This document provides information on trigeminal neuralgia, including its definition, classification, causes, and treatment. It defines trigeminal neuralgia as a disorder characterized by episodes of intense pain in the face originating from the trigeminal nerve. It classifies different types of neuralgia and lists common causes as damage to nerves from factors like old age, infection, or pressure. For trigeminal neuralgia specifically, it describes the condition as severe, brief attacks of pain in the face triggered by activities like chewing or talking. Treatment options discussed include carbamazepine and other medications as first-line treatment, with surgery like microvascular decompression for severe cases not helped by drugs.

3. CONTENTS
 1. NEURALGIA 2.TRIGEMINAL NEURALGIA
 DEFINITION
 CLASSIFICATION
 CAUSES
 TRIGEMINAL NERVE
 INTRODUCTION
 DEFINITION
 HISTORICAL REVIEW
 TIC DOULOUREUX
 ETIOLOGY
 PATHOGENESIS
 TYPES
 CLINICAL
CHARACTERISTICS
 DIAGNOSIS
 DIFFERENTIAL
DIAGNOSIS
 TREATMENT

5. DEFINITION:
Neuralgia
(Greek neuron, "nerve" + algos, "pain")
is pain in the distribution of a nerve
or nerves, as in intercoastal
neuralgia, trigeminal neuralgia,
and glossopharyngeal neuralgia

6. CLASSIFICATION:
Under the general heading of neuralgia
are:
 Trigeminal neuralgia
 Occipital neuralgia
 Glossopharyngeal neuralgia
 Postherpetic neuralgia
 Intercostal neuralgia

7. CAUSES:
Main cause is damage to nerve leading to
demyelination of nerve and finally leading to
stabbing, severe, shock like pain resulting in
neuralgia.
FACTORS CAUSING DAMAGE ARE-
 Old age
 Infection( postherpetic neuralgia)
 Multiple sclerosis
 Pressure on nerves
 Diabetes

8. ---( TIC DOULOUREUX,
TRIFACIAL NEURALGIA,
FOTHERGILL’S NEURALGIA)

12. INTRODUCTION:
 It is the most debilitating form of
neuralgia that affects the sensory
branches of the Vth cranial nerve.
 It is a disorder of the peripheral or
central fibres of the trigeminal nerve in
which the dominant symptom is pain
in the anterior half of the head.

13. DEFINITION:
 It is defined as sudden, usually unilateral, severe,
brief, stabbing, lancinating, recurring pain in the
distribution of one or more branches of the Vth
cranial nerve
 Trigeminal neuralgia also known as prosopalgia or
fothergill’s disease is aneuropathic disorder
characterized by episodes of intense pain in the
face, originating from trigeminal nerve

14. HISTORICAL REVIEW:
 JOHN LOCKE in 1677 gave the first full
description with its treatment
 NICHOLAS ANDRE in 1756 coined the term
‘Tic Doloureux
 JOHN FOTHERGILL in 1773 published detailed
description of trigeminal neuralgia

15. TIC DOULOUREUX:
 TiC DOULOUREUX painful
jerking.
 It is a truly agonizing condition, in
which the patient may clunch the
hand over the face & experience
severe, lancinating pain associated
with spasmodic contractions of the
facial muscles during attacks .
-a feature that led to use of this term

16. ETIOLOGY:
 Usually idiopathic
 Demylination of the nerve
 Multiple sclerosis
 Petrous ridge compression
 Post – traumatic neuralgia
 Intracranial tumors
 Intracranial vascular abnormalities
 Viral etiology

17. aetiology
Compression of blood vessels, especially the superior
cerebellar artery occurs
Chronic irritation of trigeminal nerve at the root entry zone
Increased firing of the afferent or sensory fibres
 TRIGEMINAL NEURALGIA

19. PATHOGENESIS:

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

22. 1. TYPICAL TRIGEMINAL NEURALGIA:
• Most common form, previously termed CLASSICAL,
IDIOPATHIC and ESSENTIAL TRIGEMINAL NEURALGIA.
• Nearly all cases of typical trigeminal neuralgia are caused by
blood vessel compressing the trigeminal nerve root.
 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, delivery
of abnormal signals to the trigeminal
nerve nucleus , this causes
hyperactivity of trigeminal nerve root
leading to trigeminal nerve pain

23. 2. ATYPICAL TRIGEMINAL
NEURALGIA:
 it is characterized by a unilateral, prominent
constant and severe aching and burning pain
superimposed upon otherwise typical symptom.
 Some believe that atypical trigeminal neuralgia is
due to vascular compression upon specific part of
the trigeminal nerve( the portio minor) while other
theorize atypical trigeminal neuralgia as more
severe progression of typical trigeminal neuralgia.

24. 3. PRE- TRIGEMINAL NEURALGIA:
- Days to years before the first attack of Trigeminal pain,
some sufferers experience odd sensations of pain,( such
as toothache) or discomfort( parasthesia).
4. MULTIPLE SCLEROSIS RELATED
TRIGEMINAL NEURALGIA:
- Symptoms of MS related trigeminal neuralgia
are identical to typical trigeminal neuralgia. Bilateral
trigeminal neuralgia is more commonly seen in
people with MS. MS involves formation of
demyelinating plaques within the brain.

