scholarly journals Neuralgias of the Trigeminal Nerve

2000 ◽  
Vol 5 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Allan S Gordon
Keyword(s):  
Neuropathic Pain ◽  
Differential Diagnosis ◽  
Trigeminal Neuralgia ◽  
Clinical Features ◽  
Trigeminal Nerve ◽  
Postherpetic Neuralgia ◽  
Facial Pain ◽  
The Other ◽  
Atypical Facial Pain ◽  
Trigeminal Neuropathic Pain

Practitioners are often presented with patients who complain bitterly of facial pain. The trigeminal nerve is involved in four conditions that are sometimes mixed up. The four conditions - trigeminal neuralgia, trigeminal neuropathic pain, postherpetic neuralgia and atypical facial pain - are discussed under the headings of clinical features, differential diagnosis, cause and treatment. This article should help practitioners to differentiate one from the other and to manage their care.

scholarly journals A Minimally Invasive Surgical Technique for the Treatment of Posttraumatic Trigeminal Neuropathic Pain with Peripheral Nerve Stimulation

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. E725-E732
Author(s):  
Jackson Cohen
Keyword(s):  
Neuropathic Pain ◽  
Surgical Technique ◽  
Trigeminal Neuralgia ◽  
Minimally Invasive ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Facial Pain ◽  
Peripheral Nerve Stimulation ◽  
Invasive Technique ◽  
Trigeminal Neuropathic Pain

Background: Facial pain occurring after traumatic injury of the facial branches of the trigeminal nerve is a medical condition that is often very difficult to treat. Patients are quite disabled by their symptoms and most therapies are ineffective in relieving this pain. Peripheral nerve stimulation has been used as a treatment to provide pain relief for this type of intractable atypical facial pain. Objective: To describe a minimally invasive peripheral nerve stimulation surgical technique for treating posttraumatic trigeminal neuralgia. Study Design: Case report based on a patient seen in a university setting with posttraumatic trigeminal neuropathic pain who underwent a minimally invasive technique for the placement of a peripheral nerve stimulator. Setting: University-based outpatient clinic. Methods: A patient with a clinical picture suggestive of trigeminal neuropathic pain secondary to trauma involving the V1 and V2 branches of the trigeminal nerve was selected. Conservative management was attempted with no improvement before peripheral nerve stimulation was tried with a minimally invasive surgical technique. We recorded the patient’s subjective assessment of pain and daily function before and after the procedure. Results: Following the procedure, the patient’s pain score decreased approximately 50% and the patient reported a better quality of life with improvement in daily function as well as a more positive outlook on her condition. There were no complications after the procedure and the patient reported no complaints with the device. Limitations: Case report. Conclusions: This surgical technique for placing peripheral nerve stimulators allows for a minimally invasive approach for the treatment of intractable posttraumatic trigeminal neuralgia with potentially less risk of facial nerve damage. This case confirms the need for further studies to be done in the future to prove the safety and effectiveness of this technique. Key Words: Peripheral nerve stimulation, posttraumatic trigeminal neuralgia, neuropathic pain, minimally invasive technique, facial pain.

scholarly journals Ultrasound-Guided Trigeminal Nerve Block via the Pterygopalatine Fossa: An Effective Treatment for Trigeminal Neuralgia and Atypical Facial Pain

2013 ◽  
Vol 5;16 (5;9) ◽  
pp. E537-E545
Author(s):  
Mark C. Kendall
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Nerve Block ◽  
Trigeminal Nerve ◽  
Local Anesthetic ◽  
Facial Pain ◽  
Case Series ◽  
Pterygopalatine Fossa ◽  
Atypical Facial Pain ◽  
Ultrasound Guided

