Trigeminal Neuralgia /cosmetic dentistry courses
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Trigeminal Neuralgia /cosmetic dentistry courses
- 1. Trigeminal Neuralgia INDIAN DENTAL ACADEMY Leader in continuing Dental Education www.indiandentalacademy.com
- 2. IntroductionIntroduction • Neuralgia – Unexplained peripheral nerve pain – The most common site: head and neck – The most frequently diagnosed form: trigeminal neuralgia (TN)trigeminal neuralgia (TN) •Tic douloureux (painful jerking) •Mean age: 50 y/o •Female predominance (male : female = 1:2 ~2:3) www.indiandentalacademy.com
- 3. Characteristics of trigeminal neuralgiaCharacteristics of trigeminal neuralgia • Very painful, sharp electric-like spasms that last a few seconds or minutes • Pain is usually only on one side of the face, often around the eye, cheek, and lower part of the face • Pain may be triggered by touch or sounds • Pain occurs while: – Brushing teeth – Chewing – Drinking – Shaving www.indiandentalacademy.com
- 5. Pathogenesis of trigeminal neuralgiaPathogenesis of trigeminal neuralgia • Uncertain – Traumatic compression of the trigeminal nerve by neoplastic (cerebellopontine angle tumor) or vascular anomalies – Infectious agents •Human herpes simplex virus (HSV) – Demyelinating conditions •Multiple sclerosis (MS) www.indiandentalacademy.com
- 6. Types of Trigeminal Neuralgia • Typical TN • Atypical TN • Pre-TN Days to years before the first attack of TN pain, some sufferers experience odd sensations in the trigeminal distributions destined to become affected by TN. These odd sensations of pain, (such as a toothache) or discomfort (like "pins and needles",), • Multiple sclerosis-related TN • Tumor-related TN • Post-traumatic TN (trigeminal neuropathy) usually constant, aching or burning, but may be worsened by exposure to triggers such as wind and cold. pain can start immediately or days to years following injury to the trigeminal nerve. www.indiandentalacademy.com
- 7. DiagnosisDiagnosis Classic TNClassic TN Atypical or mixed TNAtypical or mixed TN A persistent and dull ache between paroxysms or mild sensory loss. Magnetic resonance imaging (MRI) and blood tests may help rule out other conditions. www.indiandentalacademy.com
Editor's Notes
- During an attack of TN, the sufferer will almost always remain still and refrain from speech or movement of the face, so as not to trigger further attacks of pain. The face may contort into a painful wince. Early descriptions of TN confused these sudden attacks with seizures, leading to the term tic doloureux or neuralgia epileptiforme. TN attacks rarely occur when the sufferer is asleep, but may be worsened or alleviated by leaning or lying in a specific position.
- brief paroxysms of "shock-like" pain in 1 or more divisions of the trigeminal nerve (cranial nerve V). The pain most often occurs in "machine-gun-like" volleys, lasting a few seconds to a minute, and recurring frequently for weeks at a time. The pain can be so intense that it may precipitate facial spasms or wincing; hence the term "tic douloureux." It typically occurs unilaterally, but in 4% of patients -- of whom, most have underlying multiple sclerosis -- it is bilateral. Patients may also experience a dull ache between the paroxysms of pain.
- Pulsation of vessels upon the trigeminal nerve root do not visibly damage the nerve. However, irritation from repeated pulsations may lead to changes of nerve function, and delivery of abnormal signals to the trigeminal nerve nucleus. Over time, this is thought to cause hyperactivity of the trigeminal nerve nucleus, resulting in the generation of TN pain.
- D. Pre-Trigeminal Neuralgia Days to years before the first attack of TN pain, some sufferers experience odd sensations in the trigeminal distributions destined to become affected by TN. These odd sensations of pain, (such as a toothache) or discomfort (like "pins and needles", parasthesia), G. Trigeminal Neuropathy or Post-Traumatic Trigeminal Neuralgia The pain of trigeminal neuropathy or post-traumatic TN is usually constant, aching or burning, but may be worsened by exposure to triggers such as wind and cold. Such deafferentation pain can start immediately or days to years following injury to the trigeminal nerve. In the most extreme form, called anesthesia dolorosa, there is continuous severe pain in areas of complete numbness.
- Image: CT, MRI, MRA Try and error: carbamazepine
- Lamotrigine, Valproate, Baclofen, Clonazepam,Topiramate
- Cryotherapy (cryonanlgesia