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    Tarana PPT On Trigeminal Neuralgia

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    Mrinmayee Thakur
    Trigeminal neuralgia is a condition characterized by severe, sudden, brief, stabbing pains in the face that are triggered by everyday activities like eating, talking, or brushing teeth. It is caused by compression or irritation of the trigeminal nerve, the largest cranial nerve. Diagnosis is based on the type and location of pain, and triggers. Initial treatment involves medications like carbamazepine, while refractory cases may require surgeries like microvascular decompression to relieve pressure on the nerve. Proper diagnosis differentiates it from other dental, neurologic, or psychogenic conditions involving facial pain.

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    Tarana PPT On Trigeminal Neuralgia

    Uploaded by

    Mrinmayee Thakur
    154 views37 pages
    Trigeminal neuralgia is a condition characterized by severe, sudden, brief, stabbing pains in the face that are triggered by everyday activities like eating, talking, or brushing teeth. It is caused by compression or irritation of the trigeminal nerve, the largest cranial nerve. Diagnosis is based on the type and location of pain, and triggers. Initial treatment involves medications like carbamazepine, while refractory cases may require surgeries like microvascular decompression to relieve pressure on the nerve. Proper diagnosis differentiates it from other dental, neurologic, or psychogenic conditions involving facial pain.

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    Trigeminal neuralgia is a condition characterized by severe, sudden, brief, stabbing pains in the face that are triggered by everyday activities like eating, talking, or brushing teeth. It is caused by compression or irritation of the trigeminal nerve, the largest cranial nerve. Diagnosis is based on the type and location of pain, and triggers. Initial treatment involves medications like carbamazepine, while refractory cases may require surgeries like microvascular decompression to relieve pressure on the nerve. Proper diagnosis differentiates it from other dental, neurologic, or psychogenic conditions involving facial pain.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    154 views37 pages

    Tarana PPT On Trigeminal Neuralgia

    Uploaded by

    Mrinmayee Thakur
    Trigeminal neuralgia is a condition characterized by severe, sudden, brief, stabbing pains in the face that are triggered by everyday activities like eating, talking, or brushing teeth. It is caused by compression or irritation of the trigeminal nerve, the largest cranial nerve. Diagnosis is based on the type and location of pain, and triggers. Initial treatment involves medications like carbamazepine, while refractory cases may require surgeries like microvascular decompression to relieve pressure on the nerve. Proper diagnosis differentiates it from other dental, neurologic, or psychogenic conditions involving facial pain.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 37

    TRIGEMINAL

    NEURALGIA
    Guided by:
    DR. JYOTI KARANI mam
    DR. SALONI MISTRY mam

    presented by:
    TARANA D RAGHANI
    CONTENTS:
     TERMINOLOGIES FOR NEUROLOGICAL
    DISTURBANCES
     ANATOMIC AND FUNCTIONAL CONSIDERATION OF
    TRIGEMINAL NERVE
     WHAT IS TRIGEMINAL NEURALGIA
     EPIDEMIOLOGIC STUDIES
     ETIOLOGY
     CLINICAL CHARACTERISTICS
     RISK FACTORS
     DIAGNOSIS
     DIFFERENTIAL DIAGNOSIS
     TREATMENT MODALITIES
     DENTAL CONSIDERATIONS IN TRIGEMINAL NEURALGIA
    TERMINOLOGIES FOR
    NEUROLOGICAL
    DISTURBANCES
    ALLODYNIA pain due to stimulus that does not
    normally provoke pain

    ANALGESIA absence of pain in response to


    stimulation that will normally be
    painful

    ANAESTHESIA loss of any or all sensation


    PARESTHESIA an altered sensation, which is not
    pleasant, like tingling, crawling,
    burning, itching

    DYSAESTHESIA an unpleasant painful abnormal


    sensation, either spontaneous or
    evoked. Patient c/o burning,
    stabbing or burrowing type of pain

    HYPERAESTHESIA increased sensitivity to stimulus.

    HYPOAESTHESIA decreased sensitivity to stimulus.


    HYPERGESIA increased response to
    stimulus that is normally
    painful

    HYPOGESIA decreased response to


    stimulus that is normally
    painful

    AGEUSIA loss of taste sensation


    NEURITIS an inflammation of a
    nerve

    NEURALGIA transmission of pain


    impulse along the
    course of nerve
    ANATOMIC AND
    FUNCTIONAL
    CONSIDERATION OF
    TRIGEMINAL NERVE

     It is the largest cranial


    nerve.
     it comprises three
    branches
    1. OPHTHALMIC
    2. MAXILLARY
    3. MANDIBULAR

    B D CHAURASIA’s HUMAN ANATOMY , 5th edition


    SENSORY FIBRES

    The sensory fibres arise from the gasserian


    ganglion

    MOTOR FIBRES

    The motor fibres arise from the superior and


    inferior nuclei

    B D CHAURASIA’s HUMAN ANATOMY , 5th edition


    OPHTHALMIC NERVE
    BRANCHES
    A. Infratrochlear
    B. Anterior Ethmoid
    C. Posterior Ethmoid
    D. Lacrimal
    E. Supraorbital
    F. Supratrochlear
    G. Nasociliary