Background: Patients presenting with facial pain often have ineffective pain relief with medical therapy. Cases refractory to medical management are frequently treated with surgical or minimally invasive procedures with variable success rates. We report on the use of ultrasound-guided trigeminal nerve block via the pterygopalatine fossa in patients following refractory medical and surgical treatment. Objective: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions. Setting: Academic pain management center. Design: Prospective case series. Methods: Fifteen patients were treated with ultrasound-guided trigeminal nerve block with local anesthetic and steroids placed into the pterygopalatine fossa. Results: All patients achieved complete sensory analgesia to pin prick in the distribution of the V2 branch of the trigeminal nerve and 80% (12 out of 15) achieved complete sensory analgesia in V1, V2, V3 distribution within 15 minutes of the injection. All patients reported pain relief within 5 minutes of the injection. The majority of patients maintained pain relief throughout the 15 month study period. No patients experienced symptoms of local anesthetic toxicity or onset of new neurological sequelae. Limitations: Prospective case series. Conclusion: We conclude that the use of ultrasound guidance for injectate delivery in the pterygopalatine fossa is a simple, free of radiation or magnetization, safe, and effective percutaneous procedure that provides sustained pain relief in trigeminal neuralgia or atypical facial pain patients who have failed previous medical interventions. Key words: Trigeminal nerve, ultrasound-guided, atypical facial pain, trigeminal neuralgia, tic douloureux.

Trigeminal Neuralgia Secondary to a Tentorial Ossification: A Case Report

Neurosurgery ◽  
1982 ◽  
Vol 11 (4) ◽  
pp. 527-529 ◽  
Author(s):  
Michael Standefer ◽  
Janet W. Bay ◽  
Donald F. Dohn
Keyword(s):  
Case Report ◽  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Atypical Facial Pain ◽  
Tic Douloureux ◽  
Sensory Root ◽  
Unusual Symptoms

Abstract The authors describe a patient who suffered from tic douloureux associated with atypical facial pain and tinnitus. All preoperative neurodiagnostic findings were normal. Posterior fossa exploration disclosed a tentorial ossification compressing the sensory root of the trigeminal nerve. Ossification within the tentorium and the implications of unusual symptoms associated with trigeminal neuralgia are discussed.

Trigeminal Neuropathic Pain

2019 ◽  
pp. 31-40
Author(s):  
Mandana A. Behbahani ◽  
Nauman S. Chaudhry ◽  
Konstantin V. Slavin
Keyword(s):  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Pulse Generator ◽  
Unintentional Injury ◽  
Pain Syndrome ◽  
Management Process ◽  
Trigeminal Neuropathic Pain ◽  
Pain Syndromes ◽  
Internal Pulse Generator

Trigeminal neuropathic pain (TNP) involves pain isolated to the distribution of one or more branches of the trigeminal nerve following unintentional injury to that nerve. It is important to distinguish this facial pain syndrome from trigeminal neuralgia, as the treatment is quite different. The diagnosis is typically clinical, although local anesthetic blocks may aid in the diagnosis. Psychological testing is often performed preoperatively. Like other neuropathic pain syndromes, TNP may be treated with peripheral nerve stimulation. This chapter discusses a typical presentation of TNP, as well as the evaluation and management process, including placement of subcutaneous electrodes and connection to an internal pulse generator.

scholarly journals Trigeminal neuralgia: definition and classification

2005 ◽  
Vol 18 (5) ◽  
pp. 1-3 ◽  
Author(s):  
Jorge L. Eller ◽  
Ahmed M. Raslan ◽  
Kim J. Burchiel
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Classification Scheme ◽  
Unintentional Injury ◽  
Atypical Facial Pain ◽  
Trigeminal Neuropathic Pain ◽  
Somatoform Pain Disorder ◽  
Pain Syndromes ◽  
Specific Objective ◽  
Patient’S History

Based on specific, objective, and reproducible criteria, a classification scheme for trigeminal neuralgia (TN) and related facial pain syndromes is proposed. Such a classification scheme is based on information provided in the patient's history and incorporates seven diagnostic criteria, as follows. 1) and 2) Trigeminal neuralgia Types 1 and 2 (TN1 and TN2) refer to idiopathic, spontaneous facial pain that is either predominantly episodic (as in TN1) or constant (as in TN2) in nature. 3) Trigeminal neuropathic pain results from unintentional injury to the trigeminal nerve from trauma or surgery. 4) Trigeminal deafferentation pain results from intentional injury to the nerve by peripheral nerve ablation, gangliolysis, or rhizotomy in an attempt to treat either TN or other related facial pain. 5) Symptomatic TN results from multiple sclerosis. 6) Postherpetic TN follows a cutaneous herpes zoster outbreak in the trigeminal distribution. 7) The category of atypical facial pain is reserved for facial pain secondary to a somatoform pain disorder and requires psychological testing for diagnostic confirmation. The purpose of a classification scheme like this is to advocate a more rigorous, standardized natural history and outcome studies for TN and related facial pain syndromes.

