Please enable JavaScript.
Coggle requires JavaScript to display documents.
TRIGEMINAL NEURALGIA (TN) - Coggle Diagram
TRIGEMINAL NEURALGIA (TN)
Definition
: Recurrent,Unilateral,Brief (<1secs to 2 mins),very painful,electric shock like pain episodes in the one or more TN distribution, abrupt in onset and termination.
Affects
: Talking,Eating.Drinking,Touching the face.Increases anxiety and depression leads to risk of suicide
Age
- 53-57yrs
F>M(3:2)
Classification
Secondary(15%)
Due to underlying diseases except NVC+
Idiopathic (10%)
**
Purely paroxysmal Pain
concomitant continuous Pain
Classical(75%)
Surgery of Neurovascular compression,with changes in TN.
Purely paroxysmal Pain
concomitant continuous Pain
Treatment
Medical : Carbamazepine 50-100 mg, Baclofen 15-80 mg
Physiotherapy : 1) TENS 100Hz 20mins continuous mode 2) Low level laser 20min wavelength 830nm beam density 150-170 mw/cm2 3)EMT 20 min continuous mode 50Hz 4) Dry needling
Surgical : Microvascular decompression, balloon compression, Radiofrequency ablation
Clinical Features
:
1)Right side>Left side
2)B/L pain is rare
3) Side alternating U/L pain paroxysms
Differential Diagnosis
:
1)
Dental Cause
- Pulpitis, Alveolar Osteitis
2)
Sinus Cause
:- Maxillary Sinusitis
3)
Salivary Gland
- Salivary Stone
4)
TMJ Disorder
5)
Neuropathic Pain-
(Glossopharyngeal Neuralgia,
Nervus Intermedius Neuralgia,
Post Traumatic TN
6)
Trigeminal Autonomic Cephalgia**
-
a) SUNA/SUNCT
b) Cluster Headache
7
)Others
Persistent Idiopathic Facial pain,
Primary stabbing headcahe
Testing
1) Thermal detection : Thermal sensory analyzer 2) Mechanical detection threshold : a set of von frey filaments 3) Mechanical pain threshold : set of pin prick stimulator 4) Vibration : Rydel- Seiffer tuning fork 5) Presser pain threshold : Pressure gauge device
Pathophysiology
Pain Mechanism: Proximal compression of trigeminal sensory nerve root near brainstem by blood vessel
Clinical effect of sodium channel channel blockers suggest abnormal expression of voltage-gated channels
Concominant continious pain : abnormal nociceptove blink reflex indicates overactivates of central sensory transmission