TRIGEMINAL NEURALGIA OR TIC DOULOUREUX

1. TRIGEMINAL NEURALGIA OR
TIC DOULOUREUX
BY: SAglow007
DEPARTMENT: ORAL
MEDICINE

2. CONTENTS
DEFINITIONS
ETIOLOGY
ANATOMY OF TRIGEMINAL NERVE
GENERAL CHARACTERISTICS
CLINICAL FEATURES
DIAGNOSTIC APPROACH
TREATMENT

3. DEFINITIONS
•NEURALGIA:
• Intense typically intermittent pain along the course of nerve
especially in the head or face.
•TRIGEMINAL NEURALGIA:
• Also called TIC DOULOUREUX.
• It is a neuropathic disorder of trigeminal nerve that causes episode
of intense pain in eyes, lips, scalp, forehead and jaws.

4. ETIOLOGY
• INFECTION
• MULTIPLE SCLEROSIS
• POST TRAUMATIC NEURALGIA
• VIRAL ETIOLOGY
• INTRACRANIAL VASCULAR ABNORMALITIES
• PROLIFERATIVE CHANGES IN MYELIN SHEAT & GANGLION
• BONE CAVITIES

5. ANATOMY
OF
TRIGEMINAL
NERVE
V2 - SKIN OF UPPER LIP,
ALA, CHEEKS & UPPER
GUM
V1 – SUPRAORBITAL
RIDGE OF AFFECTED
SIDE
V3 – LOWER LIP,
TEETH OR GUMS OF
LOWER JAW

6. GENERAL
CHARACTERISTICS
INCIDENCE 8 : 1,00,000
AGE 5th – 6th DECADE OF LIFE
SEX FEMALE > MALE / 1.6 > 1.0
AFFLICTION FOR SIDE RIGHT > LEFT
DIVISION OF TRIGEMINAL
NERVE INVOLVEMENT
V3 > V2 > V1

7. Clinical Features
Of Trigeminal
Neuralgia
Character
Shooting, Sharp
Terrifying, Exhausting
Unbearable
SEVERITYModerate To Severe
SITE
Trigeminal nerve
Unilateral 97%
Right up to 60%
First division rare
Timing
Attacks
For seconds, no
after pain
Seconds, dull after
pain for minutes
Periods of complete
remission weeks, months
Provoking
Light Touch
spontaneous
Eating
Washing
Talking
relieving
Sometime sleep
Drugs
Associated Trigger points
May be sensory change

8. DIAGNOSTIC
APPROCH
• HISTORY
• CLINICAL EXAMINATION (Odontogenic structures, cranial nerve
functions, related structure muscles, TMJ, sinuses)
• DIAGNOSTIC LA BLOCK
• CT SCAN
• MRI

9. TREATMENT
PHARMACOLOGICAL
TREATMENT
SURGICAL
TREATMENT
NON DRUG THERAPY

10. PHARMACOLOGICAL
TREATMENT
DRUGS DOSAGE
CARBAMAZEPINE (Tegrol,
Tegretol)
200mg bid To 1600mg tds
PHENYTOIN (Dilantin) 300mg To 500mg tds
300mg bid To 3000mgOXYCARBAZEPINE
(Trileptal)
BACLOFEN (Liorisal) 5mg bid To 60mg bid
PREGABALIN (Lyrica,
Zeegap)
300mg tdsGABAPENTIN (Neurontin)
100mg to 300mg bid
Enhances
effect of
above
As effective as
Carbamazepine
Fewer side effects
Minimum drug interactions & side effects
DON’T STOP DRUGS ABRUPTLY

11. SURGICAL TREATMENT
PERIPHERAL
GASSERIAN
GANGLION
POSTERIOR
FOSSA
CRYOPATHY
NEURECTOMY
ALCOHOL INJRCTION
RADIOFREQUENCY,
THERMOCOAGULATION
MICROCOMPRESSION
(BALLOON COMPRESSION)
GLYCEROL INJECTION
NEUROVASCULAR
DECOMPRESSION
STEREOTACTIC
RADIOSURGERY

12. BALLOON COMPRESSION

13. GLYCEROL INJECTION

14. NON DRUG
THERAPY
LASER
RHIZOTOMY
TRANSWCUTANEUS
ELECTRIC NERVE
STIMULATION
ALCOHOL
INJECTION