Trigeminal Neuralgia

Trigeminal neuralgia, Seminar ENT Block 5.6, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia

1. Trigeminal Neuralgia Abdullatif Sami Al Rashed ENT Block 5.6 College of Medicine , KFU Al- Ahsa , Saudi Arabia

2. Anatomy of Trigeminal Nerve

3. Introduction Idiopathic trigeminal neuralgia is marked by paroxysms of intense, stabbing pain on one side of the face (tic douloureux ).

4. Clinical Features recurrent episodes of sudden onset, excruciating unilateral paroxysmal shooting “electric” pain in trigeminal root territory (V3>V2>>V1) may have normal sensory exam pain lasts seconds/minutes over days/weeks; may remit for weeks/months triggers: touching face, eating, talking, cold wind, shaving, applying make-up

5. Etiology classic TN: idiopathic secondary TN: compression by tortuous blood vessel (superior cerebellar artery) , cerebellopontine angle tumor (5%), MS (5%)

6. Epidemiology F >M; usually middle-aged and elderly

7. Diagnosis clinical diagnosis investigate for secondary causes, which are more likely if bilateral TN or associated sensory loss: MRI to rule out structural lesion, MS, or vascular lesion

8. Treatment first line: carbamazepine or oxcarbazepine second line: baclofen or lamotrigine narcotics not generally recommended if medical treatment fails : Gasserian ganglion percutaneous technique, gamma knife , invasive percutaneous denervation (radiofrequency/glycerol) , percutaneous balloon microcompression , microvascular decompression

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