for dental students

1. Mahendraraj.M.T
CRRI
Malabar Dental College

2.  Most common cranial neuralgia
 Tic Douloureux
 >>>50 yrs

3.  It is defined as sudden, usually unilateral,
severe, brief, stabbing, lancinating,
paroxysmal, recurring pain in the
distribution of one or more branches of 5th
cranial nerve.

4.  Incidence: 8: 100000
 Female >>> male
 5th – 6th decade of life
 Right >>> left

5.  Usualy idiopathic (approx 90%)
 Demyelination of nerve
 Multiple sclerosis
 Intracranial tumors
 Intracranial vascular abnormalities
 Viral etiology

6.  Episodes of intense shooting stabbing pain
 last for few seconds & then disappears
completely
 Electric shock like
 Mostly unilateral
 In between refractory periods are present
 No of attack varies from 1 to 2 per day to
several per minute
 Trigger zones are present

7.  – anticipate pain when touch – on skin & mucosa
within distribution of involved nerve branch
 Shaving, showering , eating, speaking , even
exposure to wind can trigger a painful episode
 Sometime intra oral trigger zones – can confuse
with pain due to cracked tooth

8.  Location of trigger zones
In maxillary dvsn – skin of upper lip, ala of nose
or cheek or on upper gums
In mandibular dvsn – lower lip, teeth, gums of
lower jaw
In ophthalmic dvsn – supraorbital ridge of
affected side

9.  “SWEET criteria” for diagnosis of TN:
1) Pain is paroxysmal
2) Pain may be provoked by light
touch to the face (trigger zones)
3) Pain is confined to trigeminal
distribution
4) Pain is unilateral
5) Clinical sensory examination is
normal

10.  Sensory &/or motor changes may be evident
if there is underlying CNS pathologies
 LA blocks which temporarily eliminate trigger
zone is helpful in diagnosis
 MRI to rule out tumors , multiple sclerosis &
vascular malformations

11. 1. MEDICAL
2. SURGICAL

12.  1st line of treatment – CARBAMAZIPINE (
effective in > 80% cases)
 2nd line of treatment-
BACLOFEN,LAMOTRIGINE, OXCARBAZEPINE,
PHENYTOIN , GABAPENTIN, SODIUM
VALPROATE
 Low Dose antidepressants like AMITRIPTALINE

14. 1. Peripheral procedures
Cryotherapy
alcohol block
laser
Neurectomy
2. Ganglion procedures
Thermocoagulation
Glycerol injection
Balloon compression
3. Open operation
Microvascular decompression
Trigeminal root resection:
4. Central procedures
Trigeminal tractotomy

15.  Burket's Oral Medicine Diagnosis and
Treatment 10th edition
 Text book of oral medicine oral diagnosis –
Ravikiran Ongole