The Trigeminal neuralgia ( NT ) Is a painful and unilateral facial pathology described as a brief episode of electric shock or burning sensation (Boto, 2010).
Specifically, the pathologies that cause facial pain or facial cranium constitute a series of diseases including a large number of Medical conditions: facial neuralgias, symptomatic facial pains, neurological signs, trigeminal autonomic headaches and facial Symptoms or neurological signs (Tenhamm and Kahn, 2014).
Thus, trigeminal neuralgia is considered one of the most severe and intense facial pain symptoms (Montero and Carnerero, 2016). Although his Incidence occurs in people older than 50 years (Lezcano et al., 2015) and also substantially Life of those affected (Alcántara Montero and Sánchez Carnerero, 2016).
As to the etiologic cause of trigeminal neuralgia, it is usually associated with a mechanical understanding or tension of the trigeminal nerve product of Vascular factors: abnormalities in blood vessels, arterial hypertension Or dyslipidemia, among others (International Association for Study of Pain, 2011; Lezcano et al., 2015)
The diagnostic evaluation of this pathology is usually performed based on the detailed study of the characteristics of pain and various studies That allow the detection of the presence of Neurological disorders (Tenhamm and Kahn, 2014).
Regarding the treatment of trigeminal neuralgia, the initial interventions focus on pharmacological prescription. However, in Severe, surgical procedures or percutaneous techniques may be chosen (Alcántara Montero and Sánchez Carnerero, 2016).
Characteristics of trigeminal neuralgia
Trigeminal neuralgia, also known as"painful tic", is a pathology that causes neuropathic pain, that is, pain associated with various Anomalies or nerve injuries (National Institute of Neurological Disorders and Stroke, 2015).
The clinical definition of this pathology dates back to the 17th century. Already since antiquity has been referenced as" The most intense pain that man can suffer "(Seijo, 1998). In addition, in the most recent clinical reports, trigeminal neuralgia is followed Cataloging as" One of the worst causes of pain suffering "(Lezcano et al., 2015).
The pain derived from this pathology is characterized by different episodes of burning pain, burning sensation or cramp and electric shock In the facial cranial areas innervated by the trigeminal nerve (Alexander, 2008).
In addition, it usually appears when eating, brushing teeth, touching the face, etc. (Boto, 2010), so it is mentally and physically incapacitating (National Institute of Neurological Disorders and Stroke, 2015).
The trigeminal nerve or cranial nerve V, is a nerve structure that has a mixed function: motor and sensory. Thus, its essential function is to control the Musculature and facial sensitivity (Alcántara Montero and Sánchez Carnerero, 2016):
Sensitive function
The sensory branches of the trigeminal nerve are responsible for conducting nerve impulses related to tactile sensations (external stimulation, Proprioception and pain) of the anterior areas of the tongue, teeth, the dura mater (the outermost meningeal layer), the oral mucosa and the sinuses Paranasal (cavities areas located in the superior maxillary, ethmoid, sphenoid and frontal bony zones).
Motor function
The motor branches of the trigeminal nerve mainly innervate the mandibular areas: chewing muscles (temporal, masseter pterygoid) and, moreover, The tensor tympanic muscle, mylohyoid and dysgastric.
This nervous structure, in turn, is divided into 3 fundamental branches (Alcántara Montero and Sánchez Carnerero, 2016):
- Ophthalmic nerve ( V1 ): Is responsible for conducting sensitive information through the areas of leather Scalp, forehead, upper eyelid, nose, frontal sinuses, cornea, and most of the Meninges . Specifically, it distributes
The upper facial skull areas. - Maxillary nerve ( V2 ): Is responsible for the conduction of sensitive information on the skin areas of the cheek, the Lower eyelid, tip of nose, nasal mucosa, teeth and upper lip, palate, upper pharynx and Maxillary sinus and sphenoid sinuses. It is distributed over the middle facial skull areas.
