Crispy seminar on trigeminal or dentists nerve treatment of trigeminal neuralgia in detail including gamma knife cryotherapy glycerol injections radiofrequency lesioning pretty useful for last minute brush ups at both undergraduate as well as masters level from both theory as well as practical point of view

1. TRIGEMINAL NERVE
DR.BHUPENDRA BABARIA
JR – 1
26TH SEPTEMBER 2019

3. CONTENTS
• INTRODUCTION
• Embryology
• Trigeminal nucleus
• Trigeminal ganglion
• FUNCTIONS
• Clinical significance
• BRANCHES OF TRIGEMINAL NERVE
• Assosiated Reflexes
• Applied anatomy of trigeminal nerve
3

4. INTRODUCTION
• The trigeminal nerve (the fifth cranial nerve, or simply CNV) is a
nerve responsible for sensation in the face and motor functions
such as biting and chewing
• Nerve of 1st brachial arch
• Largest and MOST COMPLEX of the cranial nerves
• DENTIST’S NERVE
4BDC Human Anatomy - Head, Neck & Brain (Volume 3)

5. Trigeminal-embryology
Appear in the 4th and 5th weeks
From the neural crest, and cells of the ectodermal
placodes , Cells at the perimeter of the neural plate
A neurogenic placode is an area of thickening of
the epithelium in
the embryonic head ectoderm layer that gives rise to
neurons and other structures of the sensory nervous
system
Motor nuclei developing in the basal columns and
sensory nuclei developing from the alar columns
5

6. • Its name ("trigeminal" = tri-, or three, and - geminus, or
twin: thrice-twinned) derives from the fact that it has
three major branches
• The Ophthalmic nerve(v1)
• The Maxillary nerve (V2)
• The Mandibular nerve (V3)
• The Ophthalmic and Maxillary nerves are purely sensory,
whereas the Mandibular nerve supplies motor as well as
sensory (or "cutaneous") functions (mixed)
6

7. Parasympathetic outflow
• Branches of this nerve provides sensory fibres to 4
parasympathetic ganglia :
1. Ciliary
2. Pterygopalatine
3. Otic
4. Submandibular
7

8. spinal
principal sensory
Mesenephalic
Trigeminal
ganglion
OPTHALMIC
(v1)
MANDIBULAR
(v3)
MAXILLARY
(v2)
Meckel’s cave
8

9. Trigeminal nucleus
A nucleus
A nucleus refers to a collection of nerve cell bodies
within the central nervous system
A ganglion
A ganglion refers to a collection of the nerve cell
bodies outside the central nervous system
9

10. • All sensory information from the
face, both touch-position and
pain-temperature, is sent to
the trigeminal nucleus
• The sensory trigeminal nerve
nuclei are the largest of
the cranial nerve nuclei
• Extend through the whole of
the midbrain, pons and medulla,
and into the high cervical spinal
cord
Trigeminal nucleus
10

11. • The sensory nucleus is divided into
three parts
spinal
principal sensory
Mesencephalic
There is also a distinct trigeminal
motor nucleus that is medial to the
chief sensory nucleus
Sensory trigeminal nuclei is the largest
of all nerve nuclei
11

12. • The spinal trigeminal nucleus is further subdivided
into three parts, from rostral to caudal
1. Pars Oralis (from the Pons to the Hypoglossal
nucleus)
2. Pars Interpolaris (from the Hypoglossal nucleus
to the obex)
3. Pars Caudalis (from the obex to C2)
12

13. obex
• The obex (from the Latin for barrier) is the
point in the human brain at which
the fourth ventricle narrows to become
the central canal of the spinal cord
• The obex occurs in the caudal medulla
• The decussation of sensory fibers happens
at this point
13

14. 1. Pars Oralis associated with transmission of
discriminative fine tactile sensation from the
orofacial region
2. Pars Interpolaris associated with tactile sensation as
well as dental pain
3. Pars Caudalis associated with transmission of
nociceptive and thermal sensations of the head
14

