What are trigeminal neuralgia symptoms. Inflammation of the trigeminal nerve: symptoms and treatment of trigeminal neuralgia. What is neuralgia, types of disease

Scientists call this disease Trousseau's pain tic and Fosergill's disease, it is known to patients as neuralgia. trigeminal nerve. You can independently determine the pathology by paroxysmal, extremely intense pain in the eyes, forehead, jaw. Upon discovery of this hallmark you need to immediately contact a medical institution, even a single symptom that has arisen is a reason to start treatment of trigeminal neuralgia as soon as possible.

Anatomical structure

The fifth pair of cranial nerves is called trigeminal, they are located symmetrically: on the right and left sides of the face. The function of the trigeminal nerve is the innervation of a number of facial muscles. It consists of three main branches, including many smaller branches. The path of the branches to the innervated areas passes through the channels in the bones of the skull, where the nerve fibers can be compressed.

Causes of trigeminal neuralgia

Identification of the origin of neuralgia allows you to objectively assess the clinical picture and cure the patient quickly and with minimal stress on the body. The most common causes of trigeminal neuralgia are:

vascular pathologies, including changes and anomalies in the development of blood vessels or their location;
deterioration of blood flow due to hypothermia of the face;
inflammatory processes in the branching zone, which can be caused by otorhinolaryngological, eye and dental problems;
face and skull injuries;
violation of metabolic processes in the body;
viral diseases in a chronic form;
congenital narrowness of the channels along the branches;
any tumors, the localization of which falls on the area of the trigeminal nerve;
multiple sclerosis;
inflammation of an allergic nature;
stem stroke;
psychogenic factors.

Risk group and features of the course of the disease

Trigeminal neuralgia is a very common reason for visiting a neurologist. This is due to a large number of factors that provoke the development of the disease, pain attacks of extremely high intensity and long-term therapy of advanced cases. The number of people at risk for trigeminal neuralgia is quite large.

Neuritis is more likely to affect middle-aged people, predominantly the disease manifests itself at the age of 40 to 50 years. The percentage of patients suffering from trigeminal neuralgia among women is much higher than among the male part. An important determining factor is the presence of chronic diseases that contribute to the development of neuralgia in the patient's history.

In seventy percent of cases, the right side is affected, both sides are affected by the disease extremely rarely. The course of the pathology is cyclical: the acute period is replaced by remission. Peaks of exacerbations occur in autumn and spring.

Symptoms of trigeminal neuralgia of the face

Fosergil's disease has obvious symptoms, obvious even to a non-specialist. However, only a doctor who takes into account the entire clinical picture can determine how to effectively treat trigeminal neuralgia.

The symptoms of Trousseau's pain tic are divided into three groups, which manifest themselves in stages: at first, only pain sensations are disturbing, then motor and reflex, and then vegetative-trophic disorders. At the third stage, not only the symptoms undergo changes, but also the medical prognosis for complete recovery worsens significantly.

The nature of the pain

The first sign of Trousseau's pain tic is intense pain attacks in the zone of innervation of the affected branch. The pain is burning and excruciating, characterized by extreme intensity, it is paroxysmal, occurs very abruptly.

Patients compare a pain attack with neuralgia with a backache and the passage of an electric current. The paroxysm lasts from several seconds to several minutes. At the time of exacerbation, the frequency of seizures is very high.

According to a scientific article devoted to the study of the disease, a painful attack with neuralgia can occur up to three hundred times per day.

Pain localization

Pain can be localized both in the zone of innervation of the entire nerve, and one of its branches. characteristic feature is that the pain spreads from one branch to another, and over time, the entire affected half of the face is involved. The longer the disease lasts without medical intervention, the more likely it becomes to damage the entire nerve. and the spread of the pathological process to other branches.

With lesions of the ophthalmic branch, the pain is concentrated in the forehead and eye. With a disease of the maxillary branch, the pain spreads over the upper and middle parts of the face. Damage to the mandibular nerve can provoke the occurrence of pain in the area of masticatory muscles, lower jaw and nasal wings. Sometimes echoes of pain are felt in the neck, temple and neck.

It happens that the pain is clearly concentrated in the area of a particular tooth, which is why the dentist often becomes the first specialist for an appointment with which a patient with neuralgia is booked. When examining a tooth, the cause of pain is not revealed, but if the treatment is still carried out, it does not bring any effect or relief. The main task of the dentist in such a situation is to refer the patient for a consultation with a neurologist.

pain provocation

Painful paroxysm can be triggered by touching or pressing on the exit points of the nerve branches in the face and trigger zones. Daily activities such as chewing and brushing teeth, washing, shaving, even blowing the wind, talking and laughing can also cause an attack of pain. At the moment when an attack occurs, the patient often freezes, afraid to make the slightest movement, and lightly rubs the pain area.

Motor and reflex disorders

Spasm of facial muscles. At the moment of paroxysm, the muscles of the face involuntarily contract. Reflex disorders begin with blepharospasm or lockjaw, with the course of the disease, spasms can be transmitted to the entire half of the face.
Degradation of the superciliary, corneal and mandibular reflexes. The disorder is revealed when examined by a neurologist.

Vegetative-trophic symptoms

On initial stage diseases, vegetative-trophic symptoms are practically absent, or the signs appear only during an attack. Only the occurrence of painful paroxysm, local redness or pallor of the skin is characteristic. The secretion of the glands changes, a runny nose, lacrimation and salivation may appear.

