THIS IS A BRIEF DESCRIPTION ABOUT THE TRIGGER ZONES OF THE OROFACIAL REGION IN TRIGEMINAL NEURALGIA

1. KRISHNAA S
III BDS
DEPT OF ORAL AND
MAXILLOFACIAL
PATHOLOGY

2. DEFINITION
• ACCORDING TO NEUROSCIENCE AND
NEUROLOGY, A TRIGGER ZONE (DOLOROGENIC
ZONE) IS AN AREA OF THE BODY / OF A CELL , IN
WHICH A SPECIFIC TYPE OF STIMULATION
TRIGGERS A SPECIFIC TYPE OF RESPONSE
• THE TERM WAS INTRODUCED BY, A JAPANESE
AUTHOR, HUGH T PATRICK IN 1914

3. TRIGGER ZONES OF
OROFACIAL REGION

4. TRIGEMINAL
NEURALGIA
SPHENOPALATINE
NEURALGIA
BELL’S PALSY
FREY’S
SYNDROME
GLOSSOPHARYNGEAL
NEURALGIA
DISEASES
OF THE
NERVES

5. TRIGEMINAL NEURALGIA
TIC DOULOUREUX
FOTHERGILL’S DISEASE
TRIFACIAL NEURALGIA
SUICIDE DISEASE

6. NEURALGIA
PAIN ALONG THE PATHWAY OF
THE NERVE
JOHN FOTHERGILL
ENGLISH PHYSICIAN
[1773]
SO
ACCORDINGLY,
TRIGEMINAL NEURALGIA
PAIN ALONG THE DISTRIBUTION OF
THE TRIGEMINAL NERVE

7.  FIFTH CRANIAL NERVE
 RESPONSIBLE FOR
SENSATION IN THE FACE +
MOTOR FUNCTIONS
 TRI THREE
1. OPHTHALMIC
2. MAXILLARY
3. MANDIBULAR
TRIGEMINAL NERVE
B
R
A
N
C
H
E
S

8. DESCRIBED AS …
• SUDDEN, SHARP, LANCINATING, ELECTRIC SHOCK –LIKE
RECURRENT PAIN ALONG THE BRANCHES OF THE NERVE.
• GIVES ‘THE MOST TERRIBLE TYPE OF PAIN KNOWN TO
HUMANS’
• FACIAL MUSCLE SPASMS MAY ALSO ACCOMPANY THE PAIN
ATTACK

9. CLINICAL FEATURES
• AGE - 50-70 yrs
• GENDER - Female predilection
• Pain is usually unilateral(right side more affected )
• Pain attack is initiated by touching specific
areas of the face called TRIGGER ZONES

10.  ALA OF THE NOSE
 CHEEKS
 VERMILLION
BORDER OF THE
LIPS
 AROUND THE EYES
 SKIN ON CHIN
 FOREHEAD
 MIDFACE
 ALVEOLAR
BONE
 NASOLABIAL
FOLDDISTRIBUTION OF
TRIGGER ZONES

11. “TRIGGERS PRECIPITATE AN ATTACK”
CHEWING /
SWALLOWING
TALKING
BRUSHING TEETH
FACE WASHING /
SHAVING
LIGHT TOUCH /
VIBRATION
COOL BREEZE ACROSS
THE FACE

12. CLINICAL FEATURES (CONTD…)
• MAXILLARY DIVISION MORE COMMONLY
INVOLVED
• EARLY PAIN IS TERMED AS
PRE-TRIGEMINAL NEURALGIA
DULL ACHING BURNING
SEARING
SHARP
TOOTHACHE

13. THE VERY SAME TRIGEMINAL NEURALGIA

14. TYPES
TRIGEMINAL
NEURALGIA
CLASSICAL
TRIGEMINAL
NEURALGIA
SYMPTOMATIC
TRIGEMINAL
NEURALGIA
ACCORDING TO THE INTERNATIONAL HEADACHE SOCIETY (IHS),

