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INTRODUCTION
Trigeminal Neuralgia (TN) is neuropathic facial pain arising from the trigeminal nerve.
Cranial Nerve V
Sensoric Portio major Motoric Portio minor Sensoric + motoric Ganglion Semilunare Gasseri
CLASSIFICATION
1. Typical Trigeminal Neuralgia
(Tic Douloureux)
(a)
(b)
(c)
CLASSIFICATION
2. Atypical Trigeminal Neuralgia
Unilateral Prominent constant Boring or burning pain Caused by vascular compression upon a specific part of trigeminal nerve (portio minor) A more severe from or progression of typical TN
CLASSIFICATION
3. Pre - Trigeminal Neuralgia
Symptoms : odd sensations of pain or discomfort before the first attack of TN pain
CLASSIFICATION
5. Secondary Trigeminal Neuralgia
Caused by a lesion (tumor) A tumor compresses or distorts the trigeminal nerve facial numbness, weakness of chewing muscles, constant pain
Develop following cranio-facial trauma, dental trauma, sinus trauma, destructive procedures (rhizotomies) Injury caused severe pain, constant ,triggers such as wind and cold, start immediately or days to years following injury
CLASSIFICATION
7. Failed Trigeminal Neuralgia
Medications, microvascular
ETIOLOGY
1.
Blood vessels compression at the trigeminal nerve root Demyelination nerve A tumor compresses trigeminal nerve Injury to the trigeminal nerve Un known
2. 3. 4. 5.
Clinical Features
1. 2.
3. 4. 5.
6.
Common triggers include touch, talking, eating, drinking, chewing, tooth brushing, hair combing and
kissing.
DIAGNOSIS
Differential Diagnosis
1.
2.
Glossopharyngeal neuralgia
Occipital neuralgia
3.
4.
5.
Trigeminal neuropathy
TREATMENT
TREATMENT
Medication
Carbamazepin (Tegretol)
Anticonvulsants, Drug of choice for TN, effective dose 600 1200 mg/ day for 3-4 x/ day Maintenance dosage 200 mg/d to prevent recurrences Side effect : drowsiness, mental confusion, dizziness, nystagmus,ataxia
Oxycarbazepine (Trileptal)
Side effect : nausea, fatique, tremor Dose : 2 x 300mg, maximum dose : 2400-3000 mg/day
TREATMENT
Phenytoin (Dilantin)
Dose: 300-500mg/day for 3x/day Side effect : nystagmus, dysarthria, gingival hyperplasia, hypertrichosis, allergic skin rash
Gabapentin (Neurontin)
TREATMENT
Baclophen (Lioresal)
Antispasmodic agents
TREATMENT
Surgical Procedure
For patients medical therapy has failed surgery is a viable and effective option
2.
3. 4. 5.
TREATMENT
Microvascular decompression
non-destructive technique Under general anesthesia, incising the skin behind the ear (Craniotomy) Identify an arterial loop compressing the nerve pad the vascular structure with Teflon felt Complication: CSF leaks, hearing loss, permanent anesthesia over the face
TREATMENT
TREATMENT
3. Radiofrequency Rhizotomy
Intravena sedation electroda insert to ganglion electroda to heat thermal injury to ganglion
5. Microsurgical Ryzotomy
CONCLUSION
Trigeminal Neuralgia (TN) is neuropathic facial pain arising from the trigeminal nerve. Treatment for TN medication is the initial therapy if pharmacologic treatment fails surgical procedure.