Trigeminal neuralgia (TN) is a neuropathic disorder characterized by severe, sporadic facial pain affecting the trigeminal nerve. It often feels like electric shocks in the face. A 57-year-old female presented with sudden, sharp left cheek pain triggered by touch or talking. No dental cause was found, and TN was diagnosed provisionally. The diagnosis was later confirmed by a neurologist. TN is caused by compression or demyelination of the trigeminal nerve root and treated initially with anticonvulsants like carbamazepine. If medications fail, surgical options include microvascular decompression, percutaneous nerve procedures, or radiosurgery.
This presentation by Professor Joanna Zakrzewska, Head of facial pain unit at Eastman Dental Hospital, looks at trigeminal neuralgia in MS and how it's diagnosed and managed.
It was presented at the MS Trust Annual Conference in November 2014.
This presentation by Professor Joanna Zakrzewska, Head of facial pain unit at Eastman Dental Hospital, looks at trigeminal neuralgia in MS and how it's diagnosed and managed.
It was presented at the MS Trust Annual Conference in November 2014.
Trigeminal neuralgia is a truly agonizing condition, in which the patient may clutch the hand over the face and experience severe, laneinating pain associated with spasmodie contractions of the facial muscles during attacks afeature that led to the use of the term (its archaie name ) “Tie Douloureux” (Painful jerking).
The International Association for the Study of Pain (IASP)1 defines trigeminal neuralgia (TN) as a sudden, usually unilateral, severe brief stabbing recurrent pain in one or more branches of the fifth cranial nerve
synonyms
Idiopathic trigeminal neuralgia / Tic Doulourex.
Trifacial Neuralgia.
Fothergell’s disease.
In 1677 John Locke, a American physician and philosopher, accurately identified the major clinical features of TN
In 1756 the French physician Nicolaus Andre coined the term “Tic douloureux” to the condition.
The English physician John Fothergill in 1773 published detailed description of TN, since then, it has been referred to as ‘Fothergill’s disease’.
Peripheral injections
Long acting LA
Alcohol
Glycerol
Peripheral neurectomy/ nerve avulsion
Cryotherapy
Gasserian ganglion procedures
Percutaneous stereotactic radiofrequency thermal lesioning of the trigeminal ganglion and/or root (rfl)
percutaneous glycerol gangliolysis of the trigeminal ganglion
percutaneous balloon microcompression of the trigeminal ganglion
Intracranial procedures
MVD
Partial sensory rhizotomy
Gamma knife radiation to the trigeminal root entry zone GKR
Trigeminal Neuralgia
A neuropathic pain caused when trigger site stimulated by brushing, tilting head and shaving, stress and tiredness, cold and hot water, chewing and swallowing, touching and washing face, light breeze or wind on face etc.
The disease is mostly unilateral and can be treated by medications like Carbazepine, oxycarbamazepine, lamotrigine and phenytoin and gabapentin and surgeries like periferal injection, Glycerol injection in the gasserian Ganglion, periferal neurectomy, Cryotherapy, open or intracranial procedures Gammaknife radiosurgeries.
Fix your appointment at Dr. Sachdeva's Dental Institute, call us at:- +919818894041,01142464041
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Facial Aesthetics you tube channel :
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This is a PPT of Trigeminal neuralgia for Masters students . take an idea from it...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
Trigeminal neuralgia is a truly agonizing condition, in which the patient may clutch the hand over the face and experience severe, laneinating pain associated with spasmodie contractions of the facial muscles during attacks afeature that led to the use of the term (its archaie name ) “Tie Douloureux” (Painful jerking).
The International Association for the Study of Pain (IASP)1 defines trigeminal neuralgia (TN) as a sudden, usually unilateral, severe brief stabbing recurrent pain in one or more branches of the fifth cranial nerve
synonyms
Idiopathic trigeminal neuralgia / Tic Doulourex.
Trifacial Neuralgia.
Fothergell’s disease.
In 1677 John Locke, a American physician and philosopher, accurately identified the major clinical features of TN
In 1756 the French physician Nicolaus Andre coined the term “Tic douloureux” to the condition.
