Trigeminal neuralgia

Sudden pain without warning

The trigeminal nerve is a mixed nerve. It is the fifth pair of cranial nerves and the thickest nerve in the face. It contains two kinds of fibers: general somatosensory and motor fibers. It innervates the movement of the face, mouth, nasal cavity, and masticatory muscles. The message is sent to the brain. The trigeminal nerve is formed by the confluence of the eye branch (first branch), maxillary branch (second branch), and mandibular branch (third branch) (see picture), which respectively innervate the sensation and sensation above the eyelid, between the eyelid and the upper jaw, and below the upper jaw. The masticatory muscles contract. The first branch includes the forehead, upper face, eyeballs and nose; the second branch includes the upper lip, lower face, side of the nose, upper alveolar and its gums; the third branch includes the lower lip, front of the ear, forehead, and lower row of the alveolar and its gums and tongue.

This disease is divided into primary (varices) and secondary (multiple sclerosis, brainstem tumor). The high-risk group of primary trigeminal neuralgia includes genetic, over 50 years old, female, people with three high problems, and smokers. Most patients suffer from sudden pain on one side of the body without aura, such as being burnt, acupuncture, electric shock or knife stabbing, and often accompanied by facial muscle twitching, tearing, drooling, facial flushing, conjunctival hyperemia and other symptoms, which worsen with the condition Attacks will become more frequent. About 60% of cases have pain extending from the corners of the mouth to the jawbone, and about 30% of cases have pain extending from the upper lip or canine teeth to the eye or eyebrows. Less than 5% of cases have pain that affects the eye nerves. Pain is easily triggered by certain actions or the external environment, such as airflow, chewing, temperature changes, etc.

Easily to be confused with other diseases

Misdiagnosis occurs from time to time

Trigeminal neuralgia is often confused with toothache and temporomandibular joint dysfunction. Although it is not difficult to diagnose, misdiagnosis often occurs. In addition to clinical diagnosis, doctors sometimes cooperate with X-ray examinations, brain scans, and magnetic resonance imaging to help diagnose. In addition, the possibility of tumors must be excluded, such as acoustic neurofibromas, cholesteatoma, hemangioma, meningioma, or dermoid cysts.

In the initial stage of the disease, medication can be used for one or two months, but medications can not cure the symptoms. Generally, it will be considered for patients who have good drug treatment effects, do not want surgery, are too old, or have other diseases that are not suitable for surgery. Injection therapy includes trigeminal nerve injection therapy, semilunar ganglion alcohol injection therapy, semilunar ganglion radiofrequency electrocoagulation therapy, or a balloon through a needle (in the previous sentence, can the doctor explain it again) to separate the compressed nerve ganglion. Surgery is commonly used for trigeminal nerve root microvascular decompression. The purpose of the operation is to isolate the compressed trigeminal nerve and blood vessels through a microscope and remove the nerve short circuit. Some patients who are not suitable for surgery can be treated with radiotherapy techniques such as digital navigator. Before performing any invasive procedures or surgery, you should seek the advice of your dentist and neurosurgeon. If treatment is delayed, long-term compression of nerve lines and irreversible lesions will reduce the cure rate of surgery, may affect the patient’s daily activities, and long-term pain can easily lead to depression.