Major trigeminal neuralgia

Abstract

1. 1. Major trigeminal neuralgia has one cardinal subjective symptom: pain. No objective sensory or motor symptoms are present. 2. 2. The pain of major trigeminal neuralgia has three characteristics: it is paroxysmal, it radiates parallel to the lower jaw and is referred to the peripheral distribution of the trigeminal nerve. 3. 3. Injection of alcohol into any of the three branches of the trigeminal will block the sensory pathways and relieve the pain. This procedure is an important diagnostic method in differentiating between neuralgia due to trigeminal involvement and pain passing over other sensory pathways. 4. 4. Permanent relief from major trigeminal neuralgia is best obtained by section of the sensory root of the fifth nerve. The temporal approach is the safer method. One hundred such operations with only one death form the basis of this report. 5. 5. The pain resulting from cancerous lesions of the face can be relieved by alcohol injection of the appropriate branch of the trigeminal nerve or by preganglionic section of its sensory root. In 34 patients the sensory root was cut for this reason by the temporal approach. Two operative fatalities resulted. Twenty-six patients were completely relieved of pain, and in 6 additional instances marked improvement occurred.