15. • Mandibular nerve in
upper part of spinal
nucleus
• Maxillary nerve in middle
part
• Ophthalmic nerve fibres
end in inferior part
15

16. • The parts of the trigeminal nucleus receive
different types of sensory information
Nucleus sensation
Spinal trigeminal nucleus pain-temperature fibers
Principal sensory nucleus touch-position fibers
Mesencephalic nucleus proprioceptor and
mechanoreceptor fibers from
the jaws and teeth
16

17. Trigeminal ganglion
The three major branches of the trigeminal nerve—
the Ophthalmic nerve (V1)
the Maxillary nerve (V2)
the Mandibular nerve (V3)
converge on the trigeminal ganglion (also called the
semilunar ganglion or gasserian ganglion)
17

18. The ganglion lies in a
depression (trigeminal depression)
At the anterior surface of
petrous temporal bone , in a
Dural cave (Meckels cave OR cavum
trigeminale)
The motor root is below and
completely separated from
sensory root at this point
18

19. Clinical significance
• After recovery from a primary herpes infection,
the virus is not cleared from the body, but rather
lies dormant in a non-replicating state within the
trigeminal ganglion
• The trigeminal ganglion is damaged, by infection
or surgery, inTrigeminal trophic syndrome
• The thermocoagulation or injection of glycerol into
the trigeminal ganglion has been used in the
treatment of trigeminal neuralgia
19

20. Trigeminal trophic syndrome
• Rare disease caused by the interruption of
peripheral or central sensory pathways of
the trigeminal nerve
• Sixty cases were reported from 1982 to 2002
Sadeghi, P.; Papay, FA.;Vidimos, AT. (May 2004). "Trigeminal trophic syndrome--report of four cases and
review of the literature". Dermatol Surg. 30 (5): 807–12, discussion 812. doi:10.1111/j.1524-
4725.2004.30220.x. PMID 15099331.
20

21. • A slowly enlarging, uninflammed
ulcer can occur in the area that has
suffered the trigeminal nerve
damage
• including but not limited to the
cheek beside the ala nasi
• sores affect the skin supplied by
the sensory component of the
trigeminal nerve
Clinical features
21

22. • Similar lesions may also occur in the corners of the eyes,
inside the ear canal, on the scalp or inside the mouth
• It has been stated that the ulceration is due to the
constant "picking" of the patient
• The lack of feeling or pain allows the patient to continue
itching or picking the area
• Even though there is no feeling, there is
constant neuropathic pain
22

23. FUNCTIONS
• The sensory function of the trigeminal nerve is to provide
tactile, proprioceptive , and nociceptive afferent to the
face and mouth
• The motor component of the Mandibular division (V3) of
the trigeminal nerve controls the movement of eight
muscles (4+4)
the four muscles of mastication : the Masseter ,
theTemporal muscle, and the Medial and Lateral
Pterygoids
The other four muscles are theTensor veli palatini,
the Mylohyoid , the anterior belly of the Digastric and
theTensor tympani 23

24. • General somatic afferent fibers (GSA), which innervate the skin
of the face via ophthalmic (V1), maxillary (V2) and mandibular
(V3) divisions
• Special visceral efferent(SVE), which innervate the muscles of
mastication via the mandibular (V3) division
• Special visceral efferent fibers (SVE) are the efferent nerve
fibers that provide motor innervation to the muscles of
the pharyngeal arches in humans
• The nerves containing SVE fibers: (5 7 9 10 11 )
the trigeminal nerve (V)
the facial nerve (VII)
the glossopharyngeal nerve (IX)
the vagus nerve (X)
the accessory nerve (XI)
24

25. • It exits the brain by a large sensory root and a
smaller motor root coming out of the pons at its
junction with the middle cerebral peduncle
25

26. BRANCHES OF TRIGEMINAL NERVE
• OPTHALMIC(v1)
• MAXILLARY(v2)
• MANDIBULAR(v3)
26BDC Human Anatomy - Head, Neck & Brain (Volume 3)