With the progression of the disease, the vegetative-trophic symptoms of trigeminal neuralgia also increase, and therefore the treatment is required for a longer and more extensive one.

Symptoms of an advanced case of neuralgia

In advanced cases, a number of additional symptoms are added. Elimination of the cause of the disease no longer leads to recovery in one hundred percent of cases; complex methods of treatment are required.

Signs of advanced trigeminal neuralgia are:

Puffiness of the face, loss of eyelashes, change in the secretion of the skin glands.
The spread of pain to other parts of the face.
The appearance of pain from the slightest pressure on any part of the face on the affected side.
The occurrence of pain on any stimuli, up to a loud sound or bright light, even a reminder of a previous attack can become a contributing factor.
The permanent nature of the pain.
Changes in the location and duration of pain attacks.
Strengthening of vegetative-trophic symptoms.

Diagnostics

Correct treatment of trigeminal neuralgia requires the identification of all symptoms, they will help determine the stage and specifics of the course of the disease. The anamnesis and questioning of the patient are of paramount importance in the diagnosis. Examination helps to determine the localization of the decrease and increase in skin sensitivity on the face, to identify possible degradation of muscle reflexes.

During the period of remission of the disease, if it is at an early stage, the pathology is not always noticeable during examination. To detect the cause of neuritis, an MRI may be recommended to the patient, however, even the most modern tomography performed in Moscow does not always show pathology. Patients with symptoms of neuralgia are advised to visit a neurologist immediately.

Methods for the treatment of Fosergill's disease

Treatment of trigeminal neuralgia is carried out by the following methods, mainly used in combination:

physiotherapy;
prescribing drugs;
surgical intervention.

Trying to heal in every possible way folk remedies not only ineffective in neuralgia, but also very dangerous. The main risk is that time will be lost and qualified assistance will not be provided on time.

Treatment with medications

The appointment of drug treatment is justified when the cause of trigeminal neuralgia is vascular pathology or a tumor. Therapy involves:

Antiepileptic drugs.
Painkillers or injections.
Muscle relaxants.
Antivirals.

The main drug in most cases is the anticonvulsant drug based on carbamazepine. Vitamin-based adjuvant therapy has proven itself well. In addition, they are used for treatment.

Valproic acid.
Pregabalin.
Baclofen.
Gabapentin.
Lamotrigine.

The doctor selects the optimal medication and dosage individually. The main objectives of therapy are the removal of pain attacks, the elimination of the causes that caused the disease, and the prevention of complications. Treatment of trigeminal neuralgia with medications takes about six months with a gradual decrease in medicinal doses.

Surgery

The operation is better early stages disease, this increases the likelihood of complete healing. To date, two main groups of operations are used for the treatment of neuralgia. One is effective in cases where it is necessary to correct the position of the artery, or if neuralgia is provoked by compression of the nerve branch by some anatomical formation. The second is used if neuralgia was treated with conservative methods, and the therapy did not give positive results.

The type of surgical exposure varies depending on the pathology that caused neuralgia:

If the cause of compression is vascular pathology, the microvascular decompression method is used. This is a microsurgical operation during which the nerve and vessel are separated. The effectiveness of the method is very high, but it must be taken into account that the operation is traumatic.
If the cause is in the development of the tumor process, the tumor is first removed, and after that treatment is prescribed.
If it is necessary to relieve pain impulses along the nerve fiber, percutaneous balloon compression is performed.

In some cases, destruction of the nerve is necessary. The following methods are used for this:

Non-invasive ionizing radiation. It is used only in the early stages of the disease.
Stereotactic percutaneous rhizotomy. The nerve root is destroyed under the influence of electric current, which is supplied to the damaged area using the thinnest electrode.
Radiofrequency ablation, in which nerve fibers are destroyed by high temperature.
Glycerin injections in the places of branching of the nerve.

Physiotherapy treatment

For the speedy removal of pain symptoms and complete healing, physiotherapy procedures are prescribed in tandem with drug therapy. After the start of treatment, surgical or physiotherapy, the pain does not recede instantly. The term for the complete disappearance of paroxysm is individual and is due to the vastness of the process, the prescription of the disease, therefore, in addition, the doctor prescribes painkillers.

The following procedures show the greatest effectiveness in the treatment of pain tic Trousseau:

laser therapy;
diadynamic currents;
electrophoresis using novocaine;
acupuncture;
ultraphonophoresis with hydrocortisone.

Preventive measures

It is impossible to avoid all potentially dangerous factors, especially considering that some causes are congenital: the narrowness of the channels, pathologies in the structure and location of the vessels. However, you can reduce the risk of developing the disease by eliminating several provoking factors. Primary prevention should be:

prevent hypothermia of the face and head;
timely treat diseases that can give rise to trigeminal neuralgia;
avoid head injury.

Doctors consider the only timely treatment of diseases of the trigeminal nerve to be a full-fledged secondary prevention, therefore, at the first symptoms of the pathology, you should immediately contact the clinic.

Possible Complications

Trigeminal neuralgia cannot be triggered, Fosergill's disease causes complications:

paresis of the facial muscles;
hearing loss;
irreversible damage to the nervous system, up to inflammation in the brain.

