Chapter 38 Trigeminal neuralgia and other facial neuralgias

Abstract

Publisher Summary This chapter explores that trigeminal neuralgia (tic douloureux) is one of the best known facial pain conditions because of its distinctive characteristics and good responsiveness to many treatments. Clinical examination reveals trigger zones in the central mask of the face and minimal sensory loss. It reviews that TN tends to occur later in life, but in the early stages usually remits for variable periods. The commonest causes for TN are compression by a neighboring blood vessel and multiple sclerosis (MS). Treatment options range from pharmacotherapy to neurodestructive and decompressive surgery with excellent early results. The chapter also provides overview on facial neuralgias such as glossopharyngeal neuralgia, nervus intermedius neuralgia, and other cranial neuralgias. There are obvious limitations in establishing an etiology for a syndrome which is defined by the patient's subjective pain rather than hard clinical signs or laboratory findings. The hypothesis of compression-induced local changes, ephaptic connections, and secondary ganglionic hyperexcitability is attractive because it explains most of the characteristics of the typical trigeminal pain.