15. CLASSICAL TN (COMMON) SYMPTOMATIC TN
i. IDIOPATHIC TN
ii. BELIEVED TO BE CAUSED
BY A BLOOD VESSEL
COMPRESSING THE
TRIGEMINAL NERVE AS IT
EXIT FROM THE
BRAINSTEM.
iii. CONSTANT COMPRESSION
CAUSES
DEMYELINATION,
WHICH RESULTS IN
HYPEREXCITABILITY OF
THE NERVE.
i. NEURALGIA CAUSED
SECONDARY TO AN
UNDERLYING MEDICAL
CONDITION
ii. NOT RELATED TO
VASCULAR COMPRESSION
iii. CAUSES CAN BE
MULTIPLE SCLEROSIS,
LEUKODYSTROPHY,
GUILLAN-BARRE
SYNDROME OR A
TUMOUR COMPRESSING
THE NERVE etc…
PATHOGENESIS

16. DIAGNOSIS
• DETAILED PAIN HISTORY (ONSET, LOCATION, INTENSITY,
AGGRAVATING FACTORS, ALLEVIATING FACTORS, FREQUENCY, DURATION)
• CLINICAL EXAMINATION
• MRI SCAN
• CT SCAN

17. DIFFERENTIAL DIAGNOSIS
• MIGRAINE
• CLUSTER HEADACHE (SPHENOPALATINE NEURALGIA)
• TEMPORAL ARTERITIS
• MULTIPLE SCLEROSIS
• MANDIBULAR OSTEOMYELITIS
• POSTHERPETIC NEURALGIA
• TROTTER’S SYNDROME

18. TREATMENT
(A) MEDICATIONS
CARBAMAZEPINE ANTICONVULSANTS
PHENYTOIN OXOCARBAZEPINE
BOTULINUM TOXIN
•RECENT STUDIES SHOWS IT
INHIBITS THE RELEASE OF
NEUROTRANSMITTERS
GABAPENTIN

19. (B) SURGICAL
MICROVASCULAR
DECOMPRESSION
ALCOHOL
INJECTIONS
GASSERIAN
GANGLION
GLYCEOL
INJECTONS
PERIPHERAL
NEURORECTOMY
INTRACRANIAL
PROCEDURES
CRYOTHERAPY
GAMMA KNIFE
RADIOSURGERY

20. SPHENOPALATINE NEURALGIA / HISTAMINE
HEADACHE / ALARM CLOCK HEADACHE /
CLUSTER HEADACHE
• EXTREMELY PAINFUL CONDITION
• INITIATING FACTOR – ALCOHOL, HEAT, CERTAIN MEDICATIONS
• EXACT ETIOLOGY IS UNKNOWN BUT IS BELIEVED THAT IT IS DUE
TO THE ABNORMALITIES IN THE HYPOTHALAMUS
• TWO TYPES:
1. Episodic
2. Chronic
• TREATED BY NERVE BLOCKS AND S EVERAL NEUROSURGICAL
PROCEDURES.

21. CONCLUSION
• PROPER DIAGNOSIS AND TREATMENT PLAN
PLAY A MAJOR ROLE IN THE SUCCESS OF ANY
TREATMENT.
• THE VARIOUS ADVANCES HELP IN
UNDERSTANDING THE CONDITION AND PROVIDE
BETTER PROGNOSIS.

22. REFERENCES
• Shafer’s textbook of Oral Pathology (8TH edition)
• National organization for rare disorders (NORD)
(www.rarediseases.org)
• www.pubmed.gov.in (Medline database)
• Jafferey P Okeson, Bells orofacial pain, 6th edition,
Quintessence publishing co Inc., 2005
• Cheryl A. Kitt et al., Topical review Trigeminal Neuralgia:
opportunities for research and treatment, International
Association for the study of Pain, 2000

23. THANK YOU!!