Relieve pain with analgesics and hope that neuralgia will pass by itself, it is impossible categorically. This is a serious neurological disease, which should be treated only by a doctor. The sooner the patient seeks help, the more successful and shorter the therapy will be.

Trigeminal neuralgia is a chronic disease, and quite common.

It is characterized by a change in periods of exacerbations and remissions.

The main symptom of the disease is intense paroxysmal pain of a shooting nature in the places of innervation of the trigeminal nerve.

In the bone canals, the branches of the nerves are compressed and this causes the development of trigeminal neuralgia.

Squeezing can be caused by various reasons:

anatomical features (narrow channels);
inflammatory pathologies in a chronic form (sinusitis, ethmoiditis, caries, periostitis);
improper metabolism;
skull and face injuries;
the presence of chronic infections (herpes, tuberculosis);
hypothermia;
changed by the pathological process, vessels (as a result of tumors).

As a result of prolonged compression, the protective layer covering the nerve is broken, the passage of the nerve impulse worsens. This leads to the formation of a focus in the brain and a paroxysmal reaction to the streams of impulses incoming to it.

Another reason is the destruction of the integrity of the myelin sheath as a result multiple sclerosis or after operations performed on the face and paranasal sinuses complicated by nerve injury.

More often, one branch of the nerve is affected; if the process is not addressed in time, the process can progress and affect the entire nerve.

Trigeminal neuralgia - symptoms

The disease is characterized by an acute onset: paroxysmal pain on one side of the jaw or cheek.

It does not last long, repetition is possible at short intervals.

Symptoms can recur from several days to weeks or months, and then disappear and sometimes do not make themselves felt for several years.

Before the next episode begins, patients experience a feeling of numbness or slight tingling on contact with the cheek (talking, eating, washing, applying cosmetics). Pain may be localized to small area face or capture the entire side. During sleep, seizures rarely disturb.

Reflex and movement disorders:

reflexes change (mandibular, corneal, superciliary);
spasm of the facial muscles (in the process of an attack, the chewing muscles, the circular muscle of the eye, and others involuntarily contract).

During an attack, vegetative-trophic symptoms occur (at first, slightly pronounced, over time, with a progressive disease, they become more noticeable):

secretion of glands changes;
skin becomes pale or red;
a long-existing disease gives rise to the appearance of late signs (dryness or increased oiliness of the skin, swelling of the face).

The late stage of the disease is characterized by the formation of a focus of pathological pain in the brain (thalamus).

After getting rid of the cause that caused the disease, recovery does not occur. Main features at this stage:

strengthening of vegetative-trophic disorders;
constant nature of pain;
the appearance of pain in response to various stimuli (sharp sound, bright light);
the occurrence of pain after touching the face (any part of it).

Existing types of pain such neuralgia:

In half of the cases, the pain appears spontaneously and also disappears, is sharp, shooting or cutting, sometimes the patient notes a burning sensation on the face.
In half of the cases, patients have chronic pain or a burning sensation.

Secondary symptoms can manifest themselves in the form of a phobic syndrome: the patient, trying not to provoke the onset of pain, tries not to take certain postures and not make movements:

chews food on the opposite pain side;
in the head there are secondary pain sensations;
irritates the facial and auditory nerves.

Over time, the attacks are aggravated, the disease is prone to relapse. The pain that constantly disturbs patients becomes debilitating, causes them physical exhaustion, and makes it difficult to perform daily activities.

Diagnostics

There are no devices that can determine the presence of such a violation. Diagnosis is based on history, symptoms, physical examination, and neurological examination. Differentiate with postherpetic neuralgia, which causes similar pain with localization on the face.

A neurological examination reveals areas on the face with reduced or increased sensitivity and altered reflexes:

mandibular (temporal and chewing muscles contract during tapping on the lower jaw);
corneal (eyes close at external stimuli);
superciliary (eyes close when tapping along the superciliary arch from the inner edge).

To exclude multiple sclerosis and tumors, additional examination methods are prescribed (brain MRI, MR angiography).

Signs of neuralgia in men and women are somewhat different. In the next article, we will consider the symptoms characteristic of the fair sex. Primary and secondary signs of pathology.

Treatment

For the treatment of trigeminal neuralgia, methods are used:

medication (is basic);
physiotherapy;
surgical (if conservative methods fail).

For drug treatment, patients are prescribed carbamazeline. A daily dose of 700 - 1000 mg prevents the recurrence of an attack of pain.

At the time of taking the drug, it is necessary to control its concentration in the blood serum (should not be higher than 12 mg / l). Excess increases the risk of side effects(cardiac arrhythmia, thrombocytopenia and leukopenia, renal and hepatic failure).

To relieve pain, baclofen, amitriptyline, gabalentin are prescribed. With particularly complex exacerbations, the administration of diazepam, sodium oxybutyrate in the form of intravenous infusions is prescribed. In the complex treatment, cavinton, trental, nicotinic acid, glycine, pantogam, phenibut, vitamin therapy are used.

Of the physiotherapy procedures, laser therapy, acupuncture, ultraiontophoresis, electrophoresis, and diadynamic currents are prescribed.

Of the surgical methods used:

microvascular decompression (separate the vessel and the nerve when compression occurs due to a changed vessel);
percutaneous surgery that destroys the trigeminal nerve with exposure to chemicals;
destruction of the sensitive root by gamma radiation.

