Trigger Zones Of Orofacial Region In Trigeminal Neuralgia

THIS IS A BRIEF DESCRIPTION ABOUT THE TRIGGER ZONES OF THE OROFACIAL REGION IN TRIGEMINAL NEURALGIA

1. TRIGGER ZONES OF OROFACIAL REGION KRISHNAA S III BDS DEPT OF ORAL AND MAXILLOFACIAL PATHOLOGY

2. DEFINITION ACCORDING TO NEUROSCIENCE AND NEUROLOGY, A TRIGGER ZONE (DOLOROGENIC ZONE) IS AN AREA OF THE BODY / OF A CELL , IN WHICH A SPECIFIC TYPE OF STIMULATION TRIGGERS A SPECIFIC TYPE OF RESPONSE THE TERM WAS INTRODUCED BY, A JAPANESE AUTHOR, HUGH T PATRICK IN 1914

3. TRIGGER ZONES OF OROFACIAL REGION

4. DISEASES OF THE NERVES

5. TRIGEMINAL NEURALGIA TIC DOULOUREUX FOTHERGILL’S DISEASE TRIFACIAL NEURALGIA SUICIDE DISEASE

6. NEURALGIA PAIN ALONG THE PATHWAY OF THE NERVE JOHN FOTHERGILL ENGLISH PHYSICIAN [1773] SO ACCORDINGLY, TRIGEMINAL NEURALGIA PAIN ALONG THE DISTRIBUTION OF THE TRIGEMINAL NERVE

7. FIFTH CRANIAL NERVE RESPONSIBLE FOR SENSATION IN THE FACE + MOTOR FUNCTIONS TRI THREE OPHTHALMIC MAXILLARY MANDIBULAR TRIGEMINAL NERVE BRANCHES

8. DESCRIBED AS … SUDDEN, SHARP, LANCINATING, ELECTRIC SHOCK –LIKE RECURRENT PAIN ALONG THE BRANCHES OF THE NERVE. GIVES ‘THE MOST TERRIBLE TYPE OF PAIN KNOWN TO HUMANS’ FACIAL MUSCLE SPASMS MAY ALSO ACCOMPANY THE PAIN ATTACK

9. CLINICAL FEATURES AGE - 50-70 yrs GENDER - Female predilection Pain is usually unilateral (right side more affected ) Pain attack is initiated by touching specific areas of the face called TRIGGER ZONES

10. ALA OF THE NOSE CHEEKS VERMILLION BORDER OF THE LIPS AROUND THE EYES SKIN ON CHIN FOREHEAD MIDFACE ALVEOLAR BONE NASOLABIAL FOLD DISTRIBUTION OF TRIGGER ZONES

11. “TRIGGERS PRECIPITATE AN ATTACK” CHEWING / SWALLOWING TALKING BRUSHING TEETH FACE WASHING / SHAVING LIGHT TOUCH / VIBRATION COOL BREEZE ACROSS THE FACE

12. CLINICAL FEATURES (CONTD…) MAXILLARY DIVISION MORE COMMONLY INVOLVED EARLY PAIN IS TERMED AS PRE-TRIGEMINAL NEURALGIA

13. THE VERY SAME TRIGEMINAL NEURALGIA

14. TYPES ACCORDING TO THE INTERNATIONAL HEADACHE SOCIETY (IHS),

15. CLASSICAL TN (COMMON) SYMPTOMATIC TN IDIOPATHIC TN BELIEVED TO BE CAUSED BY A BLOOD VESSEL COMPRESSING THE TRIGEMINAL NERVE AS IT EXIT FROM THE BRAINSTEM. CONSTANT COMPRESSION CAUSES DEMYELINATIO N, WHICH RESULTS IN HYPEREXCITABILITY OF THE NERVE. NEURALGIA CAUSED SECONDARY TO AN UNDERLYING MEDICAL CONDITION NOT RELATED TO VASCULAR COMPRESSION CAUSES CAN BE MULTIPLE SCLEROSIS, LEUKODYSTROPHY, GUILLAN-BARRE SYNDROME OR A TUMOUR COMPRESSING THE NERVE etc… PATHOGENESIS

16. DIAGNOSIS DETAILED PAIN HISTORY ( ONSET, LOCATION, INTENSITY, AGGRAVATING FACTORS, ALLEVIATING FACTORS, FREQUENCY, DURATION ) CLINICAL EXAMINATION MRI SCAN CT SCAN

17. DIFFERENTIAL DIAGNOSIS MIGRAINE CLUSTER HEADACHE ( SPHENOPALATINE NEURALGIA ) TEMPORAL ARTERITIS MULTIPLE SCLEROSIS MANDIBULAR OSTEOMYELITIS POSTHERPETIC NEURALGIA TROTTER’S SYNDROME

18. TREATMENT (A) MEDICATIONS

19. (B) SURGICAL

20. SPHENOPALATINE NEURALGIA / HISTAMINE HEADACHE / ALARM CLOCK HEADACHE / CLUSTER HEADACHE EXTREMELY PAINFUL CONDITION INITIATING FACTOR – ALCOHOL, HEAT, CERTAIN MEDICATIONS EXACT ETIOLOGY IS UNKNOWN BUT IS BELIEVED THAT IT IS DUE TO THE ABNORMALITIES IN THE HYPOTHALAMUS TWO TYPES: Episodic Chronic TREATED BY NERVE BLOCKS AND S EVERAL NEUROSURGICAL PROCEDURES.

21. CONCLUSION PROPER DIAGNOSIS AND TREATMENT PLAN PLAY A MAJOR ROLE IN THE SUCCESS OF ANY TREATMENT. THE VARIOUS ADVANCES HELP IN UNDERSTANDING THE CONDITION AND PROVIDE BETTER PROGNOSIS.

22. REFERENCES Shafer’s textbook of O ral P athology (8 TH edition) National organization for rare disorders (NORD) ( www.rarediseases.org ) www.pubmed.gov.in (Medline database) Jafferey P Okeson, Bells orofacial pain, 6 th edition, Quintessence publishing co Inc., 2005 Cheryl A. Kitt et al., Topical review Trigeminal Neuralgia: opportunities for research and treatment, International Association for the study of Pain, 2000

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