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1. TRIGEMINAL
NEURALGIA
Presented by:
Mr. DANIEL VENKATESH .A
ASSOCIATE PROFESSOR IN NURSING
VHCASCON, HYDERBAD

3. NEURALGIA
Neuralgia (Greek neuron,
"nerve" + algos, "pain") is pain in
the distribution of a nerve or
nerves.
Pain of severe throbbing or
stabbing character in the course of
distribution of a nerve.

4. CLASSIFICATION OF NEURALGIA:
• Trigeminal neuralgia
• Occipital neuralgia
• Glossopharyngeal neuralgia
• Postherpetic neuralgia
• Intercostal neuralgia

5. TRIGEMINAL NEURALGIA:
is the most debilitating form
of neuralgia affecting the
sensory branches of 5th
Craniel Nerve
It leads Sudden, recurrent,
severe pain in the distribution
of one or more branches of

6. TRIGEMINAL NERVE

7. SYNONYMS
•Trifacial neuralgia
•Fothergill’s disease
•Tic-doloureux (painful
jerking)

8. DEFINITION
• It is defined as sudden, usually unilateral, severe, brief,
stabbing, lancinating, recurring pain in the distribution of
one or more branches of the Vth cranial nerve
• Trigeminal neuralgia also known as prosopalgia or
fothergill’s disease is aneuropathic disorder
characterized by episodes of intense pain in the face,
originating from trigeminal nerve

9. ETOIOLOGY
• Usually idiopathic
• Demylination of the nerve
• Multiple sclerosis
• Petrous ridge compression
• Post – traumatic neuralgia
• Intracranial tumors
• Intracranial vascular abnormalities
• Viral etiology

10. ETOIOLOGY
• INTRACRANIAL CAUSES
1. Petrous ridge compression-internal
carotid artey pulsations
2. Multiple sclerosis
3. Intracranial tumors- at the
cerebellopontine angle
4. Intracranial vascular abnormalities-
basilar artery aneurysm, superior
cerebellar artery abnormality

11. •Neuralgias and neuritis
•Syphilis
•Tuberculosis
•Tumor of the brain
•Basilar meningitis
•Pontine diseases .
• Skull fracture
• Aneurysm of the carotid artery or circle
of willis
• Psychoneuroses,and
• Cavernous sinus thrombosis
Other disorders that may affect the trigeminal nerve include :

12. origin of the…..pain....nerve
.

13. Print master
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14. TYPES OF TRIGEMINAL
NEURALGIA
• Pre Trigeminal
neuralgia
• Idiopathic Trigeminal
neuralgia
• Symptomatic neuralgia

15. • Pre trigeminal neuralgia: dull
aching pain usually observed
before appearance of trigeminal
neuralgia
• Idopathic neuralgia: where the
etiology remains unknown
• Symptomatic neuralgia: the
type in which the etiology is
known

16. CLINICAL FEATURES
• Manifests as sudden, unilateral,
intermittent, paroxysmal, sharp,
shooting, lancinating pain, elicited
by slight touch.
• Patient usually complains of
electric shock/lightening like pain
• Usually confined to one part.
• Lasts for few seconds to minutes.
• Motionless or mask like face

17. • Rarely crosses the midline.
• Trigger points - Spontaneous attack
or triggered by trigger zone or
movement of the face as in chewing
talking, brushing or yawning
• This leads patient frequently go
unshaven or unwashed
• Paroxysms occur in cycles.
• Depression and weight loss

18. DIAGNOSIS
• History/physical Exam
• Trigeminal nerve
examination
• Diagnostic nerve
blocking
• MRI (brain)
• EEG

19. MANAGEMENT
•PHARMACOLOGICAL
•SURGICAL
•OTHERS

20. PHARMACOLOGICAL
• FIRST LINE OF APPROACH
Carbamazepine 100, 200mg..
• SECOND LINE OF APPROACH
Phenytoin 100mg
Baclofen 5-80 mg/day
Lamotrigine 25 mg/day
• THIRD LINE OF APPROACH
Clonazepam 4-8 mg
Valproic acid 250-500 mg
Oxcarbazepine 1200mg/day

21. Other methods used are
• Trichloro ethylene inhalation
• Topical capsaicin cream application
• Proparacaine 0.5% anaesthetic drops
in eye
• Anti inflammatory drug-Indomethacin
& short courses of steroids are found
useful in some cases

22. INJECTION OF NERVE WITH
ANESTHETIC AGENT
• Long acting anesthetic agents
• Alcohol injection
This older treatment is not used
often. It involves the injection of
small amounts of alcohol into the
nerve endings.

23. PERIPHERAL GLYCEROL
INJECTION
• Glycerol injection: This treatment involves
similar placement of a needle. A small amount
of glycerol4 is injected into the space around
the nerve fibers.

24. PERIPHERAL NEURECTOMY
( NERVE AVULSION)

25. OPEN PROCEDURES
( INTRACRANIAL PROCEDURES)
 1. MICROVASCULAR
DECOMPRESSION
2. PERCUTANEOUS
RHIZOTOMIES (Surgical division
of nerve roots)
3. GAMMA KNIFE
RADIOSURGERY

26. MICROVASCULAR DECOMPRESSION
This surgery is performed by
going into the skull and moving the
blood vessel away from the
trigeminal nerve. A small pad is
then placed between the vessel
and the nerve to keep them apart

27. 1.MICRO VASCULAR DECOMPRESSION

28. 1.VASCULAR DECOMPRESSION

29. 1.VASCULAR DECOMPRESSION

30. 1.VASCULAR DECOMPRESSION

31. PERCUTANEOUS RADIOFREQUENCY RHIZOTOMY
This treatment uses a radiofrequency
(RF) electrode3 placed through the skin
of the cheek. RF heating at the tip of
this electrode can then destroy selected
nerve fibers (rhizotomy). After
rhizotomy, you will be asked to sit in a
wheelchair, bent over at the waist, for
about 1 hour.

32. 2. PERCUTANEOUS RHIZOTOMIES

33. GAMMA KNIFE RADIOSURGERY

34. OTHERS
• TENS – Transcutaneous
Electric Nerve Stimulation
• Acupuncher
• Psychological approach

35. NURSING MANGEMENT
• Preventing pain-Recognize the
factors that alleviate the pain such
as food that is too hot or too cold
and washing the face, and brushing
the teeth etc., nurse should assist
the patient by providing education.
• Provide cotton pads and room
temperature water to wash the face.

36. • Instruct patient to use mouth wash
to cleanse the mouth after taking
food if tooth brush causes pain.,
• The patient is instructed to eat the
food at room temperature and to
chew the food in the unaffected
site, and to ingest soft foods.
• Provide psychological support.

37. THANK YOU