The trigeminal nerve corresponds to the V cranial nerve, which has motor and sensory functions, the sensory function being predominant. This nerve is responsible for controlling the chewing muscles and facial sensitivity.
The neuralgia of the trigeminal is then defined as a box paroxysmal pain, sharp and short - lived, usually 5 to 20 seconds, unilateral, located in the territory of one or more branches of the trigeminal nerve.
In these cases, pain can appear spontaneously or be triggered by external stimuli on certain sensitive areas in the territory of one of the branches of the trigeminal nerve.
Other activities that could trigger pain include chewing, talking, touching or manipulating the face.
The neuralgia of the trigeminal not usually accompanied by neurological deficit, so it is important to introduce rule out other etiologies.
Causes of trigeminal neuralgia
In trigeminal neuralgia, the function of the trigeminal nerve is impaired. The problem is usually the contact between a normal blood vessel, be it a vein or an artery, and the trigeminal nerve located at the base of the brain. This contact puts pressure on the nerve and causes it to malfunction.
Three main types of trigeminal neuralgia can be described, the etiological cause of which will be different, the primary (idiopathic or with no apparent identifiable cause) and the secondary, where an extrinsic compression of the nervous structure is what triggers the pain.
Regarding primary trigeminal neuralgia, there are several theories, among which the most accepted is compression of the dorsal trigeminal root at its entry into the brain stem, caused by vascular tortuosity or aneurysm, and other hypotheses that it originates due to the demyelination of thick fibers caused by various etiological processes.
A small number of patients with trigeminal neuralgia may have multiple sclerosis (an autoimmune disease that affects the neuronal covering), which can damage both the trigeminal nerve and other related parts of the brain.
The neuralgia postherpetic which takes place after suffering an episode of reactivation of the herpes virus, can cause similar symptoms if the trigeminal nerve is affected.
Symptoms of trigeminal neuralgia
Pain usually has the following characteristics to describe:
· Paroxysmal pain crisis (sudden onset and end) of short duration between one second and two minutes.
· Superficial, electric or sharp.
· Severe intensity.
· Triggered in areas related to the territory of the nerve or by external factors (chewing, brushing teeth, smiling, eating, drinking, kissing, talking, etc.).
· It can occur in one or more branches of the trigeminal nerve, without radiation, beyond the distribution of that nerve.
· Throughout the day, sudden episodes of pain affect one side of the face at a time and recur from one to hundreds of times.
· Pain also tends to run in cycles with complete remissions that last for months or even years.
· No associated neurological deficits.
· Other differential diagnoses are ruled out.
In some cases, patients develop trigeminal neuralgia after a canal injury in the dental roots, which is why it is usually attributed to a dental process without presenting remission of pain after dental care.
Dental extractions in this case do not help since the pain originates in the trigeminal nerve and not in a tooth or a nerve of the tooth root. In a small percentage, the pain could be bilateral due to the involvement of both trigeminal nerves, since one strictly innervates the left side of the face and the other innervates the right.
It is important that if any of the aforementioned symptoms are present, with the specific characteristics outlined, the person goes to a specialized medical evaluation that will guide them on the origin of the same, indicating the best behavior to follow and, of course, always avoiding self-medication.
Medication is generally based on the use of non-steroidal anti-inflammatory analgesics associated with treatments that control neuropathic pain (pain that originates in the nerve) such as gabapentin and pregabalin.
If the pain is not improved with oral medications, the doctor must evaluate the presence of an arteriovenous malformation that is compressing the trigeminal nerve fibers, so it must be decided whether it should be surgically corrected.
Treatment is also focused on improving the patient's quality of life and sedative or hypnotic treatments are indicated so that sleep is not interrupted by trigeminal neuralgia.
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