TRIGEMINAL NEURALGIA ( FACIAL PAIN )

What is Trigeminal Ganglion ?

Trigeminal ganglia is a nervous tissue in the base of skull. It is composed of three different portion which is responsible for sensation on three different region of face forehead, cheek and jaw. 

What is a Trigeminal Neuralgia – FACIAL PAIN ?

Trigeminal neuralgia is nothing but severe shooting or stabbing pain in the area of face described as electric shock. It can affect a part of face or whole face usually on one side. It is worst ever pain experienced by anyone.  At times it is described as severe spasm in one of the area of face.

 

What are the symptoms of Trigeminal Neuralgia ?

Typically it is described as a electric like shock in one of the region of face. At times it can be described as a spasm in one of area of face depending on which part of trigeminal ganglia is affected by disease process. 

Severe attack of pain can involve lip, nose, eye or ear. It can last from few seconds to less than two minutes.

What are triggers for Trigeminal Neuralgia – FACIAL PAIN ?

 Severe facial pain can be triggered by one or more of following

  • Eating
  • Shaving
  • Washing
  • While applying makeup
  • Brushing the teeth
  • Talking
  • Spontaneously

 

How is a  Trigeminal Neuralgia – FACIAL PAIN diagnosed ?

Your health care provider will begin an evaluation with a complete physical examination and medical history, including a review of your symptoms. It is mainly a clinical diagnosis. 

Certain other diagnostic tests to confirm the diagnosis such as :

  • MRI  — Magnetic resonance imaging (MRI)  can help to find out compression of nerve by blood vessel or some times secondary causes of trigeminal neuralgia.
What causes  Trigeminal Neuralgia – FACIAL PAIN ?
  • Idiopathic ( unknown reason) – commonest
  • Looping of vessel around trigeminal ganglia
  • Multiple sclerosis
  • deformity at the base of skull
  • Facial trauma
  • Atypical –  nasopharyngeal cancer

 

How is a FACIAL PAIN of Trigeminal Neuralgia treated ?
  • Medicine — This helps in reduction of neural discharge and reduction in frequency of attacks. It provides acceptable relief in 60 % of cases.
  • Advantage – avoid invasive treatment like surgery or injections.
  • Disadvantages – Life long therapy, side effects of medication, intolerability to medication,
  • Injections — “RF ABLATION”–  This is done by positioning a needle under x ray guidance near trigeminal ganglion and modulating the electrical activity there. In turn one gets long lasting pain relief. In case of relapse of disease this procedure can be repeated safely without much side effects.
  • These injection will give you instant relief and you can be mobile immediately without need of long term medical therapy. 
  • Surgery — “MICROVASCULAR DECOMPRESSION” –  Surgery is not required in most of the cases. Surgery will work in cases where cause is looping of blood vessel around trigeminal ganglia. Surgery might be needed for people who do not respond to treatment.

ADVANTAGES OF RADIO FREQUENCY ABLATION
  • Good Pain Relief
  • Less stress to the patient
  • Patient leaves the hospital in same day
  • No surgery
  • Simple injection performed under local anesthesia
  • Low relapse rate 15% in 5 yrs and 20% in 9 yrs
  • Avoid loss of sensation in affected area
  • Avoid loss of corneal reflex
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