In the name of Allah, the Beneficent, the Merciful.

TRIGEMINAL NEURALGIA Also known as… TIC DOULOUREUX PROSOPALGIA SUICIDE DISEASE NEURALGIA EPILEPTIFORME By: Aleshba Saba Roll # 02 3 rd Year BDS A neuropathic disorder of trigeminal nerve

(INTRODUCTION) TRIGEMINAL NEURALGIA Sudden, usually unilateral Brief, stabbing, electric shock like recurrent pain

Pain is limited to the sensory distribution of trigeminal nerve that includes middle face (maxillary division V2)– being most frequently involved, lower (mandibular division V3) & upper (ophthalmic division V1)– being least frequently involved

Vascular abnormality(venous or arterial) that causes compression of trigeminal root, adjacent to pons in posterior cranial fossa Association with MS Tumors in post. Cranial fossa (2%) Focal nerve injury As a result of aging, shingles, unknown causes mostly Etiology

Normal Neurovascular compression

Tumor affecting CN V

Incidence Usually develops after the age of 50, although there have been cases with patients being as young as three years of age 150 per 1million (estimated) people suffer from TN Women are more likely to be affected than men (female:male – 2:1) Usually unilateral (3% cases show bilateral involvement)

Triggering factors Shaving, washing Stroking your face (trigger zones on face) Eating Drinking Brushing your teeth Talking Putting on makeup Encountering a breeze Smiling

SYMPTOMS Pain in areas supplied by CN V Usually unilateral Sharp, stabbing, electric shock like pain Lasts for few seconds to minutes This transient attack may be repeated in matter of minutes or hours

TYPES OF TRIGEMINAL NEURALGIA

Pre-trigeminal neuralgia Odd sensations of pain, (such as a toothache) or discomfort (like “pins and needles”), may be symptoms of pre-trigeminal neuralgia Occur in 20% of patients who develop TN Pre-TN is most effectively treated with medical therapy used for typical TN

Diagnosis & Management

History Examination ( Odontogenic structures, cranial nerve functions, related structures-muscles,TMJ,sinuses ) Investigations Diagnostic local anesthetic nerve block (defines distribution of the pain, eliminate or confirm referred pain) Nerve conduction tests Imaging techniques (eliminate pain due to any other reason-odontogenic, sinus, postherpetic neuralgia, cluster headache, TMJ DS, atypical facial pain)

1 st step of treatment- Pharmacotherapy (Medical management of TN) Trigeminal neuralgia is usually treated with drugs called anti- convulsants which include: Carbamazepine (drug of choice) ( mg/day) Phenytoin (300mg/day) Oxycarbazepine Gabapentin ( mg/day) Baclofen, lamotrigine, clonazepam

2 nd step of treatment- Surgery Surgical options include: 1.Peripheral Cryotherapy Neurectomy Alcohol injections 2.Gasserian ganglion Radiofrequency, thermocoagulation Glycerol injection Microcompression (balloon compression) 3.Posterior fossa Neurovascular decompression Stereotactic radiosurgery

Non drug therapies Trancutaneus electric nerve stimulation Laser Rhizotomy Alcohol injections

There are some things that a patient can do to minimize the frequency and intensity of TN attacks: 1.Apply ice packs. Cold often numbs the area and will reduce the pain 2.Get adequate rest in normal rest cycles 3.Manage your stress well and keep stress levels low 4. Avoid foods that may act as nerve stimulants, such as coffee, tea, and foods that are high in sugar 5. Maintain adequate hydration and electrolyte levels 6. Practice healthy living principles such as diet and exercise

THANK YOU !

Reference (free search) Lecture notes by Dr. Razzaq Tyldesley’s oral medicine Cawson’s Essentials of Oral Medicine P-J Lamey- A clinical guide To Oral Medicine If you suffer, thank God! it is a sure sign that you are alive. -Elbert Hubbard