Trigeminal Neuralgia (Unexplained Facial Pain)

By Joseph Preziosi Jr., DMD

Trigeminal neuralgia is unexplained facial pain of the head and neck, which are the two most common sites of neuralgia. This causes trigeminal neuralgia to be the most frequently diagnosed type of neuralgia mean occurrence rate of approximately 4 people in every 100,000 people in the general population. The average age at diagnoses is 50 years old and there is a predilection of 1.5 to 2 times as many females being affected as males being affected.

Trigeminal neuralgia is characterized by sudden attacks or severe, relatively short lasting bouts of pain that are often descried as electric-like.  The pain effects the head and neck areas that are innervated by the trigeminal nerve and usually occur on one side or the other of the face with a predilection for the right side. The pain can effect one or all of the teeth on the affected side and include both upper and lower teeth. Each attack of pain is usually short lived but frequent recurrence can cause what most patients perceive as lingering or sustained pain. Trigeminal neuralgia attacks can occur at any time with or without sensory facial stimuli or facial movement.Trigeminal neuralgia is unexplained facial pain of the head and neck, which are the two most common sites of neuralgia. This causes trigeminal neuralgia to be the most frequently diagnosed type of neuralgia mean occurrence rate of approximately 4 people in every 100,000 people in the general population. The average age at diagnoses is 50 years old and there is a predilection of 1.5 to 2 times as many females being affected as males being affected. Trigeminal neuralgia is characterized by sudden attacks or severe, relatively short lasting bouts of pain that are often descried as electric-like. The pain effects the head and neck areas that are innervated by the trigeminal nerve and usually occur on one side or the other of the face with a predilection for the right side. The pain can effect one or all of the teeth on the affected side and include both upper and lower teeth. Each attack of pain is usually short lived but frequent recurrence can cause what most patients perceive as lingering or sustained pain. Trigeminal neuralgia attacks can occur at any time with or without sensory facial stimuli or facial movement.

Trigeminal neuralgia usually has a cyclic course of alternating periods of exacerbation and remission with shorter periods of remission as patients age. The cause of idiopathic trigeminal neuralgia is not known and this makes it difficult to diagnose and treat. To date there is no widely accepted treatment plan whether medical or surgical to treat trigeminal neuralgia. There seems to be a genetic component to trigeminal neuralgia since there is a familial occurrence rate of approximately 17 percent of patients with bilateral trigeminal neuralgia, occurring on both sides of the head and neck, and approximately 4 percent of patients with unilateral trigeminal neuralgia, occurring on only one side of the head or neck.

The cause of idiopathic trigeminal neuralgia is unknown but there are several proposed theories that include traumatic compression of the trigeminal never bundle by either neoplastic or vascular anomalies, infectious agents such as human herpes simplex virus (which is the residual virus form chicken pox) and a demyelinating condition (such as Multiple Sclerosis).
Demyelination is the loss of the outer protective layer that insulates human nerve bundles.

When the cause of trigeminal neuralgia is identifiable, such as a tumor or mass compressing the nerve treatment is focused on the removal and elimination of the pathology and the decompression of the nerve. When the cause of the trigeminal neuralgia is not known a diagnosis of idiopathic trigeminal neuralgia is made and the doctor must consider a variety of medical and surgical treatment options. The drug of first choice is usually carbamazepine and baclofen and clonazepam can be added if the carbamazepine is ineffective by itself. A clinician may then try phenytoin, primozide or valproic acid if the initial treatment regiments fail to relive the patient’s symptoms. These medications can be alone or in combination to achieve a level of pain relief that is satisfactory to the patient. When these medications are ineffective in achieving satisfactory pain relief there are several surgical procedures that are available to help elevate the patient’s symptoms. Since the cause or idiopathic trigeminal neuralgia is unknown it is often difficult to determine which surgery is most appropriate and this is often determined by the surgeon’s experience and expertise in treating idiopathic trigeminal neuralgia. Surgical treatments such as these are often performed in teaching hospitals that are referring centers of large cosmopolitan areas designed to treat difficult and unusual cases.

About the Author:

Joseph Preziosi Jr., DMD
New Jersey Cosmetic Dentist
phone. (908) 654-7100
fax 908-654-8764
email: Drpreziosi@aol.com
url: http://www.preziosidentistry.com/