57. Trigeminal and glossopharyngeal neuralgia. Etiology, clinical features, diagnosis, differential diagnosis, treatmen

Question 1

Trigeminal neuralgia (TN)

Answer 1

• Sudden, unilateral, severe, stabbing pain=>branches of the 5th cranial nerve.
• Agonizing => spasmodic contractions of the facial muscles
• Recurring

Question 2

Hypothesized etiological factors for trigeminal neuralgia

Answer 2

• Vascular factors=>Transient ischemia and autoimmune hypersensitivity responses =>
• Demyelination
• Mechanical factors=> Pressure on superior cerebellar artery=>
• Demyelination and irritation of the trigeminal ganglion
• Dental etiology=>Degeneration
  Infections
  Multiple sclerosis=>Sclerotic plaque at the root entry zone of the trigeminal nerve
  * Post-traumatic neuralgia=>trauma or dental procedures

Question 3

Typical clinical features of trigeminal neuralgia

Answer 3

• Pain triggered by touching superficial ‘trigger points’=>chewing, speaking, or even washing the face
• Confined to one part of one division of the trigeminal nerve=>
• Usually mandibular (V3) or maxillary (V2)
• Short duration pain=> seconds
• Refractory period=> dull ache between attacks

Question 4

How trigeminal neuralgia diagnosed

Answer 4

• Clinical evaluation => pain symptoms
• Identifying trigger points
• Excluding other causes =>differential diagnosis

Question 5

Differential diagnosis of trigeminal neuralgia

Answer 5

• Dental pathologies (e.g., tooth abscesses)
• Temporomandibular joint disorders
• Cluster headaches and migraines
• Multiple sclerosis

Question 5

General approach to treating trigeminal neuralgia

Answer 5

• Begins with medicinal management=>
• If patient does not respond to medicinal treatments=>
• Surgical options considered

Question 6

Medicinal management strategies for trigeminal neuralgia

Answer 6

• The first line of treatment =>modifying the paroxysmal pain w/ anticonvulsant drugs=>
• Analgesics, including opiates=> ineffective for TN
• Anticonvulsants=> carbamazepine (Tegretol) and phenytoin (Dilantin) are used

-Carbamazepine-highly specific in relieving the pain of TN and is often used as a diagnostic indicator due to its specificity