Typical trigeminal neuralgia What is the trigeminal nerve

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https://neirokirurgi.lv/en/typical-tr... • Typical trigeminal neuralgia is a disease affecting trigeminal nerve. The trigeminal nerve is a cranial nerve that provides the face with the sense of – touch, temperature and pain. The third branch of this nerve also provides motor function to the muscles of mastication. There are two trigeminal nerves serving the corresponding side of the face where they are located. • As the name of the nerve implies – it has three branches. The trigeminal nerve originates in the brain stem, at the base of the skull it divides into 3 branches that innervate the skin of the face. The first branch is responsible for sensation in the forehead and the region above the eye, the second branch is tasked with sensation in the upper jaw and the third branch deals with sensation in the lower jaw (please see picture above). • What is typical trigeminal neuralgia? • Typical trigeminal neuralgia is a disease that is characterised by typical presentation of pain in distribution of trigeminal nerve. Patients describe trigeminal nerve pain (aka tic doloureux) as a sudden, electrical shock affecting one side of the face in a specific area. The patient is usually able to accurately pinpoint the area affected by the pain. The pain is usually jolt-like, shooting, sharp and intolerable. Generally, the pain is intermittent, meaning that exacerbations, which tend to be more frequent in the autumn and spring season, are replaced by periods of remission when pain is minimal or at all absent. Such periods of remission may be several months long. It should be noted that the longer a person suffers from trigeminal neuralgia, the shorter and more unstable the painless periods become. • Pain can be spread through the innervation area of a singleor several nerve branches, sometimes all branches are affected at the same time (please see picture). Pain is most often localized to the second and third branches of the nerve. Trigeminal nerve pain can, quite often, mimic toothache. It is often observed that several healthy teeth are extracted before a correct diagnosis is established. • Trigeminal nerve pain can be provoked, amongst other factors, by touch, talking, smiling, eating, brushing teeth, shaving, cold air and wind. Patients with a long history of illness develope guarding behaviours such as limiting facial movements, for example smiling, in the painful region, eating less or in a specific manner, avoiding touching of the face. Because of the aforementioned reasons trigeminal neuralgia is considered to be a debilitating disease, limiting simple daily activities due to the excruciating pain. The pain can frequently be severe enough to limit the working ability of patients. • The disease affects women more often than men, and although typically manifests between the ages 40-50 (4th-5th decade of life) is not limited to this age group, affecting younger patients as well. • n-trigeminus zari-ar-dermatomiem-copyr • Picture: n. trigeminus innervation (spread of pain) zones • What is the cause of typical trigeminal neuralgia? • A common misconception is that the nerve can be “frozen” or damaged by cold weather, and while it can of course be a provocative factor, it definitely isn’t the cause of the condition. In up to 80-90% of all cases, typical trigeminal neuralgia is caused by pressure of an adjacent blood vessel on the trigeminal nerve, a so-called neurovascular conflict. Both arteries and veins are located near the outlet of the trigeminal nerve in the vicinity of the brain stem. When one of the blood vessels, sometimes several, press on the trigeminal nerve, nerve injury occurs, which in turn manifests as a classic shooting, electrical facial pain. • Less commonly found causes for such symptoms, to name a few, are: a tumor pressing down on the trigeminal nerve, multiple sclerosis (which causes nerve damage) and of course – dental problems. • How is typical trigeminal neuralgia diagnosed? • One of the criteria for the diagnosis of typical trigeminal neuralgia is the character of the pain itself. This means that a comprehensive history of the patient, involving specifics of the pain, its nature, affected region and duration can be sufficient to raise the doctors suspicion of the diagnosis. • A specific magnetic resonance scan of the brain is needed to confirm the diagnosis. Images of an MRI scan can demonstrate if a nearby blood vessel is pressing down on the nerve. A diagnosis can be established if the patient has both of the following: typical symptoms and an established conflict between the nerve and the vasculature demonstrated by magnetic resonance imaging.

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