27. BRANCHES FORAMINA OF SKULL
OPTHALMIC SUPERIORORBITAL FISSURE
MAXILLARY FORAMEN ROTUNDUM
MANDIBULAR FORAMEN OVALE
27

28. • The areas of cutaneous distribution (dermatomes) of
the three branches of the trigeminal nerve have
with relatively little overlap (unlike dermatomes in
the rest of the body, which have considerable
overlap)
sharp borders
28

29. OPTHALMIC
• skin of forehead upper eyelid
eyebrow
• Orbital structures nasal cavity
• part of nose
MAXILLARY
• Lower eyelid
• Upper lip gums teeth
• Cheek and nose
• Palate and part of pharynx
MANDIBULAR
• Lower gums lips teeth
• Palate part of tongue
• Muscles of mastication
29

30. OPTHALMIC AND Maxillary NERVE
• Lies in lateral wall of cavernous sinus
• Outside the tendinous ring before leaving the
cranial cavity
30
The annulus of Zinn, also
known as the annular
tendon or common
tendinous ring, is a ring of
fibrous tissue surrounding
the optic nerve at its entrance
at the apex of the orbit
It is the common origin of the
four rectus muscles

31. OPTHALMIC NERVE
31

32. • Smallest of three divisions of
trigeminal nerve
• Arises from upper part of trigeminal
ganglion
• 2.5 cm long
• Passes along the lateral wall of
cavernous sinus
• gives rise to the recurrent tentorial
branch (which supplies the tentorium
cerebelli)
• Below the occulomotor just before
entering orbit
• Through superior orbital fissure
• Divides into three parts
Lacrimal frontal nasociliary
32

33. Branches of OPTHALMIC NERVE
Frontal
• Supraorbital
• Supratrochlear
Nasociliary
• Posterior ethmoidal
• Long Ciliary
• Ciliary ganglion
• Infra trochlear
• Anterior ethmoidal
Lacrimal 33

34. 34
Nerve Branches Innervation
Frontal
(largest of three terminal
branches of CNV1)
Supraorbital
Supratrochlear
Upper eyelid and conjunctiva
Scalp
Forehead
Lacrimal
(smallest of three terminal
branches of CNV1)
Receives branch from zygomatic
nerve of CNV2 containing
parasympathetic fibers
Sensory innervation of lacrimal
gland, upper eyelid and
conjunctiva
Nasociliary
Anterior ethmoidal nerve
Sensory innervation of mucous
membranes of frontal, ethmoid
and sphenoid sinuses . Nasal
cavity
Posterior ethmoidal nerve
Absent in approximately 30% of
people . Sensory innervation to
mucous membranes of sphenoid
sinus
Infratrochlear nerve
Bridge of nose Upper eyelid and
conjunctiva
Long ciliary nerves
Sensory innervation to eye
(cornea, ciliary bodies,
iris)Contains sympathetic fibers
to dilator pupillae muscle

35. Nasociliary Nerve
1.A branch of the ophthalmic
nerve
2.Enters the orbit through the
superior orbital fissure (inside
the common tendinous ring)
3.Crosses above the optic nerve
from lateral to medial
4.Runs along the medial wall of
the orbit, between the superior
oblique and medial rectus
muscles
5. Branches into Anterior
ethmoidal nerve and
Infratrochlear nerve
35

36. Maxillary Nerve
36

37. Maxillary Nerve
• A pure sensory nerve
• Leaves the cranial cavity through
the foramen rotundum
pterygopalatine fossa
• Passes through inferior orbital fissure to
continue as infraorbital nerve
• The infraorbital n. passes through
infra-orbital groove and terminates on
the face
37

38. Branches of maxillary nerve
 In middle cranial fossa
Meningeal branch : before leaving the skull
 in the pterygopalatine fossa
1. Two roots to the sphenopalatine ganglion (ganglionic
branches)
2. Zygomatic nerve arises in the infratemporal fossa and
enters the orbit through the inferior orbital fissure
where it divides into
Zygomaticotemporal and Zygomaticofacial
38

