Trigeminal neuralgia (trigeminal neuralgia)

Trigeminal neuralgia is a pathology in which there is damage to one or more branches of the trigeminal nerve (lat. nervus trigeminus) and which manifests itself as pain in the facial area.

The symptoms and treatment of trigeminal neuralgia are described in this article. If you are suffering from this disease, contact the CELT Pain Clinic. Despite the fact that this pathology is difficult to treat, our specialists have everything necessary to make it successful.

Sometimes trigeminal neuralgia is mistakenly called facial neuralgia, confused with another disease - facial neuropathy (or neuropathy of the facial nerve). This is due to the fact that the main manifestation of the disease is facial pain.

Causes of trigeminal neuralgia

Symptoms of trigeminal neuralgia occur against the background of compression of the trigeminal nerve root by the cerebellar artery or vein in the area of its entry into the brain stem (the artery or vein compresses the nerve or wraps around the root), resulting in damage to the sheath of nerve fibers.

This pathology develops most often during inflammatory processes in the nasal mucosa, periodontal tissue or other organs, which lead to a narrowing of the lumen of the canal through which the nerve passes.

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In addition, trigeminal neuralgia can develop due to:

hypothermia of nerve fibers with subsequent spasms of facial muscles;
disruptions in the functioning of the endocrine system;
compression due to growth of tumors;
pathologies of neurogenic and vascular nature;
herpes virus;
atherosclerosis of intracerebral arteries.

Chronic course of the disease

Chronic disease of the trigeminal nerve occurs in the absence of treatment or an incorrect rehabilitation plan. If you let the process take its course, many complications may arise that are much more difficult to correct.

Amyotrophy.
Decreased sensitivity of the skin, lips, gums and tongue.
The appearance of facial asymmetry.
Impaired diction, inability to open the jaw normally.
Problems with vision and hearing.

Clinical manifestations of neuralgia

Trigeminal neuralgia is characterized by facial pain, which usually comes on suddenly.

The pain may be severe, shooting, and feel like an electric shock.
Pain may occur after touching the face, while chewing, talking, or brushing teeth.
The duration of the attack of pain reaches several seconds.
Severe pain in the facial area can be prolonged (for several days, weeks).
The pain spreads to those areas of the face that are innervated by the trigeminal nerve - the lower jaw, cheek, gums, lips, and sometimes the eye or forehead area.
Usually the pain is one-sided.
The frequency of pain attacks varies from single to tens and hundreds per day.
During the period of exacerbation, more often in the cold season, attacks become more frequent.
Over time, without treatment, attacks of pain become more frequent and their intensity increases.

Pain syndrome can be typical and atypical:

typical - the pain either subsides or intensifies; shooting pain, even touching the face can provoke it;
atypical - the pain does not subside, and as a result it seems to the patient that half of his face hurts; he cannot accurately indicate the location of the pain.

Sometimes trigeminal neuralgia is accompanied by twitching of facial muscles (painful tic) and autonomic disorders (redness of the face, lacrimation, drooling, nasal congestion). Pain, as a rule, forces patients to immediately consult a neurologist.

Trigeminal nerve, anatomy, innervation, where the trigeminal nerve is located

The trigeminal nerve, nervus trigeminus, the 5th pair of human cranial nerves is a mixed nerve that contains sensory, motor and autonomic fibers. The functions of the trigeminal nerve are varied.

The sensory fibers of the trigeminal nerve originate from the cells of the trigeminal ganglion, which is called the ganglium trigeminale. It is located in the recess of the pyramid of the temporal bone. The dendrites of these cells form 3 branches and 3 trunks.

1 branch of the trigeminal nerve, the first branch (nervus ophthalmicus) - the ophthalmic nerve passes in the lateral wall of the cavernous sinus, later through the superior orbital fissure into the orbit. Then it breaks up into branches, innervates such structures as the outer part of the conjunctiva, the skin of the outer corner of the eye, the upper eyelid, the lacrimal gland, the skin of the scalp to the temporal and parietal regions, the skin of the forehead, the skin of the root of the nose, the cornea, the frontal sinus, the main sinuses , nasal mucosa, nasal skin, posterior cells of the ethmoid bone.

2nd branch of the trigeminal nerve, second branch (nervus maxillaris) - the maxillary nerve passes (exit) through the round foramen and the pterygopalatine fossa. It further breaks down into branches and innervates the following sections: the skin of the temporal region (temporal region, temple), the skin of the zygomatic region (cheekbone), the mucous membrane of the posterior ethmoid cells and the main sinus, the vault of the pharynx (pharynx), the nasal cavity (nose), the soft palate, hard palate, mucous membrane of the tonsils (tonsils), skin of the infraorbital region (infraorbital region), wings of the nose, upper lip, gums of the upper jaw, upper teeth.