Facial pain

2018 ◽  
Author(s):  
Paul Davies
Keyword(s):  
Differential Diagnosis ◽  
Trigeminal Neuralgia ◽  
Parotid Gland ◽  
Cluster Headache ◽  
Effective Treatment ◽  
Facial Pain ◽  
Cervical Spondylosis ◽  
Atypical Facial Pain ◽  
Neurological Syndrome ◽  
Persistent Idiopathic Facial Pain

Facial pain occupies the area below the orbitomeatal line, above the neck and anterior to the pinnae. It comes in many forms and may or may not be accompanied by other symptoms. It may be acute, subacute, or chronic, arise from local pathology (e.g. dentition, parotid gland, sinus), be referred from other structures (e.g. pain behind the eye may be due to cervical spondylosis or sphenoidal sinusitis) or be part of a neurological syndrome such as trigeminal neuralgia or persistent idiopathic facial pain (previously termed atypical facial pain). There is a wide differential diagnosis. As with headache, serious causes are rare. Some benign conditions are particularly painful (trigeminal neuralgia, cluster headache) but have effective treatment.

scholarly journals Interventional Management of Refractory Trigeminal Neuropathic Pain: A Prospective Audit of a Novel Management Pathway in 70 Patients

2020 ◽  
Vol 5;23 (9;5) ◽  
pp. E525-E533
Author(s):  
G. Niraj
Keyword(s):  
Neuropathic Pain ◽  
Nerve Block ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Standard Treatment ◽  
The Novel ◽  
Prospective Audit ◽  
Ultrasound Guided ◽  
Trigeminal Neuropathic Pain ◽  
Novel Strategy

Background: Trigeminal neuropathic pain (TNP) can present as a constant, unremitting unilateral facial pain. Current management is based on expert recommendation that includes pharmacologic agents and psychological therapy. However, treatment success with pharmacologic management is poor. We adopted a novel strategy that proved to be effective in providing durable relief. Objectives: Prospectively audit a novel strategy in the management of refractory TNP. Study Design: The authors present a prospective audit of a novel structured management pathway in the treatment of refractory TNP. Setting: Multidisciplinary facial pain clinic at a University Teaching Hospital. Methods: Over a 4-year period, 70 patients with unilateral TNP were prospectively audited at a tertiary care university hospital. Initial treatment was based on pharmacologic therapy while the patient awaited psychological therapy. Patients who failed to respond were offered a novel set of interventions that included ultrasound-guided trigeminal nerve block with depot steroids. Results: Patient satisfaction with the novel pathway was high. Only 13 patients (13/70, 18%) responded to standard treatment. Of the 57 patients who were offered the novel intervention, 50 patients consented to undergo the intervention. Forty-two patients (42/50, 84%) reported clinically significant pain relief at 3 months, and 27 patients (27/50, 54%) reported on-going durable relief at 6 months. Treatment failure with the novel intervention was 16%. Out of 54 patients in the employable age, 45 patients (45/54, 83%) were able to maintain gainful employment. Limitations: Open-label, nonrandomized observational design. Conclusions: Standard treatment of TNP is ineffective. The novel set of interventions based on empirical evidence may have a role in managing patients with refractory TNP. Key words: Trigeminal neuropathic pain, ultrasound-guided trigeminal nerve block, intermediate cervical plexus block :

Differences and similarities between atypical facial pain and trigeminal neuropathic pain

Neurology ◽  
2007 ◽  
Vol 69 (14) ◽  
pp. 1451-1459 ◽  
Author(s):  
H. Forssell ◽  
O. Tenovuo ◽  
P. Silvoniemi ◽  
S. K. Jaaskelainen
Keyword(s):  
Neuropathic Pain ◽  
Facial Pain ◽  
Atypical Facial Pain ◽  
Trigeminal Neuropathic Pain
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