Trigeminal neuralgia also is known by another name of tic douloureux is a distinct syndrome of facial pain. It occurs due to the pain sensation in the fifth cranial nerve or its components known as the trigeminal nerve. The trigeminal nerve has three components: – ophthalmic nerve, maxillary nerve, and mandibular nerve. Mostly maxillary and mandibular nerves are involved in the trigeminal neuralgia. It is accompanied by facial spasm and tics in the face. The pain of trigeminal neuralgia is sharp and stabbing in nature. The patient feels very severe pain in the area supplied by the trigeminal nerve and it appears in bouts rather than a continuous pain. The pain also radiates sometimes from one part to another and can be described as shooting pain also.
What Are The First Symptoms Of Trigeminal Neuralgia?
Usually, it is unilateral in nature with a part of the face involved in it, but sometimes it can involve the whole face of one side or even occur bilaterally. It presents as attacks of pain usually short timed and can be triggered by various triggers. These include talking, chewing, smiling, hot and cold foods, shaving, brushing teeth, touching, blowing of mouth, nose or sometimes even occurs without any trigger. The right side of the face is more commonly affected than the left side. Sometimes trigeminal neuralgia is preceded by is syndrome known as pre-trigeminal neuralgia syndrome which occurs sometime before the trigeminal neuralgia. It may present as relentless sinus pain or tooth pain which doesn’t go away with normal anti-analgesic medication.
How To Test A Patient For Trigeminal Neuralgia?
Physical examination is usually the only test required for the assessment of the fifth cranial nerve and its components to rule out the trigeminal neuralgia or associated syndromes. In this test, 5th cranial nerve supply is tested with a swab or a slightly pointed object. It is touched on various parts of the face depending upon the branch of the trigeminal nerve to be tested.
The ophthalmic branch of the trigeminal nerve supplies forehead, supraorbital region, the root of nose, skin of upper eyelids. The maxillary branch of the trigeminal nerve supplies maxillary area of the face, infraorbital region, nose, and its tip, all of the nose, and some portions of the upper jaw. The mandibular branch of the trigeminal nerve supplies lower jaw, angle of mandible, some parts of cheeks, border of the mandible. These all areas can be tested separately by touching or poking with the object and then looking for the response of the patient. The patient usually winces in pain or sometimes an attack of trigeminal neuralgia may get initiated. The diagnosis of trigeminal neuralgia usually does not require any other further investigation for the same and can be confirmed on physical examination only.
At times trigeminal neuralgia is associated with systemic vasculitis and other syndromic diseases for which complete panel of blood work is required in which the cell count and functions of the liver are included. Various blood assays are done for the antibody detection in the blood responsible for attacking the trigeminal nerve like anti lupus anticoagulant, anti-nuclear antibodies, anti sm antibodies, etc. Magnetic resonance imaging is done to rule out intracranial tumors and various anatomical causes of the compression of the trigeminal nerve within its route of exit from the brain.(1)
Trigeminal neuralgia is a serious condition which brings a lot of suffering to the patients. Seeking doctor’s advice is a prerequisite for this condition so as to ensure early and proper treatment. It may get resolved in a few months to years but sometimes it may persist for even lifelong especially in the cases associated with other degenerative or autoimmune diseases. The testing and diagnosis of trigeminal neuralgia is a simple clinical assessment of the pain and tenderness bought by the condition. It is a treatable disease in most cases and the patient can live a happy and uneventful life from this condition with the existing medications.
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