Trigeminal Neuralgia PPT AMED 2024 online

Trigeminal Neuralgia

1. WEBINAR AMED DR.DRG. C.RINI SUPRAPTI, SpBMM SubSp TM-TMJ(K) FICD

2. How to Determine Whether Patient Should be Treated Trigeminal Neuralgia or Dental Pain

3. INDIKATOR HASIL BELAJAR Setelah mengikuti materi ini diharapkan peserta mampu menentukan pilihan tata laksana yang tepat pada pasien TN dan Dental pain TUJUAN PEMBELAJARAN 1.Peserta dapat memahami pengertian , etiologi dan tata laksana Trigeminal Neuralgia 2. Dapat memahami tentang Dental Pain 3.Memahami tatalaksana TN dan Dental Pain

4. Trigeminal Neuralgia Dental Pain Trigeminal Neuralgia adalah nyeri kronis pada wajah yang mempengaruhi syaraf Trigeminal yaitu syaraf yang menghantarkan sensasi dari wajah menuju otak Syaraf ini sekaligus mengontrol sebagian fungsi motorik wajah seperti mengunyah dan menggigit Dental pain merupakan odontogenic pain yang berhubungan dengan gigi dan jaringan pendukung

5. The cause Is not entirely clear >> consensus >> pressure on the root entry zone of the Trigeminal Nerve by a vascular loop >> leads to focal demyelination Other disease : Multriple sclerosis,tumor , lyme disease >> the pain similar to TN

6. Spesific inclusion criteria Most frequently older patient > 50 years old 8:100.000 Sharp, electric shocklike pain in the face or mouth Female: male 1.6:1 The pain is intense > second > 1 minute Aching, burning pain Trigger Zone Common cutaneus , corner of the lips, cheek, ala nasi , lateral brow

7. • Severe paroxysmal pain • Unilateral location (96%); right > left • Mild superficial stimulation pain • V2 and V3 most commonly affected • Frequently pain free between attacks • No neurologic deficits • No dentoalveolar cause found • Local anesthesia of trigger zone temporarily arrests pain

8. Pretrigeminal Neuralgia : ClinicalCharacteristics • • Aching or burning pain • Continuous or intermittent • Unilateral location • Local anesthesia of painful region temporarily arrests pain • Neurologic examination normal • No dentoalveolar cause found • Frequently responsive to anticonvulsant therapy From International Headache Society, 2003

9. Gamabr : https://www.slideshare.net/slideshow/trigger-zones-of-orofacial-region-in-trigeminal-neuralgia/235719853

10. Sometimes a background aching pain accompanies TN, making it difficult to distinguish from the pain of acute pulpitis or, periapical periodontitis. Importantly, local anesthetic block of the trigger zone arrests the pain of TN for the duration of anesthesia and sometimes longer, lead the dentist to mistakenly as a “dental” cause to the pain complaint. The cause of TN is not entirely clear

11. Intraoral Pain Odontogenic Pain Mucogingival and glossal pain Pain disorder ass. with salivary disease Pain associated with the teeth and periodontium. Pain may referred to other teeth or area : head, neck, jaw Dental pain Pain ass. with supporting tissues of teeth Pain associated with the mucogingival tissues, tongue , and salivary glands

12. Odontogenic Pain Dental pain Pain ass. with supporting tissues of teeth Reversible pulpitis Nonreversible pulpitis Pulpal necrosis Acute apical periodontitis Acute apical abscess Acute periodontal abscess

13. Mucogingival and glossal pain Pain disorder ass. with salivary disease Localized : Acute necrotizing ulcerative gingivitis Recurrent apthous stomatitis Herpes simplex Candidiasis Injury from trauma Generalized : Chemotherapy Radiation therapy Dermatologic disorders Systemic disease Pain secondary to HIV Pain associated with the mucogingival tissues, tongue , and salivary glands Trauma,Neoplasia , Infection –mumps, Inflammation, acute supurative sialadentitis,chronic recurrent sialadentis,sialolithiasis ( salivary calculi /stones)

14. The treatment of TN Medical or Surgical

15. Medications Dosage (mg/day) Anticonvulsants Carbamazepine (Tegretol) 400–1200 Gabapentin (Neurontin) 600–3200 Clonazepam ( Klonopin ) 2–8 Divalproex (Depakote) 500–2000 Oxcarbazepine (Trileptal) 300–2400 Lamotrigine (Lamictal) 50–500 Topiramate (Topamax) 50–400 Phenytoin (Dilantin) 300–600 Tricyclic Antidepressants Amitriptyline 10–300 Doxepin 10–300 Nortriptyline 10–150 Imipramine 10–300 Antispastic Baclofen ( Lioresal ) 15–80 Common Medications for Trigeminal Neuralgia and Neuropathic Facial Pains