39. 3. Posterior superior alveolar nerve
arises and divides into anterior and posterior branches
which enter the maxilla
supply the premolar and molar teeth
(The anterior branch may be described as middle superior
alveolar nerve)
39

40. Terminal branches in the face
Infraorbital nerve terminal branch, gives many branches
1. Nerve supply to the mucosa of the maxillary air sinus
2. Anterior superior alveolar nerve : which supplies the
incisor and canine teeth
Palpebral : to the lower eyelid
Nasal : to the side of the nose
 Labial : to the upper lip
40

41. Mandibular Nerve
• The largest division of the trigeminal
nerve
• It is a mixed nerve has a sensory root
and a motor root
• It leaves the skull through the
Foramen Ovale
• Below foramen ovale, the 2 roots
unite to form the trunk of the nerve
• Then , it divides into anterior &
posterior divisions
• The anterior is mainly motor
• The posterior is mainly sensory 41

42. Mandibular Nerve division
Branches of the trunk
• Nerve to medial pterygoid which supplies
1. Tensor veli palatini
2. Tensor tympani
3. Medial pterygoid
• Nervus spinosus
Branches of Anterior Division
• Deep temporal nerves
• Nerve to masseter
• Nerve to lateral pterygoid
• Buccal N. ( sensory) 42

43. Branches of Posterior Division
Auriculotemporal
• Auricular
• Superficial temporal
• Articular toTMJ
• Secretomotor to parotid gland
Lingual nerve (sensory ) - general sensation from
anterior 2/3 rds of tongue
 Inferior alveolar nerve(mixed)
• Lower teeth
• Mental for skin of chin
• Nerve to Mylohyoid – Mylohyoid & anterior belly of
digastrics
43

44. Inferior alveolar nerve
• The inferior alveolar nerve (sometimes called
the inferior dental nerve) is a branch of
the Mandibular nerve, which is itself the third
branch of theTrigeminal nerve
• The inferior alveolar nerves supply sensation to the
lower teeth
• After branching from the Mandibular nerve, the
inferior alveolar nerve travels behind the lateral
pterygoid muscle
• It gives off a branch, the Mylohyoid nerve, and then
enters the Mandibular foramen
44

45. Within Mandibular canal
• it supplies the lower teeth (molars and second
premolar) with sensory branches that form into
the inferior dental plexus and give off small gingival
and dental nerves to the teeth
Anteriorly
• the nerve gives off the mental nerve
• at about the level of the Mandibular 2nd premolars
• which exits the mandible via the mental
foramen and supplies sensory branches to
the chin and lower lip
• The inferior alveolar nerve continues anteriorly as
the Incisive nerve to innervate the
Mandibular canines and incisors 45

46. Clinical significance
Inferior nerve injury most commonly
occurs during surgery including
wisdom tooth, dental implant
placement in the mandible, root canal
treatment where tooth roots are
close to the nerve canal in the
mandible, deep dental local
anesthetic injections or orthognathic
surgery
Trauma and related Mandibular
fractures are also often related to
inferior alveolar nerve injuries
46

47. Associated reflexes
47

48. Corneal Reflex
• The corneal reflex is the involuntary blinking of the
eyelids – stimulated by tactile, thermal or painful
stimulation of the cornea.
• In the corneal reflex, the ophthalmic nerve acts as
the afferent limb – detecting the stimuli
• The facial nerve is the efferent limb, causing
contraction of the orbicularis oculi muscle.
• If the corneal reflex is absent, it is a sign of damage to
the trigeminal/ophthalmic nerve or the facial nerve.
• Absent in infants under 9 months
48

49. Photic sneeze reflex
• (ACHOO) syndrome
• AutosomalCompelling HelioOphthalmic Outburst
• Sun sneezing
• Reflex condition that causes sneezing in response to
numerous stimuli, such as looking at bright lights or
periocular (surrounding the eyeball) injection
49