To prevent the development of the disease, it is necessary to take preventive measures.

Diagnosis of neuralgia

Diagnosis of trigeminal neuralgia begins with a visit to a neurologist. The doctor examines the patient during remission and after exposure to pain points, the impact on which can provoke an attack of pain, collects an anamnesis of life and illness, prescribes additional studies:

Electroneurography;
Computed tomography, MRI;
Electroencephalography;
Biochemistry of blood;
Puncture of the spinal cord if necessary - if you suspect;
Consultation of an otolaryngologist, dentist, neurosurgeon.

Therapy of the disease is carried out in a complex manner, the main steps in the treatment of trigeminal neuralgia are as follows:

Prevention of factors that can provoke the development of neuralgia;
Normalization of the central nervous system - prevention of stress, reduction of hyperexcitability;
Physiotherapeutic procedures - electrophoresis, acupuncture, massage.

To stop an attack of trigeminal neuralgia and prevent pain in the future, the patient is prescribed the drug Finlepsin. This medicine belongs to the group of anticonvulsants and helps to reduce the excitability of nerve fibers and inhibit the production of neurotransmitters.

This remedy can be taken strictly according to the doctor's indications and in an individually indicated dosage, since the tablets have a number of serious contraindications.

In addition to finlepsin, the patient is prescribed:

B vitamins - have a beneficial effect on the work of the central nervous system;
Sedatives - Valerian;
Glycine or Glycesed - amino acids involved in the transmission of nerve impulses;
antihistamines;
Muscle relaxants;
Antidepressants.

During a stable remission, physiotherapy and spa treatment is indicated.

Surgical treatment of trigeminal neuralgia

If conservative methods of treatment are not effective, the patient is prescribed surgical intervention. The main indications are brain tumors, the presence of narrowed areas in the nerve exit canal from the skull, pinching of the nerve branches,.

In modern surgery, the operation to eliminate trigeminal neuralgia is performed with a laser. This intervention is minimally invasive and well tolerated by the patient.

Forecast

When seeking medical help on time and properly prescribed treatment, the prognosis of the disease is generally favorable. Doing simple preventive advice allows you to achieve a stable remission or completely get rid of the problem.

Among the lesions of the trigeminal nerve system, a significant number are trigeminal odontogenic diseases, which are a heterogeneous group. Examination of patients with lesions of the trigeminal nerve system showed that among them there are groups with different clinical manifestations: odontogenic neuralgia, odontogenic plexalgia, bilateral odontogenic neuralgia, odontogenic neuritis of the alveolar nerves.

The most common odontogenic disease of the trigeminal nerve system is odontogenic trigeminal neuralgia.

It has a number of features, its main clinical symptom is constant pain. The nature of the pain can be throbbing, aching, dull, cutting, pressing, itching. Against the background of constant pain, attacks of increased pain are noted, lasting from tens of minutes to several hours and even days, gradually subsiding. The pain is mainly localized in the area of the affected branches, sometimes there is a spread of pain to the zones of neighboring branches (all three) or irradiation to any area of the head. Patients show changes in the central nervous system. The mood of patients is usually lowered, they are fixed on their painful sensations, conflict. The disease has a chronic relapsing character. There are no trigger zones.

As a rule, odontogenic neuralgia is accompanied by the presence of autonomic disorders in the form of increased salivation, lacrimation, nasal discharge, edema and hyperemia of facial areas, which manifest themselves mainly during increased pain manifestations.

In addition to autonomic disorders of a local nature, a significant number of patients in the acute period of the disease have vegetative changes of a general nature in the form of palpitations, sweating, etc.

In patients with a long course of the disease (several years) and a history of destructive methods of treatment, trophic disorders of facial tissues, as well as sensory disturbances, are found. But usually there are no sensitive disorders.

In these cases, there is pain at the points of Balle. The severity of sensory impairment is directly dependent on the severity of the pain syndrome. In some patients, after the treatment, sensitivity is restored on the face, which proceeds in two stages - hypesthesia is replaced by hyperesthesia, followed by its replacement with normal sensitivity. Apparently, the observed changes are possible with unstable lesions of the trigeminal nerve fibers.

The second place in frequency among odontogenic lesions of the trigeminal nerve system is occupied by odontogenic dental plexalgia. The most common factor in the occurrence of odontogenic dental plexalgia are defects in the filling of teeth and root canals.

Pain in odontogenic plexalgia is permanent and localized in the gums and teeth, in the lips. The nature of the pain is mostly aching, cutting, dull. Against the background of constant pain, their periodic amplifications are noted, lasting for hours. Eating, changing the microclimate (drafts), toileting the face, as a rule, increase pain. The disease has a chronic relapsing character.

For odontogenic dental plexalgia, vegetative disorders are characteristic in the form of swelling of the gums, skin of the buccal region, and their hyperemia.

Unlike odontogenic neuralgia, odontogenic dental plexalgia is not characterized by sensory disturbances in the affected branches, pain during palpation of the points of the Balle on the face, and trophic disorders.

Among the manifestations of odontogenic lesions of the trigeminal nerve system, there is also bilateral odontogenic trigeminal neuralgia.

First, the pain appears on one side, then after a while - on the other. More often, the second and third branches of the trigeminal nerve are affected, both on one and on both sides.

