Trigeminal neuralgia is a neuropathic disorder causing episodes of intense pain in the face. It is characterized by brief, severe electric shock-like pains triggered by mundane stimuli like washing or talking. It is caused by a blood vessel compressing the trigeminal nerve root. Treatments include carbamazepine and other anticonvulsants as first-line medical options or microvascular decompression surgery to relieve nerve compression.

1. TRIGEMINAL
NEURALGIA
PRABHSIMAR, BDS THIRD PROF.

2. INTRODUCTION
 Trigeminal neuralgia is a neuropathic
disorder of trigeminal nerve that causes
episodes of intense pain in eyes,
lips,scalp,forehead and jaws.
 It has been called as a suicide disease
due to insignificant number of people
taking their own life because they are
unable to have their pain controlled by
medications or surgery.

3. DEFINITIONS HIS( international
headache society)
 Painful,unilateral affection of the face,
characterized by brief electric shock like
pain limited to distribution of one or more
divisions of trigeminal nerve. Pain is
commonly evoked by trivial stimulus like
washing, shaving, talking, smoking and
brushing teeth.the pain is abrupt in onset,
terminations may remit for varying
periods.

5. TIC DOULOUREUX
 It is truly agonising condition in which the
patient may clunch the hand over the face
and experience severe lancinating pain
associated with spasmodic contractions of
facial muscles during attack.
 A feature that led to use
of this term.

6. TYPES OF TRIGEMINAL NEURALGIA
 TYPICAL TRIGEMINAL NEURALGIA
 ATYPICAL TRIGEMINAL NEURALGIA
 PRE-TRIGEMINAL NEURALGIA
 MULTIPLE SCLEROSIS RELATED
 SECONDARY OR TUMOR RELATED
 POST TRAUMATIC TRIGEMINAL
NEURALGIA
 FAILED TRIGEMINAL NEURALGIA

7. TYPICAL TRIGEMINAL NEURALGIA
 Most common form, previously termed classical,
idiopathic,essential TN. It is caused by a blood vessel
compressing the nerve root.
 Pulsations of vessels normally do not effect the nerve root
but with repeated pulsations may lead to changes of nerve
function, delivery of abnormal signals,this causes
hyperactivity of of nerve root leading to pain.
 The superior cerebellar artery is the vessel most often
responsible for neurovascular compression upon the
trigeminal nerve root, although other arteries or veins may
be the culprit vessels.

9. ATYPICAL TRIGEMINAL NEURALGIA
 It is characterised by unilateral, prominent constant and
severe aching and burning pain superimposed upon
otherwise typical symptom
 Some believe atypical TN due to compression of specific
part of ganglion while others believe it to be a more severe
form of typical TN
 Atypical TN pain can be at least partially relieved
with medications used for typical TN, such
as carbamazepine.

10. PRE TRIGEMINAL NEURALGIA
 Days to years before the first attack of TN pain,
some sufferers experience odd sensations of pain
such as toothache or discomfort (paresthesia).
Symptoms are similar to typical, bilateral TN is
commonly seen in people with MS. Multiple
sclerosis is due to formation of demyelinating
plaques with brain

12. SECONDARY OR TUMOR RELATED
 TN caused by a lesion such as a tumor, tumor
can compress or distort the trigeminal nerve and
cause numbness, weakness of chewing muscles
or constant aching pain.
FAILED TRIGEMINAL NEURALGIA
In case of failed surgical procedures and
medications, these sufferers can suffer from
additional trigeminal neuropathy as a result of
destructive intervention they went.

14. CLINICAL FEATURES
 Manifests as a sudden, unilateral, intermittent
paroxysmal sharp, shooting, lancinating shock like
pain elicited by slight touching superficial trigger
zones.
 Pain is usually confined to one part of one division of
the nerve, it rarely crosses the midline,attacks do not
occur in sleep.
 Pain is of short duration but may recur with variable
frequency. In extreme cases the patient will have a
motionless face- the frozen or mask like face.
 10-12% cases are bilateral which is mainly seen in
cases with systemic involvement including multiple
sclerosis or expanding cranial tumor.

16. DIAGNOSIS
 History
 CT-SCAN
 MRI
 Diagnostic nerve block

17. TREATMENT
 MEDICAL
First line treatment is: carbamazepine(anticonvulsant).
Second line of treatment:baclofen,
lamotrigine,phenytoin,gabapentin,sodium valproate.
DULOXETINE is helpful where neuropathic pain and
depression are combined.
OPIATES such as MORPHINE and OXYCODONE, there is
evidence of their effectiveness on neuropathic pain,
especially if combined with gabapentin, gallium maltoate in
a cream or ointment base has been reported to relieve
refractory postherpetic TN.
Low doses of antidepressants such as AMITRYPTILINE is
thought to be effective.

18. SURGERY
Injection of nerve with
anesthetic agent.
-Alcohol injection.
-PERIPHERAL GLYCEROL
INJECTION.(MVD)
-PERIPHERAL
NEURECTOMY( NERVE
AVULSION).
-OPEN PROCEDURES:
:Microvascular
decompression.
:Percutaneous rhizotomy
:Gamma knife
radiosurgery