50. Optic-trigeminal summation
• Stimulation of the ophthalmic branch of
the trigeminal nerve may enhance the irritability of
the maxillary branch, resulting in an increased
probability of sneezing
• This is similar to the mechanism by
which photophobia develops by persistent light
exposure relaying signals through the optic nerve
and trigeminal nerve to produce increased
sensitivity in the ophthalmic branch
• If this increased sensitivity occurred in the maxillary
branch instead of the ophthalmic branch, a sneeze
could result instead of photophobia
50

51. Wallenberg syndrome
(lateral medullary syndrome)
• A stroke usually affects only one side of the body
• loss of sensation due to a stroke will be lateralized to the
right or the left side of the body
• In this syndrome, a stroke causes a loss of pain-
temperature sensation from one side of the face and the
other side of the body
• It is the clinical manifestation resulting from occlusion of
the posterior inferior cerebellar artery (PICA) or one of its
branches or of the vertebral artery, in which the lateral part
of the medulla oblongata infarcts, resulting in a typical
pattern
51

52. • This is explained by the anatomy of the brainstem
• In the medulla, the ascending spinothalamic tract (which
carries pain-temperature information from the opposite
side of the body) is adjacent to
the ascending spinal tract of the trigeminal nerve (which
carries pain-temperature information from the same side
of the face)
• A stroke which cuts off the blood supply to this area
destroys both tracts simultaneously
• The result is a loss of pain-temperature sensation in a
"checkerboard" pattern (ipsilateral face, contralateral
body), facilitating diagnosis
52

53. Applied anatomy of trigeminal
nerve
53

54. Trigeminal neuralgia
• Chronic pain disorder that affects
the trigeminal nerve
• TYPICAL (TN1) andATYPICAL(TN2)
trigeminal neuralgia
• episodes of severe, sudden, shock-like
pain in one side of the face that lasts for
seconds to a few minutes
• constant burning pain that is less severe
Episodes may be triggered by any touch to the face
Both forms may occur in the same person
It is one of the most painful conditions
and can result in depression
54

55. It is estimated that 1 in 8,000 people
per year develop trigeminal
neuralgia
It usually begins in people over 50
years old, but can occur at any age
Women are more commonly
affected than men
The condition was first described in
detail in 1773 by John Fothergill
fothergill disease
Trigeminal Neuralgia Fact Sheet NINDS November 3, 2015. Archived from the original on 19 November 2016.
Retrieved 1October 2016 National Institute of Neurological Disorders and Stroke
55

56. The exact cause is unclear, but believed to involve loss of
the myelin around the trigeminal nerve
This may occur due to
• compression from a blood vessel as the nerve exits
the brain stem
• multiple sclerosis, stroke, or trauma
• Less common causes include a tumor or arteriovenous
malformation
Diagnosis is typically based on the symptoms, after
ruling out other possible causes such as postherpetic
neuralgia
tic douloureux
56

57. Trigger factors
• by vibration or contact with the cheek
• shaving, washing the face, or applying makeup,
brushing teeth, eating, drinking, talking, or being
exposed to the wind
• TN is typified by attacks that stop for a period of time
and then return, but the condition can be progressive
• The attacks often worsen over time, with fewer and
shorter pain-free periods before they recur
• Eventually, the pain-free intervals disappear and
medication to control the pain becomes less effective
57

58. Treatment
• Includes Medication , Surgery & complementary approaches
Medication
• Anticonvulsant —used to block nerve firing—are
generally effective in treatingTN1 but often less
effective inTN2
• Carbamazepine Or Oxcarbazepine is usually the initial
treatment
• Other options include lamotrigine , baclofen ,
Gabapentin , pimozide , valproic acid , topiramate ,
pregabalin, clonazepam and phenytoin
58