One of the most common causes of bilateral odontogenic neuralgia is poorly made prostheses. As a rule, in such patients, prosthetics were performed on both sides.

The leading symptom in the clinic of bilateral odontogenic neuralgia is pain of a constant nature, localized in the area of the affected branches. The nature of the pain can be aching, throbbing, dull. Against the background of constant attacks, pain intensification is noted, lasting from 20 minutes to 2-3 hours. Provoking moments are physical overwork, mental overstrain, menstruation. Sometimes painful paroxysms occur for no apparent reason.

The disease proceeds with remissions and exacerbations. Many patients have an astheno-neurotic reaction.

Characteristic for bilateral odontogenic neuralgia, as well as unilateral, is the presence of autonomic disorders in the form of hyperemia of the skin, rhinorrhea, swelling of the soft tissues of the face, lacrimation, dry mouth. Many patients also have palpitations and sweating. Especially all these phenomena are manifested during painful paroxysms.

Patients with long-term disease with destructive methods of treatment had a history of sensory disturbances in the area of the affected branches of the trigeminal nerve, pain on palpation at the exit points of the trigeminal nerve, and trophic disorders of facial tissues.

The next most common odontogenic lesions of the trigeminal nerve system are odontogenic neuritis of the alveolar nerves. The course of the disease is chronic, relapsing. The prognosis of the disease is relatively favorable compared with odontogenic neuralgia and odontogenic plexalgia. The inferior alveolar nerve is most often affected due to its anatomical position.

The main odontogenic factor in the occurrence of alveolar nerve neuritis is a complication of conduction anesthesia.

Unlike odontogenic neuralgia and dental plexalgia, the leading in the clinical picture in patients with odontogenic neuritis of the alveolar nerves is a feeling of numbness in the upper and lower teeth. With damage to the lower alveolar nerve, a feeling of numbness is also noted in the corresponding half of the lower lip and chin. Almost half of the patients also complain of constant aching or dull pain.

A characteristic feature of odontogenic neuritis of the alveolar nerves is a violation of sensitivity in the areas of innervation of the alveolar nerves, which is directly dependent on the severity of paresthesia and the intensity of the pain syndrome. Also hallmark odontogenic neuritis of the alveolar nerves is pain during vertical percussion of the teeth.

Autonomic disorders are observed in almost half of patients with odontogenic neuritis of the alveolar nerves, usually in the acute period of the disease and manifest themselves as swelling, hyperemia of the gums, and salivation.

Examination of a group of patients with trigeminal neuralgia, predominantly of central origin (classical neuralgia), showed that odontogenic factors in them are only provoking moments, among which the first place is occupied by manipulations in the dentoalveolar system. Most often, the second branch of the trigeminal nerve is involved. The main clinical symptom of trigeminal neuralgia, predominantly of central origin, is pain, which is paroxysmal in nature and localized in the affected area of one or more branches of this nerve, sometimes spreading to adjacent parts of the face and half of the head. The duration of the attack - from. several seconds to several minutes. The provoking moment of seizures is most often any movement of the facial muscles. Unlike odontogenic lesions of the trigeminal nerve system, with neuralgia of predominantly central origin, as a rule, there is no pain in the interictal period.

A characteristic feature of trigeminal neuralgia of predominantly central origin is the presence of trigger zones. Autonomic disorders are also detected, less pronounced than with odontogenic lesions of the trigeminal nerve: involuntary contraction of the facial muscles of a tonic or clonic nature, impaired pain sensitivity and pain on palpation at the exit points of the affected branches of the trigeminal nerve.

With odontogenic neuralgia, the peripheral neurons of the trigeminal nerve are affected, resulting in the formation of groups of neurons with a disturbed mechanism of inhibitory control, which, according to G. N. Kryzhanovsky, become generators of increased excitation. The fact that the peripheral neuron is the primary link in the development of the mechanisms of odontogenic neuralgia indicates that neuralgia is classified as neuralgia of predominantly peripheral origin.

In the development of trigeminal neuralgia of predominantly central origin, central mechanisms are mainly involved. It can be assumed that constant painful pathological impulses, according to A. A. Ukhtomsky, lead to the formation of congestive foci of excitation (pathological dominant) in the region of the brainstem, thalamus and cerebral cortex. Clinically, this is confirmed by an exacerbation of the disease caused by mental trauma, negative emotions, etc.

Despite the fact that the study of rheofasciography in facial pain is of great importance for revealing the pathogenetic mechanisms of the disease, there are no reports in the literature about rheofasciography in odontogenic lesions of the trigeminal nerve.

Comparative analysis of rheofaciograms recorded using the proposed device showed that in odontogenic lesions of the trigeminal nerve, rheographic changes were more stable than in trigeminal neuralgia of predominantly central origin, and changed more slowly. Usually, patients have a change in the blood flow of the face, manifested in a decrease in the rheographic index in the area of pain. In almost all cases, with odontogenic lesions of the trigeminal nerve system, there were rheographic signs of changes in vascular tone. Most of the patients showed an increase.

Studies of the electrical excitability of the points of exit of the branches of the trigeminal nerve and the oral mucosa revealed that in patients with odontogenic lesions of the trigeminal nerve system, in contrast to neuralgia of predominantly central origin, an increase in the threshold of electrical excitability at the points of exit of the affected branches and a distortion of the polar formula AZR>KZR on the mucosa are characteristic the membrane of the oral cavity in the affected area, clinically combined (long periods of the disease and destructive methods of treatment in history) with hyperesthesia, hypoesthesia, pain on palpation.