- Mandibular nerve ( V3 ): Is responsible for conducting the sensitive information of the dental pieces and the lip Inferior, the chin, the nasal wings and, in addition, the one related to the pain and temperature of the mouth. Specifically, it distributes the areas Lower facial skull.
Due to these characteristics, when the trigeminal nerve presents damages or lesions in one or several of its branches, this pathology is associated to a Significant decrease in quality of life And labor capacity. It is also common for many affected individuals to develop syndromes Depressants (Alcántara Montero and Sánchez Carnerero, 2016).
About us
Trigeminal neuralgia is a medical condition that is usually chronic.
Although there are few statistical data on this pathology, it has been possible to identify that it presents an approximate incidence of 12 cases per Every 100,000 people a year (National Institute of Neurological Disorders and Stroke, 2014).
It is estimated that in the United States about 140,000 people can live with this pathology (International Radio Surgery Association, 2016).
It has been observed that, as a function of sex, it mainly affects women and that it is more prevalent in the population with a higher age At age 50 (Mayo Clinic, 2015).
However, trigeminal neuralgia is a pathological condition that can develop any person, man or woman and at any stage Maturation (National Institute of Neurological Disorders and Stroke, 2014).
Characteristic signs and symptoms
The essential clinical feature of trigeminal neuralgia is the presence of episodes of facial pain that is characterized by (Mayo Clinic, 2015):
- Acute episodes of burning, stabbing sensations. Many patients report being"hit"or"electric shock".
- Episodes of pain occur spontaneously and usually appear when you start talking, chewing, talking or brushing your teeth.
- The episodes of pain are usually temporary, lasting a few seconds or several minutes.
- It is common for these episodes to occur recurrently in active periods, for days, weeks or months.
- The annoying and painful sensations usually present unilaterally, that is, they affect a single side of the face.
- The pain episode can appear focused on a particular area and progressively, it extends to other areas, generating a broader pattern.
- It is possible that with the development of pathology, pain crises become more intense and frequent.
Although the presentation of these episodes may be variable among the affected individuals, often the intensity of pain is defined as Unbearable, and kept the individual immobile (Seijo, 1998).
As for the most affected areas, the pain typically appears on the cheek or in the jaw and occasionally, in the areas surrounding the nose and Eyes, although this situation will depend mainly on the nerves that are affected (Alexander, 2008).
In addition, this pathology can also be classified into two different types, depending on its clinical purpose (National Institute of Neurological Disorders and Stroke, 2014):
- Type 1 ( NT1 ): It is the classic or typical presentation form of trigeminal neuralgia, it is usually associated with Development of episodes of extreme pain, similar to a shock they have to last from minutes to hours. In addition, these attacks often happen to each other quick way.
- Type 2 ( NT2 ): It is the atypical form of this pathology, characterized by a sharp and constant pain, but of minor Intensity than in type 1.
Causes
This pathology is classified into two differential forms depending on its cause (Boto, 2010):
- Primary trigeminal neuralgia : The etiologic cause that explains the clinical picture of the pathology can not be discover. It is the most common form of trigeminal neuralgia.
- Secondary trigeminal neuralgia : The underlying cause of this pathology is associated with an event or medical condition Identified.
Although the factors that may lead to the development of this pathology are diverse, they will all affect the trigeminal nerve, causing injury and / or Mechanical comprehension.
Among the most common causes of trigeminal neuralgia are:
- Mechanical compression by a blood vessel or arteriovenous malformation.
- Demyelination of the nerve branches resulting from other pathologies, such as multiple sclerosis
- Mechanical compression by the development and growth of tumor masses.
- Nerve injury or mechanical compression resulting from facial trauma or Cranioencephalic .
- Nerve injury or mechanical compression from Cerebrovascular attacks .
- Secondary lesions and neurosurgical interventions.