59. • Eventually, if medication fails to relieve pain or
produces intolerable side effects such as
cognitive disturbances, memory loss, excess
fatigue, bone marrow suppression, or allergy,
then surgical treatment may be indicated
• SinceTN is a progressive disorder that often
becomes resistant to medication over time,
individuals often seek surgical treatment
Need for surgery in trigeminal neuralgia
59

60. Surgery
• Several neurosurgical procedures are available to
treatTN
• Depending on the nature of the pain; the individual’s
preference, physical health, blood pressure, and
previous surgeries
• presence of multiple sclerosis, and the distribution
of trigeminal nerve involvement (particularly when
the upper/ophthalmic branch is involved)
60

61. Associated risks
• Some degree of facial numbness is expected after
many of these procedures, andTN will often return
even if the procedure is initially successful.
• Depending on the procedure, other surgical risks
include hearing loss, balance problems, leaking of
the cerebrospinal fluid (the fluid that bathes the
brain and spinal cord), infection, anesthesia
dolorosa (a combination of surface numbness and
deep burning pain), and stroke, although the latter
is rare
61

62. RHIZOTOMY ( rhizolysis )
• Procedure in which nerve fibers are damaged to block
pain
• A rhizotomy forTN always causes some degree of
sensory loss and facial numbness
• Several forms of rhizotomy are available to treat
trigeminal neuralgia :
I. Balloon compression
II. Glycerol injection
III. Radiofrequency thermal lesioning (Radiofrequency
Ablation)
IV. Stereotactic radiosurgery (Gamma Knife, Cyber Knife)
V. Microvascular decompression (MVD) 62

63. Balloon compression
• works by injuring the insulation on nerves that are involved
with the sensation of light touch on the face
• The procedure is performed in an operating room under
general anesthesia
• A tube called a cannula is inserted through the cheek and
guided to where one branch of the trigeminal nerve passes
through the base of the skull
• A soft catheter with a balloon tip is threaded through the
cannula and the balloon is inflated to squeeze part of the
nerve against the hard edge of the brain covering (the Dura)
and the skull
63

64. • After about a minute the balloon is deflated and
removed, along with the catheter and cannula
• Balloon compression is generally an outpatient
procedure, although sometimes the patient may
be kept in the hospital overnight
• Pain relief usually lasts one to two years
64

65. Glycerol injection
• Outpatient procedure in which the individual is sedated
with intravenous medication
• A thin needle is passed through the cheek, next to the
mouth, and guided through the opening in the base of the
skull where the third division of the trigeminal nerve
(Mandibular) exits
• The needle is moved into the pocket of spinal fluid (cistern)
that surrounds the trigeminal nerve center (or ganglion)
• The procedure is performed with the person sitting up,
since glycerol is heavier than spinal fluid and will then
remain in the spinal fluid around the ganglion
65

66. • The glycerol injection bathes the ganglion and
damages the insulation of trigeminal nerve fibers
• This form of rhizotomy is likely to result in
recurrence of pain within a year to two years
• However, the procedure can be repeated multiple
times
66

67. Radiofrequency thermal lesioning
• Most often performed on an outpatient basis
• The individual is anesthetized and a hollow needle is passed
through the cheek through the same opening at the base of
the skull where the balloon compression and glycerol
injections are performed
• The individual is briefly awakened and a small electrical current
is passed through the needle, causing tingling in the area of
the nerve where the needle tips rest
• When the needle is positioned so that the tingling occurs in
the area ofTN pain, the person is then sedated and the nerve
area is gradually heated with an electrode, injuring the nerve
fibers
"RF Ablation" or “RF Lesioning
67
Trigeminal Neuralgia Fact Sheet NINDS November 3, 2015. Archived from the original on 19 November 2016.
Retrieved 1October 2016 National Institute of Neurological Disorders and Stroke

68. • The electrode and needle are then removed and
the person is awakened.The procedure can be
repeated until the desired amount of sensory loss is
obtained; usually a blunting of sharp sensation,
with preservation of touch
• Approximately half of the people have symptoms
that reoccur three to four years following RF
lesioning
• Production of more numbness can extend the pain
relief even longer, but the risks of anesthesia
dolorosa also increase
68

