Trigeminal Neuralgia

Trigeminal neuralgia, predominantly seen in middle-aged and elderly individuals, is a medical condition characterised by acute facial pain.

This pain, often sharp and intense, can also manifest in and around the gums, leading to frequent misinterpretation as a standard toothache.

The Trigeminal Nerve Explained

The trigeminal nerve, known as the fifth cranial nerve, plays a crucial role in motor functions like chewing and relays facial sensations to the brain. Humans possess 12 pairs of cranial nerves, each originating directly from the brain. The trigeminal nerve is pivotal in conveying all facial sensations, including touch and temperature. Disruptions in its normal functioning can trigger symptoms known as trigeminal neuralgia.

What Triggers Trigeminal Neuralgia?

Trigeminal neuralgia commonly arises when a blood vessel encroaches too close to the trigeminal nerve, causing irritation or compression. This abnormal interaction increases the nerve's sensitivity and may lead to inflammation, sometimes attributed to conditions like multiple sclerosis.

Symptoms of Trigeminal Neuralgia

Individuals with trigeminal neuralgia experience intense facial pain, often described as akin to an electric shock. This pain can extend to the gums, resembling a typical toothache. The symptoms occur sporadically, often triggered by facial contact or actions like face washing, tooth brushing, shaving, or exposure to windy conditions.

Diagnosing Trigeminal Neuralgia

To diagnose trigeminal neuralgia accurately, doctors undertake a thorough examination of the patient's medical history. Additionally, diagnostic imaging, such as Magnetic Resonance Imaging (MRI), is often employed. This approach aids in distinguishing trigeminal neuralgia from other conditions that present similar symptoms, ensuring precise treatment planning.

Treatment Strategies for Trigeminal Neuralgia

Medication as the Initial Approach

In the initial phase of treatment, healthcare professionals typically prescribe anticonvulsant medications to mitigate the pain. While effective in pain management, these medications do not address the underlying cause of trigeminal neuralgia. Should the patient's symptoms remain unresponsive to anticonvulsants, alternative treatments may be considered.

Surgical Interventions

One of the key surgical options is microvascular decompression (MVD), aiming to alleviate the root cause of the condition. This procedure involves opening the skull and placing a sponge between the nerve and the pressing blood vessel. MVD has a high success rate (80-85%) in symptom relief. However, like any surgery, it carries risks, such as infection or bleeding. A significant advantage of MVD is the minimal risk of facial numbness compared to other treatments.

Radiation Therapy

Radiation therapy targets the affected nerve to numb the painful area. Despite its effectiveness, there is a possibility of the pain recurring, a condition known as anaesthesia dolorosa.