Trigeminal Neuralgia

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Trigeminal neuralgia (TN) paroxysmal pain cutaneous sensory field

trigeminal nerve V1 (ophthalmic branch), V2 (maxillary branch) V3 (mandibular
branch). trigger zone skin, mucosa teeth
ipsilateral trigeminal nerve.
electric-like, shooting lancinating (piercing/stabbing)
. V2 V3
V1 . attack , V2
V3 . unilateral .
multiple sclerosis bilateral alternating,
unilateral simultaneously bilateral. meta-analysis idiopathic TN
8,124 58%; right side 60%, left side 36%, bilateral 4%; 0.5% 20
70% 50 ; 17% V2, 15% V3, 4% V1, 32%
V2+V3, 14% V2+V1 0.3% V1+V3.

vascular impingement facial nerve.
involuntary tic douloureux ( tik doolooroo).

Trigeminal neuralgia (TN) 2 1) idiopathic TN 2)

symptomatic/secondary TN . pain
trigeminal neuropathy 3
1. Vascular impingement superior cerebellar artery, anterior
inferior cerebellar artery petrosal vein root entry zone trigeminal nerve
2. Multiple sclerosis ( demyelination central myelin)
3. Tumor compression sensory trigeminal nerve

Trigeminal Neuralgia 1/5

 TN vascular impingement.
abnormal nerve impulse trigeminal nerve pain excitability
threshold . vascular impingement
sensory axon. capacitance .
depolarization. sensory fiber
trigeminal nerve pain pathway ephaptic conduction
pain fiber . touch non-noxious receptor trigeminal nerve
pain pathway second order neuron spinal trigeminal nucleus synaptic convergence.
convergence trigeminal neuralgia
greater auricular nerve occipital nerve.
.


attack . idiopathic TN .
secondary symptomatic TN
. schawannoma trigeminal nerve reduced sensory
function weakness muscle of mastication . malnutrition

. trigger zone
. .

clinical pain trigeminal neuralgia distribution trigeminal nerve

branch. idiopathic
secondary TN. TN clinical diagnosis definite diagnosis.

trigeminal neuralgia headache, facial pain neuralgia.

headache (structural/non-structural causes), facial pain
refractive error, glaucoma, sinusitis, dental caries, otitis, TMJ disorder .
neuralgia glossopharyngeal nerve .

Trigeminal Neuralgia 2/5

 dental caries, sinusitis, TM joint, cluster

headache. Dental caries sinusitis steady throbbing pain
TG . dental caries
pain ice-water irrigation. acute sinusitis
post nasal drip discharge paranasal sinuses.
. TMJ disorder pain paroxysm preauricular region.
trigger zone . .

Onset
Duration
Characteristic

TG
With trigger
Seconds to minutes
Sharp, lancinating

Dental caries
TMJ disorder
Gradual
Gradual/ no trigger
Hours
Not paroxysmal
Throbbing
Exacerbated by jaw movement

.

(atypical manifestation of common disease VS typical manifestation of
rare disease).
headache, facial pain, neuralgia non-odontogenic cause .
1. Inadequate local dental cause of pain
2. Stimulating, burning, non-pulsatile pain
3. Constant, unremitting, non-variable pain
4. Persistent, recurrent pain over months or years
5. Spontaneous multiple episodes of toothache/pain
6. Failure to respond to local anesthetic block of any suspected tooth
7. Failure to respond to reasonable dental therapy of any suspected tooth

acute
sinusitis . muscle of mastication, trigeminal
sensory impairment long tract signs intracranial/intracerebral trigeminal
nerve . idiopathic TN .

Trigeminal Neuralgia 3/5


TN exacerbation remission attack
remission .
idiopathic ( attack trigger zone ) vascular
impingement tumor compression progressive
.

vascular impingement tumor
. idiopathic TN
nerve block, nerve section, thermocoagulation gaserrian ganglion acupuncture .
idiopathic TN epileptic
seizure trigeminal nerve. analgesics paracetamol opiate compound .
antiepileptic drug
1. Carbamazepine therapeutic blood level 4-10
ugm/mL 600-1,200 mg/day. diplopia, headache,
agranulocytosis .
2. Phenytoin carbamazepine 300 mg/day
therapeutic blood level 10-2o ugm/mL. ataxia, gum hypertrophy,
hirsutisim, lymphadenopathy .
3. Valproate 600-1,200 mg/day, therapeutic blood level 50-100 ugm/mL.
alopecia, obesity, hepatic failure .
antidepressant antiepileptic drug
amitryptyline 10 mg/day. .
.
.

1. Lange DJ, Trojoborg W, Rowland LP. Peripheral and cranial nerve lesions. In: Rowland LP, ed. Merritt's
Textbook of Neurology. Baltimore: Williams & Wilkins, 1995, pp 461-484.

Trigeminal Neuralgia 4/5

2. Nurmikko TJ, Eldridge PR. Trigeminal neuralgia--pathophysiology, diagnosis and current treatment. Br J
3.
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5.

6.

Anaesth. 2001;87:117-32
Okeson JP, Falace DA. Nonodontogenic toothache. Dent Clin North Am. 1997;41:367-83.
Sens MA, Higer HP. MRI of trigeminal neuralgia: initial clinical results in patients with vascular compression of
the trigeminal nerve. Neurosurg Rev. 1991;14:69-73.
Sindou MP, Chiha M, Mertens P. Anatomical findings observed during microsurgical approaches of the
cerebellopontine angle for vascular decompression in trigeminal neuralgia (350 cases). Stereotact Funct
Neurosurg. 1994;63:203-7.
Wilkins RH. Trigeminal Neuralgia. Introduction. IN: Wilkins RH, Rengachary SS, eds. Neurosurgery. New
York: McGraw-Hill, 1996, pp 3921-3929.

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2544.

Trigeminal Neuralgia 5/5