The English physician John Fothergill in 1773 published detailed description of TN, since then, it has been referred to as ‘Fothergill’s disease’.
Peripheral injections
Long acting LA
Alcohol
Glycerol
Peripheral neurectomy/ nerve avulsion
Cryotherapy
Gasserian ganglion procedures
Percutaneous stereotactic radiofrequency thermal lesioning of the trigeminal ganglion and/or root (rfl)
percutaneous glycerol gangliolysis of the trigeminal ganglion
percutaneous balloon microcompression of the trigeminal ganglion
Intracranial procedures
MVD
Partial sensory rhizotomy
Gamma knife radiation to the trigeminal root entry zone GKR
Trigeminal Neuralgia
A neuropathic pain caused when trigger site stimulated by brushing, tilting head and shaving, stress and tiredness, cold and hot water, chewing and swallowing, touching and washing face, light breeze or wind on face etc.
The disease is mostly unilateral and can be treated by medications like Carbazepine, oxycarbamazepine, lamotrigine and phenytoin and gabapentin and surgeries like periferal injection, Glycerol injection in the gasserian Ganglion, periferal neurectomy, Cryotherapy, open or intracranial procedures Gammaknife radiosurgeries.
Fix your appointment at Dr. Sachdeva's Dental Institute, call us at:- +919818894041,01142464041
Follow our link:-
Google link:
https://business.google.com/dashboard/l/04970356233769420071
Facebook link for Dental Courses:
https://www.facebook.com/dentalcoursesdelhi/
Facebook link for Dental Treatments:
https://www.facebook.com/sachdevadental/
You tube Link:
https://www.youtube.com/user/drrajatsachdeva
Linkedin link:
https://www.linkedin.com/in/drrajatsachdeva/
Slideshare:
https://www.slideshare.net/drrajatsachdeva
Twitter Page :
https://twitter.com/drrajatsachdeva
Instagram page :
https://www.instagram.com/surgicalmasterrajat/
Practo Profile :
https://www.practo.com/delhi/doctor/dr-rajat-sachdeva-dentist
Blogger Profile :
http://drrajatsachdeva.blogspot.com/
Facial Aesthetics Facebook Page :
https://www.facebook.com/facialaesthetics.delhi
Facial Aesthetics you tube channel :
http://www.youtube.com/channel/UCheM4wF9nWGXJYOmScvsQNw
This is a PPT of Trigeminal neuralgia for Masters students . take an idea from it...................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
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Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
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Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
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In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Trigeminal Neuralgia
Case summary
A 57 years old female presented with a
complaint of a sudden, sharp, electric
shock-like pain involving left cheek. The
pain started two days back and is initiated
by touching the face or talking. Patient
thinks that it is a dental pain and
requested treatment
3. Trigeminal Neuralgia
Case summary
No dental cause was identified
and a diagnosis of trigeminal
diagnosis was made as a
provisional diagnosis. The
patient was advised to be seen
by a neurologist.
The diagnosis was confirmed and
patient given carbamazepine
4. Trigeminal Nerve Anatomy
5th cranial nerve CNV
Two roots
1- Sensory root with trigeminal
(gasserian, semilunar) ganglion
2- Motor root
Three divisions
1- Ophthalmic V1 sensory
2- Maxillary V2 sensory
3- Mandibular V3 mixed
5. Trigeminal Neuralgia
Clinical presentation
Sharp brief pain
Sudden, sharp, stabbing, electric shock-like,
brief (few seconds to less than two
minutes), intense paroxysms of pain
confined to one or more divisions of the
trigeminal nerve
6. Clinical presentation
Unilateral location
Usually unilateral (96%) with the right side
more affected
V2 and V3 most affected
No neurologic deficit
No dentoalveolar cause found
Local anesthesia of trigger zone temporarily
arrests pain
7. Clinical presentation
Refractory period
There is refractory period during which pain
cannot be reinitiated for a period of time.
At times, a background aching or burning
pain is present
8. Clinical presentation
trigger-zone
Usually a trigger-zone is present where
mechanical stimuli may provoke an attack.
Common cutaneous trigger zones include
the corner of the lips, cheek, ala of the
nose. Intraoral sites include teeth, gingivae
or tongue.
