Trigeminal Neuralgia

Abstract

AbstractNeuralgia can be defined as paroxysmal, intense intermittent pain that is usually confined to specific nerve branches to the head and neck. The trigeminal nerve is responsible for sensory innervation of the scalp, face and mouth, and damage or disease to this nerve may result in sensory loss, pain or both. >85% of cases of Trigeminal Neuralgia are of the classic type known as Classical Trigeminal Neuralgia (CTN), while the remaining cases can be separated to secondary Trigeminal Neuralgia (STN). STN is thought to be initiated by multiple sclerosis or a space-occupying lesion affecting the trigeminal nerve, whereas the leading cause of CTN is known to be compression of the trigeminal nerve in the region of the dorsal root entry zone by a blood vessel. There is no guaranteed cure for the condition of Trigeminal Neuralgia, but there are several treatment options that can give relief. In this chapter, we review the common neuralgias occurring within the oral and maxillofacial region with special emphasis on Trigeminal Neuralgia. We will discuss the historical evolution of treatment including the medical and surgical modalities with the use of current literature and newer developments. It has been highlighted that the first line of treatment for trigeminal neuralgia is still pharmacological treatment, with Carbamazepine and Oxcarbazepine being the first choice. Possible surgical methods of treatment are discussed within this chapter including modalities such as Microvascular Decompression, Gamma Knife Radiosurgery and Peripheral Neurectomy. As an OMF surgeon, it is important to obtain a good clinical history to rule out other pathology including dental focus. Many clinicians involved ranging from primary care dentists and doctors to secondary care (neurologists, Oral Medicine, OMFS, etc.) to deliver the appropriate first course of action, which is the medical management. The management of TN patients should be carried out in a multidisciplinary setting to allow the patients to choose the best-suited option for them. It is also important to set up self-help groups to enable them to share knowledge and information for themselves and their family members for the best possible outcomes.