Trigeminal Neuralgia: Sudden Facial Pain and How It’s Managed
Question. Write a note on trigeminal neuralgia.
Or
Write short note on trigeminal neuralgia
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Answer. Trigeminal neuralgia is also called Tic Douloureux.
A disorder characterized by the paroxysmal (occurring repeatedly without warning) attacks of neuralgic pain with affection of one or more divisions of the trigeminal nerve.
The pain involves the first and second divisions equally and rarely the fist.
Clinical Features
- The pain is unilateral and confined to one of the three divisions of the nerve. It is sharp and sudden in onset and lasts only a few seconds.
- During attcks there is flushing of face, i.e. redness of the face.
- Dilatation of pupil is present.
- There is excessive lacrimation.
- After repeated attcks skin becomes shiny and hair in the area becomes gray.
Sometimes secretion of nasal mucus and saliva may occur on the side of the pain.
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Etiology
Trigeminal neuralgia is spontaneous and follows exposure to cold wind, blowing on face, or chewing or eating, drinking hot or cold fluid, and washing the face.
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Management
- Elimination of all possible sources of infection.
- Drugs.
- Analgesics: Potent analgesics must be used with caution because of danger of habituation.
- Carbamazepine: 100200 mg BD a day and increasing the dose to 600800 mg per day.
- Phenytoin sodium: 0.1 gm TDS when carbamazepine is not tolerated.
- Vitamin B12: 1000 micrograms IM daily for two weeks.
- Injection of alcohol: It is given in affected nerve or gasserian ganglion. If more than one division is affected inject 10 minims of 90% alcohol after local anesthesia with 2 to 3 drops of procaine.
- Surgery: Selective or complete preganglionic selection of trigeminal root.
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