Diagnosis
The diagnostic evaluation that is usually used in pathologies related to facial pain is mainly focused on clinical analysis, Paying special attention to the details (Tenhamm and Kahn, 2014).
The essential objective is, therefore, to perform an anamnesis to recognize the clinical and evolutionary profile of pain (Tenhamm and Kahn, 2014).
- Age.
- Time period of evolution.
- Duration of each episode or crisis.
- Location or areas most affected.
- Intensity of pain.
- Factors that trigger or worsen the event.
- Factors that reduce or alleviate the intensity of the event.
- Another secondary symptomatology.
In addition, this is usually accompanied by a physical examination that confirms some data such as anatomical distribution or triggers.
On the other hand, the use of complementary laboratory tests, such as magnetic resonance . This test allows us to identify The presence or absence of nerve involvement in the trigeminal nerve branches (Alcántara Montero and Sánchez Carnero, 2016).
Likewise, the identification of the possible etiological medical cause is another essential point, since it will allow the design of an effective therapy and Individualized (Seijo, 1998).
Treatments
In the medical literature and in the professional practice several therapeutic interventions have been described that are effective both in the treatment of The signs and symptoms of trigeminal neuralgia, and in the control of etiological medical conditions. Some of these have been described by Authors such as D. M. Alexander (2008):
The initial treatment of facial pain, usually includes various drugs: analgesics, anticonvulsants or muscle relaxants. In some patients, the Pain can be treated through opiates such as methadone or Antidepressants , Used in the treatment of other types of neuropathic pains.
Although this approach is usually effective in the initial episodes, many patients have adverse reactions such as myelosuppression, drowsiness, ataxia Or fatigue.
In more severe cases, there are other options such as surgery. However, their use will depend fundamentally on the characteristics of the Patient and the identification of the cause of trigeminal neuralgia.
Some interventions include:
- Stereotactic radiosurgery : Through this method a high dose of radiation is applied in a particular area of the nerve Trigeminal. It is used to produce an injury in this one that allows to interrupt the transmission of signals of pain towards the brain.
- Percutaneous rhizotomy : Through the insertion of a needle into areas that allow reaching the trigeminal nerve, especially through Of the foramen ovale on the cheek, the fibers are damaged or destroyed to prevent the conduction of pain.
- Myocardial decompression: through a Craniotomy And placement of a pad between the blood vessels that compress the Trigeminal nerve, it is possible to relieve the neurovascular pressure and consequently, the symptoms of pain. Although it is the most effective, they present Important risks: facial weakness, Paresthesia , Diplopia, hearing loss, stroke, among others.
References
- Alcántara Montero, A., & Sánchez Carnero, C. (2016). Update on the management of trigeminal neuralgia. Semergen , 244-253.
- Alexander, D. (2008). Facing the pain of trigeminal neuralgia. Nursing. , 50-51.
- Boto, G. (2010). Trigeminal neuralgia. Neurosurgery , 361-372.
- IRSA. (2016). TRIGEMINAL NEURALGIA . Retrieved from the International RadioSurgery Association.
- ISAP. (2011). Trigeminal neuralgia and idiopathic persistent facial pain. International Association for the Study of Pain .
- Lezcano, H., Barrios, L., Campos, R., Rodríguez, T., & Alamel-Din, M. (2015). Factors associated with the development of trigeminal neuralgia by Vascular compression. Neurl. Arg. , 95-99.
- Mayo Clinic. (2014). Trigeminal neuralgia . Obtained from Mayo Clinic.
- NIH. (2015). Trigeminal Neuralgia Fact Sheet . Retrieved from the National Institute of Neurological Disorders and Stroke.
- NORD. (2014). Trigeminal Neuralgia . Retrieved from the National Organization for Rare Disorders.
- Seijo, F. (1998). Trigeminal neuralgia. Rev. Soc. , 70-78.
- Have, E., & Kahn, M. (2014). Facial Pain Syndrome. Med. Clin. Rev. , 658-663.