Therefore, the determination of the threshold of electrical excitability of the exit points of the branches of the trigeminal nerve and the oral mucosa in patients with odontogenic lesions of the trigeminal nerve system in combination with clinical data allows us to assess the damage to the terminal structures of this system, monitor the effectiveness of the treatment as a result of a dynamic study, and judge the prognosis of the disease. , and is also a differential diagnostic criterion for recognizing odontogenic lesions of the trigeminal nerve and neuralgia, predominantly of central origin.

Studies of the electrical conductivity of symmetrical facial TA in patients with odontogenic lesions of the trigeminal nerve system showed that the initial indicators of electrical conductivity in them are high (ranging from 21 to 150 μA), while in patients with neuralgia, predominantly of central origin, they are low (from 2 to 16 µA). These indicators confirm the presence of two types of trigeminal neuralgia, predominantly peripheral and predominantly central.

Analyzing the results of the use of auxiliary research methods for odontogenic lesions of the trigeminal nerve system, we came to the conclusion that rheofaciography, electrothermometry, studies of the electrical conductivity of the facial TA, as well as the electrical excitability of the exit points of the trigeminal nerve and the oral mucosa, make it possible to clarify the topical diagnosis, identify the stage of the disease, and conduct observations for the dynamics of the pathological process for the appointment and correction of the appropriate treatment.

In order to increase the efficiency and reduce the duration of treatment, we have developed a method for the treatment of odontogenic lesions of the trigeminal nerve system using reflexology (acupuncture, electropuncture), in which TA electrical conductivity is used to select points.

The nature of the therapeutic effect is determined depending on the values of the studied indications of the electrical conductivity of the selected TA. In patients with odontogenic lesions of the trigeminal nerve system, electropuncture proved to be effective (since the TA electrical conductivity values are high, ranging from 21 to 100 μA). The course of treatment consists of 8-10 procedures.

In patients with a long-term disease and multiple novocaine and alcohol-novocaine blockades in history therapeutic effect from electropuncture is significantly reduced. Therefore, these patients, simultaneously with a course of electroacupuncture, should be given a comprehensive course of treatment for each group of odontogenic lesions of the trigeminal nerve system, including medication and physiotherapy. The main drugs in the complex treatment for unilateral and bilateral odontogenic trigeminal neuralgia are analgesics, local anesthetics, vegetotropic drugs, tranquilizers, vitamins, biostimulants, physiotherapeutic treatment (diadynamic currents).

In case of odontogenic plexalgia, the acupuncture method included physiotherapeutic treatment (diadynamic currents with a narcotic mixture), as well as medication, consisting of local anesthetics, vegetotropic agents, tranquilizers, and vitamin therapy, in addition to the acupuncture method. Treatment of odontogenic neuritis of the alveolar nerves is prescribed in combination with physiotherapy (longitudinal gilvanization), as well as with vitamin therapy and biostimulants, tranquilizers, while in trigeminal neuralgia of predominantly central origin, the greatest therapeutic effect was achieved from the use of drugs such as carbamazepine (finlepsin, stazepin) in combination with antihistamines, local anesthetics, vitamin therapy in combination with physiotherapy (diadynamic currents).

Thus, the methods of treatment of odontogenic lesions of the trigeminal system and trigeminal neuralgia, predominantly of central origin, are different. This allows us to confirm the assumptions made that the mechanisms of development of odontogenic lesions of the trigeminal nerve system differ from the mechanisms of the occurrence of trigeminal neuralgia, predominantly of central origin.

The use of complex treatment, which is based on a course of acupuncture, gives a good therapeutic effect. With odontogenic trigeminal neuralgia, improvement was obtained in approximately 93% of cases, with odontogenic dental plexalgia - in 88.9 and with odontogenic neuritis - in 84.9% of cases. Dynamic observation showed the stability of the obtained results.

Trigeminal neuralgia (Trousseau's pain tic, Fosergil's disease, trigeminal neuralgia) is a fairly common disease of the peripheral nervous system, the main symptom of which is paroxysmal, very intense pain in the innervation zone (connection to the central nervous system) one of the branches of the trigeminal nerve. The trigeminal nerve is a mixed nerve, it carries out sensory innervation of the face and motor innervation of the masticatory muscles.

A wide variety of factors underlying the disease, excruciating pain, social and labor maladjustment, long-term drug treatment in case of untimely treatment - this is not the whole range of reasons that keep this problem at the top of the rating of neurological diseases. The symptoms of trigeminal neuralgia are quite easily recognizable even by non-professionals, but only a specialist can prescribe treatment. Let's talk about this disease in this article.

Causes of trigeminal neuralgia

Areas of innervation of the trigeminal nerve.