25. GENERAL CHARACTERISTICS
 INCIDENCE- 8: 100000
 AGE- 5th-6th decade of life
 SEX- female> male
 AFFLICTION FOR SIDE- right> left
 DEVISION OF TRIGEMINAL NERVE
INVOLVEMENT- V3>V2>V1
TRIGGERING
ZONES

26. 5. SECONDARY OR TUMOR
RELATED TRIGEMINAL NEURALGIA:
Trigeminal pain caused by a lesion, such as a
tumor.
Tumor that severely compresses or distorts the
trigeminal nerve may cause numbness, weakness of
chewing muscles or constant aching pain
6. FAILED TRIGEMINAL NEURALGIA:
In a very small proportion of suferrers, all medications,
surgical procedures prove ineffective in controlling the
pain.
Such individuals also suffer from additional trigeminal
neuropathy as a result of destructive intervention they
underwent.

27. CLINICAL CHARACTERISTICS
 Manifests as a sudden, unilateral, intermittent paroxysmal,
sharp, shooting, lancinating , shock like pain, elicited by slight
touching superficial ‘trigger points’ which radiates from that
point, across the distribution of one or more branches of the
trigeminal nerve
 Pain is usually confined to one part of one division of trigeminal
nerve
 Pain rarely crosses the midline
 Attacks do not occur during 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’.
 Common trigger zone include- cutaneous( corner of the lips,
cheek, ala of the nose, lateral brow); intraoral( teeth, gingivae,
tongue). Trigger area on the face are so sensitive that touching
or even air currents can trigger an episode.
 10-12% of cases are bilateral, or occurring on both sides. This
mainly seen in cases with systemic involvement include multiple
sclerosis or expanding cranial tumor

28. DIAGNOSIS
 From a well taken history
 CT- scan
 MRI
 Diagnostic nerve block

29. TREATMENT
1. MEDICAL
• First line of treatment is: CARBAMAZIPINE ( anticonvulsant)
• Second line of treatment is: BACLOFEN, LAMOTRIGINE,
OXCARBAZEPINE, PHENYTOIN, GABAPENTIN, PREGABALIN,
SODIUM VALPROATE
• Low dose of Antidepressants such as AMITRYPTILINE are thought to
be effective in treating neuropathic pain. Antidepressant are also used
to counteract a medication side effect.
• 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

30. 2.SURGICAL METHOD:
 INJECTION OF NERVE WITH ANESTHETIC
AGENT• Long acting anesthetic agents
• Alcohol injection
 PERIPHERAL GLYCEROL INJECTION
 PERIPHERAL NEURECTOMY( NERVE AVULSION)
 OPEN PROCEDURES ( INTRACRANIAL PROCEDURES)
- MICROVASCULAR DECOMPRESSION
- PERCUTANEOUS RHIZOTOMIES
- GAMMA KNIFE RADIOSURGERY

31. SOME
SURGICAL
SNAPS

32. DIFERENTIAL DIAGNOSIS
 MIGRAINE- severe type of periodic
headache is persistent, at least over a period
of hours and it has no trigger zone.
 SINUSITIS- pain is not paroxysmal.In this
pain is persistent, associated nasal
symptoms.

33.  DENTAL PAIN- localized, related to biting or hot
or cold foods, visible abnormalities on oral
examination.
POST HERPETIC NEURALGIA:
Pain is usually involved in ophthalmic division.
The history of skin lesion prior to onset of
neuralgia, pain is persistent, associated nasal
symptoms.

34.  Tumors of nasopharynx - In this similar
type of pain is produced, manifested in the
lower jaw, tongue and side of the head with
associated middle ear deafness. This
complex lesion is called TROTTER’S
syndrome. Patient exhibit asymmetry and
defective mobility of the soft palate and
affected side. As the tumor progresses,
trismus of internal pterygoid muscle
develops, and patient is unable to open the
mouth. Here actual cause of pain is
involvement of mandibular nerve in the
foramen ovale.

37. FINAL WORDS:
 Patients with trigeminal neuralgia
deserve an accurate and
dispassionate explanation of merits
and drawbacks of all methods of
treatment from the outset.
 Surgical approaches are performed
when medication cannot control
pain,patient cannot tolerate the
adverse effects of the medication or in
particular medically compromised
patients contraindicated for the
required medication.

38.  GRAY’S ANATOMY
 TEXTBOOK OF ORAL SURGERY-
NEELIMA MALIK
 TEXT BOOK OF ORAL PATHOLOGY-
SHEFFER’S
 TEXTBOOK OF ORAL PATHOLOGY-
NEVILE
 TEXTBOOK OF LOCAL ANESTHESIA-
MONHIMS
 TEXTBOOK OF ORAL MEDICINE- ANIL
GHOM’S