Clinical and Radiological Profile of Trigeminal Neuralgia- A Retrospective Study

Abstract

Introduction: Trigeminal neuralgia is described as severe, stabbing unilateral pain along the distribution of trigeminal nerve branches. The three subtypes include- Classical, secondary and idiopathic. Aim: To study the clinical profile, presentation and radiological imaging features in trigeminal neuralgia patients. Materials and Methods: This cross-sectional study included outpatient medical records of 60 trigeminal neuralgia patients between June 2015 to June 2020 (five years) in a Tertiary care Medical College Hospital. Various parameters studied were: (a) Age; (b) Gender; (c) Dental treatment; (d) Pain severity; (e) Trigger factors; (f) Side and branch involved; (g) Sensory abnormalities; (h) MRI. Data was entered in Microsoft excel and analysed using SPSS statistical software 20.0. Chi-square test was used for categorical variables. Results: Among the 60 patients studied, the common demographic and clinical features were as follows: 34 were females (56.7%); 36 with right side presentation (60%); 25 had maxillary nerve division distribution (41.7%); 57 patients experienced shock/lancinating pain (95%); and 40 had numeric pain severity scale of 4-6 (66.7%). Classical Trigeminal Neuralgia was the most common subtype seen in 31 patients (51.7%). Involvement of dual divisions (maxillary and mandibular), absence of trigger factors and presence of hypoesthesia were more suggestive of Secondary Trigeminal Neuralgia (p<0.05). Based on MRI imaging, 31 (51.7%) showed neurovascular compression with atrophy or displacement of trigeminal nerve root. Only 5 (8.4%) had secondary causes (schwannoma, meningioma, demyelination, infarct). Conclusion: The key clinical features of trigeminal neuralgia include female preponderance, right side presentation, maxillary nerve division distribution, shock/lancinating pain with touch and breeze as common trigger factors. As some of them had a previous dental treatment or procedure, dentists need to be aware of this entity. Certain clinical features would help to differentiate the secondary from classic and idiopathic neuralgia subtype.