In the name of Allah, the Beneficent, the Merciful.

TRIGEMINAL NEURALGIAAlso known as…

TIC DOULOUREUXPROSOPALGIASUICIDE DISEASENEURALGIA EPILEPTIFORME By: Aleshba Saba Roll # 02 3rd Year BDS A neuropathic disorder of trigeminal nerve

(INTRODUCTION)

TRIGEMINAL NEURALGIA

Sudden, usually unilateral

Brief, stabbing , electric shock like

recurrent pain

Pain is limited to the sensory distribution of trigeminal nerve that includes middle face (maxillary division V2)– being most frequently involved, lower (mandibular division V3) & upper (ophthalmic division V1)– being least frequently involved

• Vascular abnormality(venous or arterial) that causes compression of trigeminal root, adjacent to pons in posterior cranial fossa

• Association with MS• Tumors in post. Cranial fossa (2%)• Focal nerve injury• As a result of aging, shingles, unknown causes

mostly

Etiology

Normal

Neurovascular compression

Tumor affecting CN V

Incidence

Usually develops after the age of 50, although there have been cases with patients being as young as three years of age

150 per 1million (estimated) people suffer from TN

Women are more likely to be affected than men (female:male – 2:1)

Usually unilateral (3% cases show bilateral involvement)

Triggering factors

• Shaving, washing• Stroking your face (trigger zones on face)• Eating • Drinking • Brushing your teeth • Talking • Putting on makeup • Encountering a breeze • Smiling

SYMPTOMS•Pain in areas supplied by CN V•Usually unilateral•Sharp, stabbing, electric shock like pain•Lasts for few seconds to minutes•This transient attack may be repeated in matter of minutes or hours

TYPES OF TRIGEMINAL NEURALGIA

Pre-trigeminal neuralgia

• Odd sensations of pain, (such as a toothache) or discomfort (like “pins and needles”), may be symptoms of pre-trigeminal neuralgia

• Occur in 20% of patients who develop TN

• Pre-TN is most effectively treated with medical therapy used for typical TN

Diagnosis &Management

• History• Examination (Odontogenic structures, cranial nerve

functions, related structures-muscles,TMJ,sinuses)• Investigations Diagnostic local anesthetic nerve block (defines distribution of the pain, eliminate or confirm referred pain) Nerve conduction tests Imaging techniques (eliminate pain due to any other reason-odontogenic, sinus,

postherpetic neuralgia, cluster headache, TMJ DS, atypical facial pain)

1st step of treatment- Pharmacotherapy(Medical management of TN)

Trigeminal neuralgia is usually treated with drugs called anti- convulsants which include:

• Carbamazepine (drug of choice) (400-1000mg/day)• Phenytoin (300mg/day)• Oxycarbazepine• Gabapentin (600-1200mg/day)• Baclofen, lamotrigine, clonazepam

2nd step of treatment- Surgery

Surgical options include:

1. Peripheral • Cryotherapy• Neurectomy• Alcohol injections

2. Gasserian ganglion• Radiofrequency, thermocoagulation• Glycerol injection• Microcompression (balloon compression)

3. Posterior fossa• Neurovascular decompression• Stereotactic radiosurgery

Non drug therapies

• Trancutaneus electric nerve stimulation• Laser• Rhizotomy• Alcohol injections

There are some things that a patient can do to minimize the frequency and intensity of TN attacks:

1. Apply ice packs. Cold often numbs the area and will reduce the pain

2.Get adequate rest in normal rest cycles 3.Manage your stress well and keep stress levels low 4. Avoid foods that may act as nerve stimulants, such as

coffee, tea, and foods that are high in sugar5. Maintain adequate hydration and electrolyte levels 6. Practice healthy living principles such as diet and exercise

THANK YOU !

Reference www.google.com (free search)

Lecture notes by Dr. RazzaqTyldesley’s oral medicine

Cawson’s Essentials of Oral MedicineP-J Lamey- A clinical guide To Oral MedicineIf you suffer, thank God!

it is a sure sign that you are alive. -Elbert Hubbard