    B D CHAURASIA’s HUMAN ANATOMY , 5th edition


    MAXILLARY NERVE
    BRANCHES

    A. Zygoticaticotemporal
    B. Zygomaticofacial
    C. Post. Sup. Alveolar
    D. Nasopalatine
    E. Greater Palatine
    F. Lesser Palatine
    G. Mid. & Ant. Alveolar
    H. Infraorbital

    B D CHAURASIA’s HUMAN ANATOMY , 5th edition


    MANDIBULAR NERVE
    BRANCHES

    A. Auriculotemporal
    B. Lingual
    C. Inferior Alveolar
    D. N. to the Mylohyoid
    E. Mental
    F. Buccal

    B D CHAURASIA’s HUMAN ANATOMY , 5th edition


    TRIGEMINAL
    NEURALGIA

    Trigeminal neuralgia is
    defined as sudden, usually
    unilateral, severe, brief,
    stabbing, lancinating type of
    pain in the distribution of
    one or more branches of the
    5th cranial nerve

    Oral and maxillofacial surgery by neelima malik


    EPIDEMIOLOGICAL
    STUDIES
    YEAR SCIENTISTS CONCLUSIONS FROM
    THEIR STUDIES
    1972 YOSHIMASU, TN is more common in
    KURLAND and females than males in US
    ELVELVACK

    1996 JACOB AND the incidence of TN occurs


    RHOTON predominantly in females

    Prevalence of trigeminal neuralgia: A systematic review.


    J Am Dent Assoc. 2016 Jul;147(7):570-576.e2. doi:
    10.1016/j.adaj.2016.02.014. Epub 2016 Mar 24
    2004 VALLE et al  72 % showed intraoral
    evaluated the trigger zone
    dental conditions  16% had TMJ disorders
    of 50 patients with  6% had burning mouth
    TN syndrome
     42% of the patients show
    limitations for the
    performance of daily
    activities

    1998 SHANMUHAS- female predominance


    NTHARAM et al Right side 5 times more
    investigated the affected than the left side (in
    clinical unilateral cases)
    characteristics of Largest frequency was in the
    TN in 44 Asian age group of 60-70 years
    patients
    A RETROSPECTIVE STUDY OF 72
    CASES DIAGNOSED WITH
    IDIOPATHIC TRIGEMINAL
    NEURALGIA IN INDIAN POPULACE
    by DR SUNIL YADAV and others
    A retrospective study of 72 cases diagnosed with idiopathic trigeminal neuralgia
    in indian populace
    ETIOLOGY

    i. Neurovascular compression
    ii. Multiple sclerosis
    iii. Tumor and cyst
    iv. Diabetes mellitus
    v. Herpes simplex virus
    vi. Allergy

    http://tnaaustralia.org.au/dental-care-and-tn/
    CLINICAL
    CHARACTERISTICS
     Itis characterized by sudden,
    unilateral, intermittent paroxysmal,
    sharp, shooting, lancinating, like pain.

     Pain is elicited by slight touching


    superficial ‘Trigger points’ which
    radiates from that point, across the
    distribution of one or more branches of
    trigeminal nerve.
    The location of Trigger point depends
    on which division of Trigeminal nerve
    is involved

    In V2 – points are located on the


    skin of upper lip, ala of nose,
    cheek, or on upper gums

    In V3 – lower lip, teeth or gums of


    lower jaw

    In V1 – Supraorbital ridge
    TRIGGERS
    A variety of triggers may set off the pain
    of trigeminal neuralgia, including:
     Shaving
     Touching your face
     Eating
     Drinking
     Brushing your teeth
     Talking
     Putting on makeup
     Encountering a breeze
     Smiling
     Washing your face
    RISK FACTORS

    1) Multiple Sclerosis (major)


    2) Hypertension (common in the age
    group at risk)
    3) Familial tendency – in a
    retrospective study by POLLOCK et
    al females with bilateral TN had a
    higher rate of familial TN
    DIAGNOSIS
     Your doctor will diagnose trigeminal
    neuralgia mainly based on your
    description of the pain, including:
     TYPE OF PAIN related to
    trigeminal neuralgia is sudden,
    shock-like and brief.
     LOCATION. The parts of your face
    that are affected by pain will tell
    your doctor if the trigeminal nerve
    is involved.
     TRIGGERS Trigeminal neuralgia-
    related pain usually is brought on
    by light stimulation of your cheeks,
    such as from eating, talking or
    even encountering a cool breeze.
    A NEUROLOGICAL EXAMINATION.
    Touching and examining parts of your
    face can help your doctor determine
    exactly where the pain is occurring and
    — if you appear to have trigeminal
    neuralgia — which branches of the
    trigeminal nerve may be affected. Reflex
    tests also can help your doctor determine
    if your symptoms are caused by a
    compressed nerve or another condition.
     MAGNETIC RESONANCE IMAGING
    (MRI).
    Your doctor may order an MRI scan of your
    head to determine if multiple sclerosis or a
    tumor is causing trigeminal neuralgia. In
    some cases, your doctor may inject a dye
    into a blood vessel to view the arteries and
    veins and highlight blood flow (magnetic
    resonance angiogram).