3rd branch of the trigeminal nerve, third branch (nervus mandibularis) - the mandibular nerve leaves the skull through the foramen ovale (exit point, exit point), innervates the following areas: mucous membrane of the cheek, mucous membrane of the lower gum (lower gum), skin of the corner of the mouth (angle mouth), skin of the external auditory canal, anterior part of the auricle, temple, all lower teeth, skin and mucous membrane of the lower lip.

The motor fibers of the trigeminal nerve originate from the motor nucleus nucleus motorius nervi trigemini. The core is located in the bridge tire. Fibers extending from the nucleus leave the cranial cavity through the foramen ovale. They innervate the masticatory muscles and the anterior belly of the digastric muscle. The axons of the trigeminal ganglion cells form a root and go to the bridge, where they divide into 2 branches.

The descending branch forms the descending spinal tract of the trigeminal nerve, which is responsible for conducting temperature and pain sensitivity. It ends in the nucleus spinalis nervi trigemini. The descending spinal tract and its nuclei are analogous in their function and structure to the posterior horns of the spinal cord. The nuclei and path are divided into 5 segments, as a result of which the innervation of the facial skin in the Zelder zones is located in a ring.

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Trigeminal nerve, symptoms of trigeminal nerve damage, pathology

Damage to one of the sensory branches of the trigeminal nerve results in a disturbance of all types of sensitivity on the face of a peripheral type in the zone of innervation of this branch. In this case, symptoms : pain, decreased reflexes, extinction of reflexes. When the optic nerve is damaged, the conjunctival reflex, corneal reflex, and superciliary reflex are affected. When the motor part of the mandibular nerve is damaged, the mandibular reflex suffers. When the trigeminal nerve ganglion is damaged, all types of sensitivity in the area of 3 of its branches are lost, herpetic eruptions (herpes, herpetic blisters), and trophic disorders are often observed. A lesion of one of the sensitive nuclei in the pons results in a dissociated type of sensitivity disorder - superficial or deep. When the nucleus and oral parts of the spinal tract are damaged, a violation of superficial types of sensitivity in the mouth and nose occurs. If the caudal region is affected, sensitivity is impaired in the area of the outer part of the face. When the optic thalamus and the posterior third of the posterior limb of the internal capsule are affected, contralateral hypersthesia is observed on the face, trunk (body), and limbs (arms, legs) according to the hemitype. When the motor nucleus and its fibers are damaged, peripheral paresis occurs, which is characterized by symptoms such as insufficient muscle tension when chewing, muscle atrophy, retraction in the temple area, angle of the lower jaw, deviation of the lower jaw towards the affected side when opening the mouth. If bilateral peripheral paresis occurs, the lower jaw droops, as a result of which a man or woman cannot chew, cannot close his teeth, or close his mouth. Central paresis of the masticatory muscles on one side does not occur, since the corticonuclear fibers approach the motor nucleus of the trigeminal nerve from both hemispheres of the brain. With bilateral lesions, chewing becomes slightly more difficult (difficulty chewing), and the mandibular reflex is significantly enhanced. Small children have difficulty sucking.

Diagnosis of neuralgia

Diagnosis of neuralgia in the CELT clinic does not cause difficulties, since it has a number of pronounced signs. When talking about the clinical manifestations of the disease, patients try not to touch the affected side of the face and remain in a tense state, as they expect a new attack to develop.

Studies are carried out on the function of the branches of the trigeminal nerves, which begin with assessing the symmetry of the patient’s face. In addition, a number of tests are carried out to check taste and sensitivity.

For additional diagnosis of pathological processes in the nerves of the face, an ultrasound scan of the nerves is performed.

Possible complications

Almost all diseases of the trigeminal nerve are associated with either damage (pinching) or an inflammatory process. In both cases, high-quality treatment is necessary, since the consequences of trigeminal nerve disease can be serious. Disruption of the structure of nervous tissue not only causes severe and sudden pain, but also affects facial expressions, tissue sensitivity and even the psychological state of a person. The difficulty is that it is sometimes quite difficult to determine the cause of problems with the trigeminal nerve. Only high-quality diagnostics helps to create an optimal treatment plan.

Treatment of neuralgia

Treatment of neuralgia is a long and difficult process, but doctors at the CELT Pain Clinic know how to carry it out with maximum positive effect. For this, two treatment methods are used.

Conservative method of treating neuralgia

Conservative treatment involves taking medications:

antispasmodics;
anticonvulsants;
non-steroidal anti-inflammatory drugs;
glucocorticoids;
anticholinesterase drugs;
antidepressants;
vitamins

It is very important to correctly calculate the dosage of medications (this is done by the doctor) and take them regularly (this is the patient’s function), since this is the only way to achieve the desired effect. In complex conservative therapy, physiotherapeutic methods of treatment - Bernard currents - help to achieve a good effect; acupuncture; paraffin applications, etc.

