The
pain of neuralgia is described as intense, sharp, stabbing, burning, or
electric like.It is typically unilateral. The trigeminal and
glossopharyngeal cranial nerves are most frequently involved in
paroxysmal neuralgia of the orofacial region.Its duration may be from a
few seconds to minutes, and there may be a refractory period between
attacks. Neuralgic pain is episodic. Attacks may occur for a few weeks
or months and then enter a period of remission, which may last months or
years.
- Greater Occipital Entrapment Neuropathy
- It is a potential source for head pain. Inflammation or
entrapment of this nerve results in referral of moderate to severe
frontal headache, which may simulate migraine headache. It may be
relieved by anesthetic block.
- Trigeminal Neuralgla
- It was first discribed by John Locke in 1677.
It is commonly referred to as tic douloureux,It is a paroxysmal facial
pain disorder that occurs unilaterally in the distribution of the
trigeminal nerve. It usually begins after age 40 and involves women more
than men in a 3:2 ratio. The mandibular division is most frequently
involved followed by the maxillary division.
- CAUSES
- Majority of cases are idiopathic.
- Compression of root of trigeminal nerve due to pathological lesions.
- Glossopharyngeal Neuralgias
- It is a rare condition that occurs in its somatosensory
branches and the vagus nerve. Men and women are equally represented. The
pain of glossopharyngeal neuralgia is felt in the ear, pharynx, tonsil,
and retromandibular areas. Although similar in quality to trigeminal
neuralgia, it may not be as severe and cutaneous, and mucosal trigger
points are rare. Chewing, talking, and swallowing, especially cold
liquids, may precipitate the pain.
TREATMENT
Medical Treatment
Many drugs like Baclofen, Carbamazepine, Phenytoin, Chlorphenesin, Tizanidine, etc. are used for treatment for neuralgia.
Destructive Procedures
A.Injection of Alcohal,Hot water,Phenol in wax or glycerene along the Trigeminal Nerve pathway, or Gasserian Ganglion produces releif in pain.
Surgical Treatment(Peripheral Neurectomy)
Between 25 to 50 percent of patients eventually fail on drug therapy and need neurosurgical treatment like Local Avulsion of peripheral nerves and wide section of sensory roots of the trigeminal nerves.
Radio Frequency Rhizotomy(Thermocoagulation)
It is done placing an electrode under radiographic control in the root of trigeminal nerve MicroVascular Compression is done by compressing the trigeminal root closed by the brain stem. For this a formal craniotomy is required.