    http://tnaaustralia.org.au/dental-care-and-tn/
    DIFFERENTIAL DIAGNOSIS
    OF TRIGEMINAL
    NEURALGIA
     SECONDARY TRIGEMINAL NEURALGIA

     PAIN OF DENTAL ORIGIN


    a. Pulpal pain
    b. Periodontal pain
    c. Parafunction induced alveolitis
    d. Crack tooth syndrome

     EXTRACRANIAL
    a. Sinusitis
    b. Temporomandibular disorders
     NEUROPATHIC
    a. Pretrigeminal neuropathy
    b. Trigeminal neuropathy
    c. Glossopharyngeal neuralgia
    d. Post herpetic neuralgia
    e. Nerve compression

     NEUROVASCULAR
    a. Migraine
    b. Cluster headache
    c. Chronic paroxysmal hemicrania
    d. Giant cell arteritis

     PSYCHOGENIC
    http://tnaaustralia.org.au/dental-care-and-tn/
    TREATMENT MODALITIES
     Medications are the first line of treatment
    for TN and include carbamazepine,
    phenytoin, gabapentin & baclophen.
     As the disease progresses and pain
    becomes more frequent & severe,
    increased doses of medications are
    required which may lead to intolerable
    side effects and/or inadequate pain
    control.
     The surgical procedures then considered
    are either Microvascular decompression
    or some form of nerve injury procedure
    (Rhizotomies).
    TREATMENT WITH MEDICATIONS
    Anticonvulsant medications, which slow down the
    nerve’s conduction of pain signals, are usually the
    first treatment option. These include:
     Tegretol (carbamazepine)
     Trileptal (oxcarbazepine)
     Carbatrol (carbamazepine)
     Dilantin (phenytoin)
     Lamictal (lamotrigine)
     Topamax (topiramate)
     Neurontin (gabapentin)
     Klonopin (clonazepam)
    Tegretol (carbamazepine) is the primary drug used to
    treat TN.
    SURGICAL TREATMENTS
     Microvascular Decompression (MVD)
     Balloon Compression
     Glycerol Injection
     Radiofrequency Lesioning
     Radiosurgery (GammaKnife,
    CyberKnife, etc.)
    PALLIATIVE TREATMENT

     Acupuncture
     Biofeedback
     Capsaicin
     Homeopathy
     Nutritional therapy
     Electrical Nerve Stimulation
     TENS (Transcutaneous Electrical Nerve Stimulation)
     Upper cervical chiropractic
     Vitamin B-12 Injections
     Botox

    http://tnaaustralia.org.au/dental-care-and-tn/
    DENTAL
    CONSIDERATIONS
    IN TRIGEMINAL
    NEURALGIA
    ACRYLIC RESIN
    STENT AS VEHICLE
    FOR MAINTAINING
    TOPICAL
    APPLICATION OF
    ANALGESIC GEL TO
    TISSUES

    ACRYLIC RESIN
    STENT in situ.
    ANALGESIC GEL IS
    COATED ON FITTING
    SURFACE

    Neuropathic implications of prosthodontic treatment


    Robert E. Delcanho, BDSc, MS a
    Perth Pain Management Center, Applecross, Western Australia
    PREVENTING TN
    FLARE-UPS AFTER
    DENTAL WORK
     Anesthesia should be WITHOUT
    EPINEPHRINE FOR THE LOCAL
    ANAESTHETIC.
     long acting local anesthesia should
    be used to avoid multiple injections
     the dentist should inject the local
    anesthetic at a site as far away as possible
    from the trigger point for the TN pain
    http://tnaaustralia.org.au/dental-care-and-tn/
    CONCLUSION

     Though there are not definitive signs


    and symptoms of this condition we
    should examine our patients
    carefully with a proper detailed
    record of case history and render
    the dental treatments in such
    patients carefully
    REFERENCES
     B D CHAURASIA’s HUMAN ANATOMY, 5th edition
     Peterson’s text book of oral and maxillofacial surgery
     Oral and maxillofacial surgery by neelima malik
     Monheim’s book of Local anesthesia
     Malamed’s book of local anesthesia
     http://tnaaustralia.org.au/dental-care-and-tn/
     http://trigeminalneuralgia-ronaldbrismanmd.com/Dental-
    Issues.html
     A retrospective study of 72 cases diagnosed with idiopathic
    trigeminal neuralgia in indian populace
     Neuropathic implications of prosthodontic treatment Robert E.
    Delcanho, BDSc, MS a
     Perth Pain Management Center, Applecross, Western Australia

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