The trigeminal nerve is the 5th cranial nerve. A person has two trigeminal nerves: left and right; the basis of the disease is the defeat of its branches. In total, the trigeminal nerve has 3 main branches: the ophthalmic nerve, maxillary nerve, mandibular nerve, each of which breaks up into smaller branches. All of them, on their way to the innervated structures, pass through certain holes and channels in the bones of the skull, where they can be subjected to compression or irritation. The main reasons for this can be summarized as follows:

congenital narrowing of holes and channels along the branches;
pathological changes in the vessels located next to the nerve (aneurysms, or protrusions of the walls of the arteries, any anomalies in the development of blood vessels, atherosclerosis) or their abnormal location (often the superior cerebellar artery);
cystic-adhesive processes in the branching of the trigeminal nerve as a result of eye, otorhinolaryngological, dental diseases (inflammation of the sinuses - frontal sinusitis, sinusitis, ethmoiditis; odontogenic periostitis, pulpitis, caries, iridocyclitis, etc.);
metabolic disease ( diabetes, gout);
chronic infectious diseases (tuberculosis, brucellosis, syphilis, herpes);
tumors (any localized along the nerve);
hypothermia of the face (draft);
face and skull injuries;
rarely - stem stroke.

The pathological process can affect both the entire nerve and its individual branches. More often, of course, one branch is affected, but in most cases, untimely treatment leads to the progression of the disease and involvement of the entire nerve in the pathological process. During the course of the disease, several stages are distinguished. At a late stage (the third stage of the disease), the clinical picture changes and the prognosis for recovery worsens significantly. Establishing the cause of the disease in each case allows you to choose the most effective treatment and, accordingly, accelerate healing.

Symptoms

The disease is more typical for middle-aged people, more often diagnosed in 40-50 years. The female sex suffers more often than the male. Damage to the right trigeminal nerve is more often observed (70% of all cases of the disease). Very rarely, trigeminal neuralgia can be bilateral. The disease is cyclic, that is, periods of exacerbation are replaced by periods of remission. Exacerbations are more typical for the autumn-spring period. All manifestations of the disease can be divided into several groups: pain syndrome, motor and reflex disorders, vegetative-trophic symptoms.

Pain syndrome

Patients with trigeminal neuralgia are disturbed by bouts of intense pain in the zone of innervation of the affected branch of this nerve.

The nature of the pain: the pain is paroxysmal and very intense, excruciating, sharp, burning. Patients at the time of an attack often freeze and do not even move, compare the pain with the passage electric current, lumbago. The duration of the paroxysm is from several seconds to several minutes, however, during the day, attacks can be repeated up to 300 (!) Times.

Localization of pain: pain can capture both the zone of innervation of one of the branches, and the entire nerve on one side (right or left). One of the features of the disease is the irradiation (spread) of pain from one branch to another, involving the entire half of the face. The longer the disease exists, the more likely it is to spread to other branches. Localization zones:

ophthalmic nerve: forehead, anterior scalp, bridge of the nose, upper eyelid, eyeball, inner corner of the eye, mucous membrane of the upper part of the nasal cavity, frontal and ethmoid sinuses;
maxillary nerve: upper cheek, lower eyelid, outer corner of the eye, upper jaw and its teeth, wing of the nose, upper lip, maxillary (maxillary) sinus, mucous membrane of the nasal cavity;
mandibular nerve: lower cheek, chin, lower jaw and its teeth, lower surface of the tongue, underlip, mucous membranes of the cheeks. The pain can be given to the temple, neck, neck. Sometimes the pain is clearly localized in the area of one tooth, which encourages patients to go to the dentist. However, treatment of this tooth does not eliminate the pain.

Pain provocation: the development of a painful paroxysm can be caused by touch or light pressure on the so-called trigger zones. These zones are quite variable in each individual patient. More often it is the inner corner of the eye, the back of the nose, the eyebrow, the nasolabial fold, the wing of the nose, the chin, the corner of the mouth, the mucous membrane of the cheek or gums. Also, provocation of an attack is possible by pressing on the exit points of the branches on the face: supraorbital, infraorbital, mental hole. Pain can also be caused by talking, chewing, laughing, washing, shaving, brushing teeth, applying makeup, even blowing the wind.

Behavior at the time of the attack: patients do not cry, do not scream, but freeze, trying not to move, rubbing the pain area.

Motor and reflex disorders:

spasms of the muscles of the face (hence the name of the disease “pain tic”): during a painful attack, an involuntary muscle contraction develops in the circular muscle of the eye (blepharospasm), in the masticatory muscles (trismus), and in other muscles of the face. Often muscle contractions extend to the entire half of the face;
changes in reflexes - superciliary, corneal, mandibular - which is determined during a neurological examination.

Vegetative-trophic symptoms: observed at the time of the attack, in the initial stages they are slightly expressed, with the progression of the disease they necessarily accompany a painful paroxysm:

skin color: local pallor or redness;
changes in the secretion of glands: lacrimation, salivation, runny nose;
late signs: develop with prolonged existence of the disease. There may be swelling of the face, greasiness of the skin or its dryness, loss of eyelashes.

In the late stage of the disease, a focus of pathological pain activity is formed in the visual tubercle (thalamus) in the brain. This leads to a change in the nature and localization of pain. Eliminating the cause of the disease in this case does not lead to recovery. Distinctive features this stage of the disease are as follows:

the pain spreads to the entire half of the face from the onset of the paroxysm;
touching any part of the face leads to pain;
even the memory of it can lead to a painful paroxysm;
pain can occur in response to stimuli such as bright light, loud sound;
pains gradually lose their paroxysmal character and become permanent;
vegetative-trophic disorders are intensified.

