Trigeminal Neuralgia

exp date isn't null, but text field is

Trigeminal neuralgia (TN) is a syndrome characterized by chronic paroxysmal brief episodes of  unilateral electric shock-like pains, in one or more divisions of the trigeminal nerve. TN is often  mistaken as a dental problem leading to delayed correct diagnosis and appropriate treatment. 
The diagnosis is based on the characteristic clinical picture. 

Clinical presentation

Unilateral jaw pain exacerbated by cutaneous stimuli - e.g., chewing, brushing

Investigations 

• CT scan to exclude structural brain pathologies
• MRI to assess the trigeminal nerve root entry zone (REZ)

Pharmacological Treatment  First line treatment:  

A: carbamazepine (PO) 200mg 12hourly for 4-12weeks 

Non-pharmacological management 

Refer to neurosurgeon for procedures that involve controlled trigeminal ganglion ablation to alleviate  pain 

• Radiofrequency ablation
• Gasserian ganglion baloon compression rhizotomy
• Glycerol rhizolysis
• Stereotactic radiosurgery rhizotomy

Surgical managementRefer  all  patient  with  poor  response  to  conservative  management  for  expert  neurosurgical  evaluation  for  microvascular  decompression  (MVD),  a  surgical  procedure  undertaken  to  identify,  isolate and separate a vascular loop abutting the trigeminal nerve at the root entry zone (REZ).