GF11: Neuro Trigeminal Neuralgia Flashcards
What is Trigeminal Neuralgia (TN)?
Trigeminal neuralgia (TN) (tic douloureux) is characterized by sudden, usually unilateral, severe, brief, stabbing, recurrent episodes of pain in the distribution of the trigeminal nerve (one side of the face).
How is TN classified?
Classified TN as classic (TN 1) or atypical (TN 2). Patients may have both types.
True or False
The pain intensity and lifestyle disruption that accompany TN can cause marked physical and psychologic dysfunction
True
What is the patho of TN?
- TN usually affects the sensory (afferent) branches of the second and third divisions (Maxillary and Mandibular)
- Most cases result from vascular compression of the trigeminal nerve root by an abnormal loop of the superior cerebellar artery.
- This artery compresses the nerve as it exits the brainstem.
- Constant compression appears to lead to chronic injury, causing flattening and atrophy of the nerve and damage to the myelin sheath
What are some associated conditions related to the onset of TN?
related to underlying pathology, such as
- multiple sclerosis,
- shingles, or
- masses in the cerebellum or brainstem
Risk factors for TN?
- Age
- MS or other similar disorder that damages the myelin sheath
- Hx of surgical injuries, stroke or facial traumA
What are the diagnostic factors for TN?
- Diagnosis is based almost entirely on history, along with results from physical and neurologic examinations.
- Other disorders that cause facial pain should be ruled out before TN is diagnosed
- A complete neurologic assessment is required along with consulting other subspecialties, such as neurology, neuroradiology, neurosurgery, dentistry, maxillofacial surgery, and pain management.
What diagnostic tests are used for TN?
- MRI may be used to assess for
- sinusitis, cancer, multiple sclerosis, or masses in the cerebellopontine angle.
- 3D reconstruction and angiography MRI are helpful with seeing
- the specific brain anatomy, nerve roots, and vasculature involved.
What are the clinical manifestations and s/s of TN1?
- Patient has an abrupt onset of waves of excruciating pain.
- It is described as a burning, knifelike, or lightning-like shock in the lips, upper or lower gums, cheek, forehead, or side of the nose
- Facial twitching, grimacing, and frequent blinking and tearing of the eye can occur during the acute attack
- Some patients may have facial sensory loss.
- Attacks are usually brief, lasting only seconds to 2 or 3 minutes. Frequency ranges from 1 to over 50 times a day
- Pain episodes are usually started by a triggering mechanism of light touch at a specific point (trigger zone) along the distribution of the nerve branches.
- Precipitating stimuli include chewing, brushing the teeth, feeling a hot or cold blast of air on the face, washing the face, yawning, or even talking.
- As a result, the patient may eat improperly, neglect hygienic practices, wear a cloth over the face, and withdraw from interaction with others.
- The patient may sleep excessively as a means of coping with pain.
What are the clinical manifestations and s/s of TN2?
- TN 2 manifests as constant aching, burning, crushing, or stabbing pain.
- The pain has a lower intensity and does not subside completely
- The distinct attacks associated with TN 1 do not occur in TN2
What is the pt teaching for TN pts?
- Appropriate teaching related to surgical procedures depends on the type of procedure planned (e.g., percutaneous).
- The patient needs to know they will be awake during local procedures in order to cooperate when corneal and ciliary reflexes and facial sensations are checked.
- Teach the patient about any medications.
- Although pain may be relieved, encourage the patient to keep environmental stimuli to a moderate level and to use stress management techniques.
What are key follow up actions to TN surgical procedures?
- After the procedure, compare the patient’s pain with the preoperative intensity.
- Evaluate the corneal reflex, extraocular muscles, hearing, sensation, and facial nerve function often
- If the corneal reflex is impaired, take special care to protect the eyes.
- This includes using artificial tears or eye shields
What are the nursing actions post percutaneous radiofrequency procedure for TN?
- apply an ice pack to the jaw on the operative side for 3 to 5 hours.
- Teach: To avoid injuring the mouth, the patient should not chew on the operative side until sensation has returned.
Long-term TN management after surgical intervention depends on residual effects of the procedure. What is the pt teaching If anesthesia is present or the corneal reflex is altered?
- chew on the unaffected side;
- avoid hot foods or beverages, which can burn the mucous membranes;
- check the oral cavity after meals to remove food particles;
- practice meticulous oral hygiene and continue with semiannual dental visits;
- protect the face against extremes of temperature;
- use an electric razor;
- wear a protective eye shield and avoid rubbing eyes; and
- examine eye regularly for symptoms of infection or irritation.
What are the types of therapy available for TN?
- Drug therapy
- Local nerve block
- Surgical therapy
