Trigeminal nerve block and surgery

Abstract

The trigeminal nerve is one of the peripheral nerves often involved in painful conditions. It supplies the sensory fibers to the entire face and the anterior two-thirds of the head. It is the target of “tic douloureux”, a fascinating disorder, characterized by paroxysmal lancinating pain which is triggered by non-noxious tactile stimulation and which is probably the most tractable chronically painful condition known. Furthermore, along its intra- and extracranial course, the trigeminal nerve is commonly subject to trauma from head injury, tumor, sinus disease, facial trauma, dental procedures and other causes, presenting, like other peripheral nerves, a broad spectrum of associated syndromes of neuropathic pain, often included in the wastebasket diagnosis of “atypical facial pain”. Thus, since the early nineteenth century it has been the object of direct surgical attempts to injure this nerve with the aim of pain relief. Some decades later, it was suggested that a peripheral nerve might be destroyed by injecting a toxic substance into it and Bartholow used chloroform for this in 1876 [11: the dichotomy between open surgery and percutaneous techniques, still debated nowadays, was born. In this chapter techniques, indications and results of trigeminal nerve surgery and block will be described and discussed.