16. Bila Carbamazepine kurang menolong , maka dapat ditambahkan fenilhidantoin (3x25) sd 100 mg per hari Obat lain : antidepresan trisiklik seperti amiltriptilin atau imipramin Bila medikamentosa tidak berhasil : Suntikan alkohol setempat Termokoagulasi dari saraf trigeminus Atau membuka fosa kranii posterior dan dilakukan dekompresi

17. Bedah  gamma knife radiosurgery pada ganglion gasseri Keberhasilan : 70-80%

18. For the dentist >>> unneeded dental treatment or extractions are avoided. Unfortunately, when the trigger zone is located in an intraoral, dental, or periodontal site, unnecessary dental treatment is common. Surgical treatment includes Microvascular decompression vascular loop (so-called Janetta procedure) Gamma knife radiosurgery Percutaneous needle thermal rhizotomy Balloon compression of the root entry zone

19. Microvascular decompression Adalah sebuah tindakan bedah yang mengurangi kompresi abnormal dari saraf kranial Tindakan dapat dilakukan kepada pasien dengan trigeminal neuralgia atau hemifacial spasme Dilakukan dengan bius umum gambar : internet “https://www.valleygammaknife.com/microvascular-decompression-mvd/

20. Gamma knife radiosurgery Suatu metode pembedahan non invasive ( tidak memerlukan sayatan ) Metode ini tidak menggunakan pisau bedah , melainkan Sinar Gamma Metode Leksell Gamma Knife Perfecxion : memfokuskan radiasi sinar gamma dari 192 sumber Co-60 ke Lokasi tumor dengan akurasi klinis bertoleransi kurang dari 0.50 mm sehingga meminimalisir kerusakan jaringan sekitar target bidik

21. Percutaneous needle thermal rhizotomy Adalah operasi bedah saraf minimal invasive, yang bertujuan untuk menghilangkan tekanan langsung pada saraf trigeminal Dibutuhkan sayatan kecil sekitar 3-4 cm di belakang telinga Diperlukan mikroskop dan neuroendoskopi

22. PERCUTANEOUS RADIOFREQUENSY RHIZOTHOMY Gambar :https://tnaaustralia.org.au/tag/radiofrequency-rhizotomy/

23. Dentists focusing on Orofacial Pain Diagnosis and Management use them in dental practice so that unneeded dental treatment or extractions are avoided The classic medication TN is carbamazepine but Newer anticonvulsants (e.g., gabapentin and oxcarbazepine ) and antispastic baclofen are commonly used Rangkuman

24. HISTORY LENGKAP KELUHAN UTAMA PEMERIKSAAN KLINIS TREATMENT EVALUASI HAL PENTING

25. © International Headache Society 2003/5 . Pain Terms Allodynia Pain caused by a stimulus that does not normally provoke pain Analgesia Absence of pain in response to stimulation that would normally be painful Anesthesia Absence of all sensation Deafferentation pain Pain caused by loss of sensory input into the central nervous system Dysesthesia Unpleasant abnormal sensation, whether spontaneous or evoked ( Note: Dysesthesia includes paresthesia, but not vice versa.) Hyperalgesia Increased sensitivity to noxious stimulation Hyperesthesi Increased sensitivity to all stimulation, excluding special senses ( Note: When the sensation is painful, the terms allodynia and hyperalgesia may be appropriate.) Hypoalgesia Diminished sensitivity to noxious stimulation Hypoesthesia Diminished sensitivity to all stimulation, excluding the special senses ( Note: When the sensation is pain, the terms hypoalgesia and analgesia may be appropriate.) Neuralgia Pain in the distribution of a nerve or nerves Neuropathy Disturbance of function or pathologic change in a nerve Paresthesia Abnormal sensation, whether spontaneous or evoked

26. “ TAK ADA RAHASIA UNTUK MENGGAPAI SUKSES, SUKSES ITU DAPAT TERJADI KARENA PERSIAPAN, KERJA KERAS, DAN MAU BELAJAR DARI KEGAGALAN “ ( COLIN POWELL )