Trigeminal Neuralgia

Question 1

Describe the presentation of trigeminal neuralgia

Answer 1

Unilateral maxillary or mandibular div short stabbing pain

Lasts 5-10 seconds

Question 2

Causes of trigeminal neuralgia

Answer 2

1. No cause
2. Compression of the trigeminal nerve
3. Secondary - MS/tumour

Question 3

Triggers for trigeminal neuralgia

Answer 3

Wind
Cold
Chewing
Touch

Question 4

Age affected by trigeminal neuralgia usually

Answer 4

40+

Question 5

Red flags for trigeminal neuralgia

Answer 5

<40yo
Hearing loss - acoustic neuroma

Question 6

TN management

Answer 6

REFER TO OM - no dental cause out of my scope

MRI - baseline, rule out other causes
Bloods - GP, confirm + monitor
Anticonvulsants/epilepsy drugs required as common painkillers not strong enough

Carbamezipine 100mg 1 tablet 2x daily

Question 7

Second line

Answer 7

Gabapentin, Pregabalin

Question 8

Side effects of Carbamazepine

Answer 8

Dec platelets/neutrophils - monitor bloods to assess effect on liver+blood
Electrolyte imbalances
Liver toxicity
Dizziness/drowsiness
Memory/concentration issues

Question 9

Surgery indications for TN (2)

Answer 9

Meds not working
Young pt

Question 10

Surgery options for TN (3)

Answer 10

Microvascular decompression
Balloon compression
Gamma knife

Question 11

TN branches

Answer 11

1 - Scalp, forehead + upper eyelid
2 - Maxilla, lower eyelid + teeth, cheek, upper lip
3 - Lower jaw, lower lip, chin + teeth