Trigeminal neuralgia case ppt

1. By Maryam Arbab
House Officer

2.  Date: 29 Aug, 2016
 Patient ID: 43130
 Name: M/O Javed
 Age: 40
 Address: Peshawar

3.  Chief Complaint:
Pain on right side of the face.

4.  History Of Chief Complaint:
• Pain on right side of the face for last five
months.
• Sharp stabbing pain in the morning, reduces
during the day.
• Pain in unilateral.
• Pain is exacerbated with cold air, washing
face and smiling.
• Pain radiated to the temporal region
• Difficulty in performing daily chores.

5.  Past Dental History:
Patient got her treatment done for the
same complaint two months back. She
was advised extractions for lower right 28,
29, 30, 31 but the symptoms didn’t relieve.

6.  Medical History:
• Hypertension

7.  Family History:
• Diabetes
• Hypertension

8.  Medications:
• Anti hypertensive drugs

9.  Clinical Examination:
 Extra Oral:
A. Visual:
- No facial asymmetry
- No abnormality present
B. Palpation:
- Not tender on palpation

10.  Intra Oral:
• DMFT
- 16, 14 decayed
- 28, 29, 30, 31 missing
- 18, 17 filled
- Normal mucosa
- Normal tongue
- No pathological lesion present

11.  Investigations:
No clinical investigations were carried out.
 Differential Diagnosis:
1. Dental pain
2. Sinus pain
3. Post herpetic neuralgia
4. Cluster headache
5. Atypical facial pain
6. Temporomandibular pain dysfunction
syndrome
7. MPDS

12.  Specific Diagnosis:
Trigeminal Neuralgia

13.  Trigeminal neuralgia has three branches:
1. Ophthalmic divison
2. Maxillary division
3. Mandibular division
 Trigeminal neuralgia affects one or more
branches of trigeminal nerve.

14.  Pathophysiology:
• Slowly evolving process, either caused by the
compression exerted on the nerve by a blood
vessel or a tumor
• Or alteration of neural functions by a MS
plaque at the level of dorsal root entry zone
leads to increased excitability in some of the
trigmenial afferents and subsequently to
typical TGN.

15.  Management:
• Patient Education: To establish patient’s
treatment goals and adherence to therapy.
• Elimination of odontogenic pain.
 Medical Treatment:
A. Drug Therapy:
1. Anticonvulsants; drug of choice is
carbamazepine
Initial dose is 100 mg BD
This is increased 100 mg each day until the pain
is controlled
Maximum dose 800-1000 mg

16.  Surgical Treatment:
1. Cryotherapy
2. Neurectomy
3. Alcohol injections
4. Radio frequency
5. Thermocoagulation
6. Glycerol injections
7. Micro compression

17. THANK YOU