69. Stereotactic radiosurgery
• uses computer imaging to direct highly focused beams of
radiation at the site where the trigeminal nerve exits the brain
stem
• This causes the slow formation of a lesion on the nerve that
disrupts the transmission of sensory signals to the brain
• People usually leave the hospital the same day or the next
day following treatment but won’t typically experience relief
from pain for several weeks (or sometimes several months)
following the procedure
• The International RadioSurgery Association reports that
between 50 and 78 percent of people withTN who are treated
with Gamma Knife radiosurgery experience "excellent" pain
relief within a few weeks following the procedure
• For individuals who were treated successfully, almost half
have recurrence of pain within three years.
(Gamma Knife, Cyber Knife)
Trigeminal Neuralgia Fact Sheet NINDS. November 3, 2015 from the original on 19 November 2016. Retrieved 1
October 2016 National Institute of Neurological Disorders and Stroke
69

70. Microvascular decompression
• most invasive of all surgeries
forTN, but also offers the
lowest probability that pain will
return
• About half of individuals
undergoing MVD forTN will
experience recurrent pain
within 12 to 15 years
• This inpatient procedure,
which is performed under
general anesthesia, requires
that a small opening be made
through the mastoid bone
behind the ear
70

71. • While viewing the trigeminal nerve
through a microscope or
endoscope, the surgeon moves
away the vessel (usually an artery)
that is compressing the nerve and
places a soft cushion between the
nerve and the vessel
• Unlike rhizotomies, the goal is not
to produce numbness in the face
after this surgery
• Individuals generally recuperate
for several days in the hospital
following the procedure, and will
generally need to recover for
several weeks after the procedure
71

72. neurectomy
• Involves cutting part of the nerve, may be performed near
the entrance point of the nerve at the brain stem during an
attempted Microvascular decompression if no vessel is found
to be pressing on the trigeminal nerve
• Neurectomies also may be performed by cutting superficial
branches of the trigeminal nerve in the face
• When done during microvascular decompression, a
neurectomy will cause more long-lasting numbness in the
area of the face that is supplied by the nerve or nerve branch
that is cut
• However, when the operation is performed in the face, the
nerve may grow back and in time sensation may return
• With neurectomy, there is risk of creating anesthesia
dolorosa
partial nerve section
72

73. Complementary approaches
• Some individuals manage trigeminal neuralgia using
complementary techniques, usually in combination with
drug treatment
• These therapies offer varying degrees of success. Some
people find that low-impact exercise, yoga, creative
visualization, aroma therapy, or meditation may be
useful in promoting well-being
• Other options include acupuncture, upper cervical
chiropractic, biofeedback, vitamin therapy, and
nutritional therapy
• Some people report modest pain relief after injections
of botulinum toxin to block activity of sensory nerves
73

74. conclusion
• Trigeminal nerve is called dentists nerve because of
rightful reasons
• Anatomy of trigeminal nerve and its branches plays
an important role in dentistry
• Its branches forms the foundation stone for most
of the problems encountered in dental practice
• Application of local anaesthesia and certain
surgical procedures requires a thorough knowledge
of its anatomy
74

75. references
• BDC Human Anatomy - Head, Neck & Brain (Volume 3)
• Gray's Anatomy for Students 3rd Ed
• Lippincott’s Concise Illustrated Anatomy - Head & Neck
-Volume 3 - Ben Pansky,Thomas R. Gest – 1st Edition
(2014)
• Textbook Of Anatomy Head, Neck And Brain -Volume
III -Vishram Singh - 2nd Edition (2014)
75

76. • Malamed's HandBook of Local Anasthesia, 6ed
• Oral_and_Maxillofacial_Surgery_3rdEd_Neelima_
Malik
• Malamed's HandBook of Local Anasthesia, 6ed
• Anand's HumanAnatomy For Dental Students -
Mahindra KumarAnand - 3rd Edition (2012)
76

77. 77