Neuralgia of the trigeminal nerve (Phosergil's disease) is a chronic disease characterized by sudden, intense, often recurring pains in the innervation zones by the branches of the trigeminal nerve, more often unilateral. This pathology is often disabling because of limited activity, difficulty in eating and maintaining oral hygiene. The prevalence of trigeminal neuralgia is about 7 cases per 100 thousand people. More common in people older than 50 years, as well as in women in comparison with men.
Neuralgia of the trigeminal nerve - Causes
There is no consensus on the cause of the development of this disease today. It is believed that in most cases trigeminal neuralgia arises from compression of the trigeminal nerve (in the area of its exit at the base of the brain) by pathologically deformed vessels or, much less often, a tumor. Sometimes the cause may be multiple sclerosis, namely the formation of a plaque in the region of the exit of the trigeminal nerve (its sensitive nucleus). It is also believed that demyelinating diseases (including the destruction of the myelin sheath during aging) can serve as an etiological factor. According to some reports, the cause of neuralgia of the trigeminal nerve may be viral diseases (postherpetic neuralgia), trauma, inflammatory processes. Odontogenic causes include traumatic tooth extraction, periodontitis and pulpitis, gingivitis, poorly selected dentures, osteomyelitis of the jaw bones, etc. However, in some cases the etiology of this disease remains unknown.
Neuralgia of the trigeminal nerve - Symptoms
The main clinical manifestation of neuralgia of the trigeminal nerve is spontaneous pain. Attacks of pain are usually short-lived (from a few seconds to several minutes), intense, shooting character. Such pain is more often one-sided. Often the pain is accompanied by a spasm of the facial muscles on the affected side ("painful tick"). Basically, patients during a painful attack "freeze", afraid to increase the pain of stitching. Also, patients can feel pain in the forehead, eyes, ears, lips, scalp, nose, jaw and teeth, and even in the left index finger. In the interictal period, there is no pain.
Most of the trigger zones are located in the region of the nasolabial triangle. An attack of pain can provoke a smile, a conversation, a gust of wind, shaving, drinking or eating, brushing your teeth and even touching or stroking your face.
Neuralgia of the trigeminal nerve - Diagnosis
The main method of diagnosis is a neurological examination. Among the instrumental methods, computer and magnetic resonance imaging can be used to determine the morphological cause of trigeminal neuralgia (compression by blood vessels, brain tumors, multiple sclerosis, inflammatory processes and scar changes).
Neuralgia of the trigeminal nerve - Types of the disease
According to the etiological sign of neuralgia of the trigeminal nerve is divided into:
- idiopathic (essential, typical, primary);
- symptomatic (secondary).
There is also a division of trigeminal neuralgia into such groups:
- neuralgia of the trigeminal nerve of predominantly peripheral origin, that is, the peripheral component predominates;
- Trigeminal neuralgia predominantly of central origin (the central component predominates).
Neuralgia of the trigeminal nerve - Patient's actions
In the case of a one-sided intense pain in the face, it is recommended that you immediately consult a specialist.
Neuralgia of the trigeminal nerve - Treatment
Conservative (drug) treatment consists in prescribing analgesics (ichthyol ointment for local anesthetic effect) and anti-inflammatory drugs (menovazine), anticonvulsants (carbamazepine, gabapentin, phenytoin, etc.), spasmolytic and muscle relaxants, inhibitors of reverse neuronal seizure of serotonin and norepinephrine (duloxetine, venflaxin). With insufficient effectiveness of conservative methods of treatment resort to surgical interventions. Surgical methods for treating trigeminal neuralgia are the methods of radiosurgery (gamma knife and cyber-knife), microvascular decompression - the operation of Janet (in the case of compression of the trigeminal nerve by vessels), injections of glycerin under the control of MRI or CT, transcutaneous balloon microcompression, radiofrequency trigeminal rhizotomy destruction of the spine of the trigeminal nerve), cryodestruction.
Neuralgia of the trigeminal nerve - Complications
With prolonged absence of treatment (untimely application for qualified care), it is possible to disrupt the nourishment of the facial skin in the area of the lesion, which leads to its thinning, loss of eyebrows and eyelashes. Depressive states can also develop.
Neuralgia of the trigeminal nerve - Prophylaxis
Specific prevention of trigeminal neuralgia does not exist. However, inflammatory diseases of the nervous system, craniocerebral trauma should be avoided.