Uui

1. Trigeminal Neuralgia:
also known as Fothergill’s disease
Tic douloureux (painful jerking)
it is defined as
sudden ,usually ,unilateral ,severe ,brief ,stabbing ,
recurring pain in the distribution of one or more
branches of trigeminal nerve.
Mean age: 50 y onwards
Female predominance (male : female = 1:2 ~2:3)

2. "Trigeminal" = tri, and "-geminus" or twin, or thrice twinned
derives from the fact that it has three major branches:
1.Ophthalmic nerve (V1) 1st branch – sensory
2.Maxillary nerve (V2) 2nd branch - sensory
3.Mandibular nerve (V3) 3rd branch - sensory and motor.
Controlling the muscles of mastication: Temporalisand Masseter.
Introduction

3. Causes
Trigeminal Neuralgia is first of all due to the demyelinating disorder.
Common causes of compression can be tumours or their associated blood
vessels however in many cases the cause can be unknown.
Other causes may include:
•Multiple Sclerosis (MS): approximately 1-2% of patients with MS develop TN.
•A tumor
•Physical damage to the nerve
•Family history of blood vessel formation
•Craniovertebral junction abnormalities such as Chiari Malformations
•Bony disorders like Paget's disease
•Osteogenesis imperfecta

4. Risk factors
According to ], the following have been identified as
important risk factors for TN:
•Increased age
•Stroke
•Hypertension in women
•Charcot-Marie-Tooth Disease
•Tumors in the trigeminal nerve region

5. Classification
• Typical TN
• Atypical TN
• Pre-TN
• multiple-sclerosis-related TN
• secondary TN
• post-traumatic TN
(trigeminalneuropathy),
• failed TN

6. Trigeminal nerve

7. Clinical characteristics:-
1.sudden
2.unilateral
3.intermittent paroxysmal
4.sharp shooting
5.lancinating shock like pain elicted by slight touching

8. Pain characteristics
• 1.superficial trigger points which radiates across the
distribution of one or more branches of the trigeminal nerve
2.pain rarely crosses the midline
3.pain is of short duration and last for few seconds to minutes
4.in extreme cases patient has a motionless face called the
frozen or mask like face
5.presence of intraoral or extraoral trigger points

9. • Provocated by obvious stimuli like
Touching to face at particular site
Chewing
Speaking
Brushing
Shaving
Washing the face
The characteristic of the disorder being that the attacks do not
occur during sleep.

10. • DIAGNOSIS:-
CLINICAL EXAMINATION with HISTORY is mandatory.
Response to treatment with tablet of carbamazepine is
universal.
Injections of local anaesthetic agents into patients trigger zone
gives temporarily relief from pain.

11. TREATMENT:-
Medical treatment
Surgical treatment:-
Peripheral injections
Peripheral neurectomy
Cryotherapy
Peripheral radiofrequency
Neurolysis(thermocoagulation)
Gasserian ganglion procedures

12. Medical management
A range of anti-epileptic drugs has
proved to be useful in the
management of TN, with
carbamazepine in particular having a
large number of studies demonstrating
efficacy Non anti-epileptic drugs can
also be prescribed, often in
conjunction with carbamazepine
Other medications include muscle
relaxants and tricyclic antidepressants

13. Complementary approaches
•Low-impact yoga
•Aromatherapy
•Meditation
•Acupuncture
•Upper Cervical Chiropractic
•Vitamin Therapy
•Nutritional Therapy
•Injections of botulinum toxin

15. REFERENCES
• Scott and Brown, Head & neck surgery, 7th
edition.
• Gray’s anatomy for student 4th edition.

16. Thank you