A CASE PRESENTATION ON TRIGEMINAL NEURAL GIA

Trigeminal neuralgia

. . . . CONTENTS. • INRODUCTION. • DEFINITION. • CLASSIFICATION.

. . Supratrochlear nerve Infratrochlear nerve Posterior ethmoidal nerve Long ciliary nerves Short ciliary nerves Trigeminal nerve Trigeminal ganglion Recurrent tentorial branch Of ophthalmic nerve Ophthalmic nerve Optic nerve.

. . Sensory nerve, smallest division of trigeminal nerve, divides into three branches: 1. Lacrimal nerve 2. Frontal nerve : divides into supraorbital and supratrochlear nerves..

. . . . • Long root of the ciliary ganglion. • Long ciliary nerves.

. . Branches from divided nerve: A. Anterior division: pterygoid nerve, masseter nerve, nerves to temporal muscle, buccal nerve B. Posterior division: auriculotemporal nerve, lingual nerve, inferior alveolar nerve.

. . Trigeminal nerve Trigeminal Nerve. . Maxillary zone Ophthalmic zone Mandibular zone Trigeminal nerve Trigeminal Nerve.

. . . . • The superior region of the head, that is, meninges and cornea are.

. . The most common is the classical unrelated to pathology and the most probably caused by neurovascular compression of the trigeminal nerve root..

. . Classic TN is defined as: a unilateral disorder characterized by brief electric shock-like pains, abrupt in onset and termination, limited to the distribution of one or more divisions of the trigeminal nerve. Pain is commonly evoked by trivial stimuli including washing, shaving, smoking, talking and/or brushing the teeth (trigger factors) and frequently occurs spontaneously..

. . . . Classical trigeminal neuralgia:. • Paroxysmal attacks of pain lasting from a fraction of a second to 2.

. . minutes, with or without persistence of aching between paroxysms, affecting one or more divisions of the trigeminal nerve and fulfilling criteria Pain has at least one of the following characteristics: 1. Intense, sharp, superficial or stabbing 2. Precipitated from trigger areas or by trigger factors.

. . . . OTHER NAMES:. • Tic douloureux- Nicholaus Andre.

. . which fire in response to light touch resulting in brief episodes of intense pain..

. . . . • Trigeminal neuralgia occurs in :. • Fourth and fifth decade of life..

. . zones" during brushing, washing face , during flow of cold wind. Radiates from that point, across the distribution of one or more branches of the trigeminal nerve. Pain very rarely crosses midline..

. . . . CASE HISTORY. • Patient’s Name: XXXXXXXX ,.

. . . . • History of present illness:. • Pain was severe, intermittent, sharp and shooting type, electric shock.

. . GENERAL PHYSICAL EXAMINATION: Gait : No abnormality detected Built : No abnormality detected Orientation : No abnormality detected Nourishment : No abnormality detected.

. . . . • Pallor : Absent. • Icterus: Absent. • Cyanosis: Absent.

. . . . • Extra-oral examination:. Examination of the face:.

. . Post herpetic neuralgia Myofascial pain Migraine Tension type headache Glossooharvnaeal Neuralaia.

. . . . • INVESTIGATIONS:. Chair side investigation:.

. . . . Treatment Plan:. • Patient was advised to take medications for.

. . Patient was advised to continue same medication for 2 more weeks. Second follow up was done on (11-01-2020 and patient gave history of mild to moderate pain from last couple of days). was advised to take along with the previous medications for 15 more days and was.

. . to stay in home and communication was done via telephone and tele health care was provided. The fourth follow up was done on 27-07-2020 and as the patient had complained of similar pain and burning sensation from last 15 days then, Magnetic Resonance Imaging (MRI) of Brain was advised to rule out any pathogenic abnormalities. ( Report of MRI is attached).

. . of midline structures is seen. • The cerebral sulci, cisterns, cerebellar foliae and ventricular system appear unremarkable. • The major intracranial vessels display normal flow voids. • The visualized paranasal sinuses, orbits and calvarium appear unremarkable. • Vascular loop ( probably SCA branch is abutting cisternal of bilateral 5th nerves .No obvious indentation/ displacement noted CT scan MRI scan semces under PPP With NHM, Commiss•onerate Health Family Welfare & Apush Kunataka District Hospital. Ward No. 18, Tumkur, - 572101. Ph.: 0816-22SS9cX) 1 Mob.: 14052 Krsnoo Diagnostics Pvt_ Led _ Thanks for reference, Dr.SANJAY S.MARAKWAD MD ERCR €uK) R No 2003041709 T Ot-porting CT Scan PPP Mode With N HM, missionerate Ot Health. Family Welfare & Ayush Services, Karnataka rict Hospital, ward No. 18, Tumkur, - 0816-2255900 | Mob.: 14052 Diagnostics Pvt. Led _ www_krsnaadiagnostics.com.

. . . . • After seeing the MRI report no obvious indentation /.

. . . . ADVANCE. INVESTIGATIONS:. • Quantitative sensory thresholds.

. . . . TREATMENT MODALITIES:. • Pharmacological.

. . Baclofen Lamotrigine Third line approach Clonazepam Valporic Acid ganglion Radiofrequency thermo-coagulation at ganglion Medullary tractomy Midbrain tractomy C) Peripheral Neurectomy Supraorbital.

. . . . The clinically available AEDs have several potential sites of action, including modulation of neuronal cation channels, enhancement of central inhibitory mechanisms (primarily at gamma-aminobutyric acid receptors), and suppression of excitatory transmission (principally at glutamate receptors). Individual drugs may work at multiple sites to suppress abnormal neuronal discharge..

. . cnog u, Bnartl et al. "comparison or tne erncacy or caroamazepne, gaoapenun and lamotrigine for neuropathic pain in rats." Indian journal of pharmacology vol. 43,5 (2011): 596-8. Chogtu, B., Bairy, K. L., Smitha, D., Dhar, S., & Himabindu, P. (2011). Comparison of the efficacy of carbamazepine, gabapentin and lamotrigine for neuropathic pain in rats. Indian journal of pharmacology, 43(5), 596-598. Chogtu B, Bairy KL, Smitha D, Dhar S, Himabindu P. Comparison of the efficacy of carbamazepine, gabapentin and lamotrigine for neuropathic pain in rats. Indian J Pharmacol. 2011.

. . . . ACKNOWLEDGEMENT. • TO ALL THE STAFFS OF. DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY, SRI SIDDHARTHA DENTAL COLLEGE TUMKUR..

. . . . SUBMITTED BY:. SHIVANGI DOKANIYA. HOUSE SURGEON..