9. Epidemiology
Incidence 3 – 8 : 100,000 / year
Female-to-male ratio 1.6 - 1.74 :1 (3:2)
Occurs above 50 years of age
10. Epidemiology
Pain Distribution in the Various Nerve Branches
in Trigeminal Neuralgia
V1 only 4%
V2 only 17%
V3 only 15%
V2 + V3 32%
V1 + V2 14%
V1 + V3 0.4
V1 + V2 + V3 17%
Rozen 2004
12. Causes of trigeminal neuralgia
Vascular compression
Pressure on the root by a vascular loop
leads to local demyelination
This in turn precipitates hyperactive
discharge of the nerve
The site of demyelination determines the
trigeminal division involved and hence the
clinical presentation
13. Causes of trigeminal neuralgia
Tumors and MS
Paroxysms of pain last longer, pain tends to
be constant, neurologic deficit is often
detected (cutaneous hypoesthesia, loss of
corneal reflex, masticatory muscle
weakness)
14. Diagnosis of trigeminal neuralgia
1- Clinical features
2- MRI:
- Exclude specific pathologies such as
a tumor or multiple sclerosis.
- Sometimes the MRI scan is sensitive
enough to detect blood vessels that
have come in contact with the
trigeminal nerve.
17. Medical Treatment
Carbamazepine
Initially it is started with low dose of 100mg once or
twice a day and gradually increasing Up to
1200mg/day or till pain is relieved.
Maintenance dose 400-1200 mg/day for at least 4-6
months before one plans to taper the medications.
It gives an initial relief of pain in about 70 - 90% of
cases.
18. Medical Treatment
Phenytoin
The dose is 300 mg/day and can be
increased up to 600mg/day depending
upon the response and tolerability of the
patients.
It gives an initial relief of pain in about 50 -
60% of cases.
19. Medical Treatment
Baclofen
2nd line drug. Dose 15 - 60 mg/day.
It gives an initial relief of pain in about 65 – 74
% of cases.
Baclofen is used with other anticonvulsants
One warning is there that premature tapering
of baclofen may lead to recurrence of pain and
which may be difficult to control with
medications.
20. Surgical Treatment
1- Microvascular decompression MVD
2- Denervation
- Sectioning of the nerve
- Percutaneous procedures
(radiofrequency lesion(RF), alcohol or
glycerol injection balloon compression,)
- Radiosurgery
21. Surgical Treatment
Microvascular decompression (MVD)
Introduced by Jannetta 1979,
Decompressing by placing alloplastic materials between the
vessels and the roots
Advantages:
Nondestructive spares nerve, Treat cause, may be curative
Rare sensation problems
Disadvantages:
GA and craniotomy required
Risk of serious and lethal complication
Limited to healthy patients
24. Surgical Treatment
Percutaneous procedures
Advantages:
Safe well tolerated despite age or infirmity
Brief, no hospitalization
Easily repeated if necessary
Disadvantages:
Treat symptoms not cause
Destructive alters facial sensation
Risk of corneal anesthesia
Dysesthetic sequelae could be severe
Increased recurrence with passage of time
25. Surgical Treatment
Radiosurgery
Advantages:
Safe well tolerated despite age or infirmity
Brief, no hospitalization
Easily repeated if necessary
Disadvantages:
Treat symptoms not cause
Delayed therapeutic response
Risk of corneal anesthesia
Increased recurrence with passage of time
26. Surgical Treatment
Balloon compression
This procedure was originally
recommended when other
techniques failed to relieve
trigeminal pain
There is significant risk of
masseter weakness
28. Surgical Treatment
Gammaknife Radiosurgery (GKRS)
Minimally invasive. It is based on the
principle of using focused radiation beam
to alter axonal function in such a way to
relieve pain. Useful in old and unhealthy
patients.
The effect of GKRS takes 3 weeks to 3
months for pain relief to begin
29. Conclusion
For the the dentist the critical issue is
recognizing TN so that unneeded dental
treatment is avoided.
Unfortunately when the trigger zone is
located in an intraoral site unnecessary
dental treatment is quite common
Peterson
Contemporary Oral and Maxillofacial Surgery
4th edition 2003