) at 250 Hz with a pulse of 120 u for 20 minutes five days a week for four weeks over the route of the afflicted nerve. One electrode was put immediately before the ear, while the other was implanted near the nerve's end. When necessary, however, the location was adjusted to accommodate pain referral and effectiveness.

•A heated moist pack was applied to the neck and trapezius muscle for at least 10 minutes to treat muscle spasms.

•For five repetitions, isometric neck exercises for each side were administered, as well as pain-free neck range of motion exercises (neck flexion, extension, and side-bending).

•For ten minutes, relaxation techniques were used, including deep breathing exercises.

•Patients were instructed to cover the injured side of their face with a soft cloth or a cotton pad for 15 minutes each day to lessen hypersensitivity, which may aid in reducing the nervous system's exposure to continual afferent input.

 

Surgery

• The surgeon Cut the Skull behind the ear through a small 2- inch incision and 1- inch opening in the bone.

• Once found, the vessel is moved aside and a small piece of padding is placed to keep the vessel off the nerve.

• Often, a small grove is seen in the nerve where the vessel was compressing it.