If conservative therapy does not bring the desired effect, the attending physician may decide on surgical treatment.

Surgical method for treating neuralgia

The following surgical treatment methods have proven themselves well:

microvascular decompression of the root using implants that prevent compression on the nerve;
radiofrequency destruction, which involves destruction of the nerve root;
stereotactic radiosurgery (implies a targeted impact on the pathological focus with ionizing treatment using Gamma Knife and CyberKnife devices);
balloon compression (carried out without violating the integrity of the skin) - a conductor with a balloon at the end is inserted into the area of the trigeminal nerve ganglion using a special needle. By inflating the balloon, the doctor compresses the nerve, which leads to its destruction and cessation of pain impulses.

In any case, the key to successful treatment is timely consultation with a doctor. Contact the CELT clinic, our specialists are always ready to help and relieve you of pain!

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Treatment methods

Inflammation of the trigeminal nerve and neuralgia are treated in a comprehensive manner and only under the guidance of specialists. This is taking antibiotics, NSAIDs, glucocorticoids, muscle relaxants and anticonvulsants, coupled with novocaine blockades. Additionally, a number of physiotherapeutic procedures are prescribed. If these measures do not bring the desired result, surgical intervention is required. Depending on the clinical case, radiofrequency destruction or microvascular decompression is prescribed.

You can read more about the treatment of neuritis and neuralgia in a separate article.

Diagnosis of the disease

As a rule, patients who have the first symptoms of optic neuritis turn to an ophthalmologist. The disease is considered an interdisciplinary pathology; an ophthalmologist or neurologist must take part in its treatment. If neuritis develops against the background of other pathologies, it is necessary to clarify the diagnosis and carry out specific therapy for the primary diseases. Source: Visualization of the optic nerve in the diagnosis and monitoring of retrobulbar neuritis. Yuryeva T.N., Burlakova E.V., Khudonogov A.A., Ayueva E.K., Sukharchuk O.V. Acta Biomedica Scientifica, 2011. p. 133-136. Then the appropriate specialists are involved in the treatment - an immunologist, an otolaryngologist, an infectious disease specialist, a phthisiatrician.

The first step in diagnosing optic neuritis is collecting anamnesis, external examination of the patient, and palpation. During the medical history, the doctor will clarify the presence of concomitant pathologies, the time of onset of the disease, what complaints the patient has (pain, decreased visual acuity, changes in color perception, the appearance of “blind” spots), how quickly the symptoms developed and how severe they are, whether one eye or both is affected.

External examination and palpation may often not provide additional data. Pain, forward displacement of the eyeball, and limitation of its movements may occur with retrobulbar neuritis, but are not obligatory.

Next, the doctor proceeds to an ophthalmological examination. It includes:

determination of visual acuity;
the study of color perception is carried out using Rabkin’s polychromatic tables;
study of pupil reaction to light;
measurement of intraocular pressure, which can be a symptom of glaucoma and other diseases that provoke the development of neuritis;
biomicroscopy – examination of the anterior segment of the eye to exclude its pathology;
ophthalmoscopy (examination of the fundus of the eye) after instillation of drops that dilate the pupil;
computer examination of visual fields at 120 points;
study of visual fields using kinetic perimetry.

To clarify the diagnosis, the following methods are used:

electrophysiological diagnostics - study of the threshold of electrical sensitivity of the retina and visual evoked potentials;
ultrasound examination of the eyes, MRI of the orbit of the eye and brain;
coherence tomography of the optic nerve;
fluorescein angiography of the retina.

Laboratory diagnostics:

general blood analysis;
blood for HIV, syphilis, rheumatoid factor;
blood culture for sterility;
PCR studies;
histological, immunochemical analysis.

If the patient has concomitant diseases, he is prescribed consultations with specialists.

Disease prevention

To prevent optic neuritis, it is recommended to give up bad habits, promptly treat infectious diseases, avoid eye and head injuries, and visit specialized doctors in the presence of chronic pathologies.

Article sources:

Retrobulbar optic neuritis. Kukhtik S.Yu., Popova M.Yu., Tantsurova K.S. Bulletin of the Council of Young Scientists and Specialists of the Chelyabinsk Region, 2016
Visualization of the optic nerve in the diagnosis and monitoring of retrobulbar neuritis. Yuryeva T.N., Burlakova E.V., Khudonogov A.A., Ayueva E.K., Sukharchuk O.V. Acta Biomedica Scientifica, 2011. p. 133-136
Modern view on the problem of optic neuritis (systematic review). Krivosheeva M.S., Ioileva E.E. Saratov Scientific and Medical Journal, 2021. p. 602-605
Results of treatment of optic neuritis. Latypova E.A. Saratov Scientific and Medical Journal, 2021. p. 875-879