trigeminal neuralgia - Dental Clinic in Delhi

MANAGEMENT OF FACIAL NERVE PAIN

Pain is defined as a feeling or
discomfort of physical suffering caused
by illness or injury or a sensation caused
by a noxious stimulus to the naked
nerve endings.
It is normally associated with tissue
damage and characterized by
discomfort like pricking, throbbing,
aching, etc.

TYPES OF PAINS
Acute pain and chronic pain.
Acute pain can last a moment; rarely does it become
chronic pain.
Chronic pain persists for longer periods. It is resistant to
most medical treatments and cause severe problems.
Identifying the etiology instead of simply treating the pain
can give more targeted and successful pain treatment.

FACIAL NERVE PAIN
The nerve which is most commonly associated with facial
nerve pain is trigeminal nerve. The branches of trigeminal
nerve are:

The facial pain cause by this nerve is called trigeminal
neuralgia (Tic Douloureux).
It is a chronic neuropathic condition affecting any part of
the face, head, neck, shoulders and is considered one of the
most painful conditions. It can affect any of the three
branches.

Trigeminal neuralgia is unpredictable, cause due to
compression or damage of the nerve resulting in
pricking, sharp pain like electric shocks.

SIGNS AND SYMPTOMS
Women are more common than male.
Individual above 50years are more commonly affected.
Onset is sudden and last for few seconds to several minutes.

Occur several times a day or a week, followed by painfree
or refractory period.
The pain worsens with time and mostly affects only one
side of the face.
If both sides of the face are involved then it is called
bilateral trigeminal neuralgia.

The cheek, jaw, teeth, gums, and lips
are most commonly affected.
People with trigeminal neuralgia may
have anxiety because they are
uncertain when the pain will return
so they are also called suicidal disease.

TRIGGER FACTORS
Hair brushing and cleaning of teeth
Tilting head and shaving
Stress and tiredness
Cold and hot weather

Chewing and swallowing
Touching and washing face
Light breeze or wind on face etc.

TREATMENT
Depending on the severity and types, the
treatment can be with classified as –
Medications.
Surgery.

Medications (non invasive)
Carbazepine is the drug of choice due to fewer side effects.
If carbazepine causes more troublesome side effects, lower the
dose and add baclofen.
Oxycarbazepine with lamotrigine or phenytoin may also be use.
During refractory period, gabapentin is most commonly used.

In recalcitrant cases, pregabalin, topiramate or older
anticonvulsants – valproate and phenytoin may be used.
Recent advances like botulinum toxin, has
antinociceptive effect and inhibit the release of
neurotransmitters giving analgesic effect and better
results.

SURGERY (INVASIVE)
Those patients who do not respond to medications and are
physically fit can go for invasive procedures.
Peripheral Injections
Longer acting anesthetic agents
Agents like bupivacaine without adrenaline but with or
without corticosteroids are injected to the peripheral nerve
end.

Alcohol injections
0.5-2ml of 95% absolute alcohol is used for injection.

Glycerol Injection In The Gasserian Ganglion
Injected behind the ganglion and destroy both small and
large nerve fibers.

Peripheral Neurectomy
Oldest and most effective method.
Mostly performed on the infraorbital nerve, inferior
alveolar nerve, mental nerve and rarely lingual nerve.

Cryotherapy
Direct application of cryoprobe (temperature -60◦)
intraorally to the affected nerve producing wallerian
degeneration of the affected nerve.
In this, the nerve is not sectioned but destroyed.

Open Or Intracranial Procedures
Incision given over the mastoid process and release
the nerve compression from the pulsating artery.
Separate the nerve and the artery by placing Teflon
between them.

Gamma Knife Radiosurgery
Non invasive, scalpless radiosurgery by delivering
radiation to the targeted site.

CONCLUSION
Trigeminal neuralgia has been an enigma since ages.
Although the pain is intense, progresses and worsens with
time the condition is not life-threatening.
Proper diagnosis and treatment plan still plays an
important role in success of the treatment.
However, the various advances help in understanding the
condition and increase the success rate of the treatment.

If not cure there is a way to reduce pain and improve the
quality life of the patients with trigeminal neuralgia.