This 3D video demonstrates what is Trigeminal Neuralgia and how it can be treated by Trigeminal Nerve Block and how this procedure is done.
Trigeminal nerve is divided into three branches
- Opthalmic branch
- Maxillary branch
- Mandibular branch
Severe intractable Trigeminal nerve pain is called trigeminal neuralgia. Pain may spread along the one branch or all three branches or combination of any two branches. Trigeminal nerve pain is treated with medications and physical therapy. If Conservative treatment is failed then patient is considered for diagnostic or therapeutic block. Diagnostic block is performed to diagnose the origin of pain. Therapeutic procedures of 3 to 4 injections are performed for long term pain relief lasting 3 to 4 months or longer.
Trigeminal Nerve block
Procedure is performed at surgical center under strict aseptic precautions. Procedure is performed by experienced Interventional Pain Specialist. Patient lies in supine position. Skin around angle of mouth is prep with iodophor or povidone-iodine prep solution. Prep skin is covered with sterile dressing.
Skin and subcutaneous tissue 1 to 1.5 cm lateral to angle of mouth is anesthetized with 1.5 to 2 ccs of 1% lidocaine. After local anesthesia causing numbness needle is passed towards trigeminal nerve through skin and subcutaneous tissue. Image intensifier used for procedure. Antero-posterior and lateral Xray image is observed during placement of needle. A 22 G or 23 G spinal needle of 10 inch in length is passed towards trigeminal nerve through skin and subcutaneous tissue under continuous image intensifier. Needle is advanced posteriorly towards external auditory meatus in parallel plane passes through pupil. Therapeutic block is performed using long acting local anesthetics like bupivacaine or neurolytic agent like alcohol (50 to 70 %), phenol (4 to 10 %) or glycerol (100 %). Bupivacaine block may last for 2 to 6 weeks or longer. If bupivacaine or local anesthetic block last less than 6 weeks then neurolytic block is performed, which may last 4 to 6 months or longer. Surgery or gamma radiation treatment is advised if diagnostic or therapeutic block is failed to relieve pain.