Diagnostics

The main role in establishing the diagnosis belongs to carefully collected complaints and anamnesis of the disease. A neurological examination may reveal areas of decreased or increased sensitivity on the face, as well as changes in the following reflexes:

superciliary - that is, closing the eyes when tapping along the inner edge of the superciliary arch;
corneal - that is, the effect of closing the eyes in response to external stimuli;
mandibular - that is, contraction of the masticatory and temporal muscles during tapping on the lower jaw).

During the period of remission, a neurological examination may not reveal pathology. To search for the cause of neuralgia, the patient may be shown magnetic resonance imaging (MRI), but it does not always reveal the truth.

Treatment

The main methods of treatment of trigeminal neuralgia include:

medication;
physiotherapy;
surgical treatment.

Carbamazepine (tegretol) remains the main drug in drug treatment. It has been used in the treatment of this disease since 1962. It is used according to a special scheme: the initial dose is 200-400 mg / day,
gradually the dose is increased and brought up to 1000-1200 mg / day in several doses. Upon reaching clinical effect(cessation of pain attacks) the drug in a maintenance dose is used for a long time to prevent the onset of seizures, then the dose is also reduced in steps. Sometimes the patient has to take the drug for 6 months or more. Currently, oxcarbazepine (trileptal) is also used, which has the same mechanism of action as carbamazepine, but is better tolerated.

In addition to carbamazepine, in order to relieve pain, baclofen 5-10 mg 3 times a day (the drug should also be discontinued gradually), amitriptyline 25-100 mg / day are used. Of the new drugs synthesized in recent decades, gabapentin (gabagamma, tebantin) is used. In the treatment of gabapentin, dose titration is also necessary until a clinically effective dose is reached (the initial dose is usually 300 mg 3 r / d, and the effective dose is 900-3600 mg / day), followed by a stepwise decrease until the drug is discontinued. In order to stop a severe exacerbation, sodium hydroxybutyrate or intravenous diazepam can be used. In complex therapy, nicotinic acid, trental, cavinton, phenibut, pantogam, glycine, B vitamins (milgamma, neurorubin) are used.

Physiotherapy treatment is quite diverse. Diadynamic currents, electrophoresis with novocaine, ultraphonophoresis with hydrocortisone, acupuncture, laser therapy can be used. Physiotherapeutic techniques are used only in combination with drug treatment to achieve a faster and better effect.

In the absence of the effect of conservative treatment, as well as in cases where trigeminal neuralgia is caused by compression of the root by an anatomical formation, surgical methods of treatment are used:

if the cause of compression is a pathologically altered vessel, then microvascular decompression is performed. The essence of the operation is to separate the vessel and nerve using microsurgical techniques. This operation has high efficiency, but very traumatic;
percutaneous stereotaxic rhizotomy: the nerve root is destroyed using an electric current supplied to the nerve with a needle in the form of an electrode;
percutaneous balloon compression: cessation of pain impulses along the nerve by squeezing its fibers with a balloon brought to the nerve with a catheter;
glycerin injections: destroying the nerve by injecting glycerin into the branching of the nerve;
nerve destruction using ionizing radiation: a non-invasive technique using radiation;
radiofrequency ablation: destruction of nerve fibers with the help of high temperature;
if the cause was a tumor process, then, of course, the removal of the tumor comes to the fore.

A characteristic feature of all surgical methods is a more pronounced effect when they are performed early. Those. the earlier this or that operation is carried out, the higher the likelihood of a cure. It should also be borne in mind that the disappearance of pain attacks does not occur immediately after surgical treatment, but somewhat remotely (the timing depends on the duration of the disease, the extent of the process and the type of surgical intervention). Therefore, all patients with trigeminal neuralgia need to see a doctor in a timely manner. Previously, the technique of injecting ethyl alcohol into the branching of the nerve was used. Such treatment often gave a temporary effect, had a high rate of complications. With the regeneration of the nerve, the pain resumed, so today this method of treatment is practically not used.

Prevention

Of course, it is not possible to influence all the probable causes of the disease (for example, the congenital narrowness of the canals cannot be changed). However, many factors in the development of this disease can be prevented:

avoid hypothermia of the face;
timely treat diseases that can cause trigeminal neuralgia (diabetes mellitus, atherosclerosis, caries, sinusitis, frontal sinusitis, herpes infection, tuberculosis, etc.);
prevention of head injuries.

It should also be borne in mind that the methods of secondary prevention (i.e., when once the disease has already manifested itself) include high-quality, complete and timely treatment.

Video version of the article:

TVC channel, program “Doctors” on the topic “Trigeminal Neuralgia”

What are trigeminal neuralgia symptoms. Inflammation of the trigeminal nerve: symptoms and treatment of trigeminal neuralgia. What is neuralgia, types of disease

Anatomical structure

Causes of trigeminal neuralgia

Risk group and features of the course of the disease

Symptoms of trigeminal neuralgia of the face

The nature of the pain

Pain localization

pain provocation

Motor and reflex disorders

Vegetative-trophic symptoms

Symptoms of an advanced case of neuralgia

Diagnostics

Methods for the treatment of Fosergill's disease

Treatment with medications

Surgery

Physiotherapy treatment

Preventive measures

Possible Complications

Trigeminal neuralgia - symptoms

Diagnostics

Treatment

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