Area of ​​innervation of the trigeminal nerve. trigeminal neuralgia

Neuralgia trigeminal nerve described as one of the most excruciating pains, known to mankind. This pain usually covers lower part face and jaw, but sometimes it can also affect the area around the nose and on the eyes. Pain with trigeminal neuralgia is severe, reminiscent of an electric shock. The cause of it will be irritation of the trigeminal nerve, which gives branches to the forehead, cheeks and lower jaw. Usually the pain occurs in any particular half of the face.

Although trigeminal neuralgia is not always curable, in currently there are methods that can significantly alleviate the pain in this disease. The first drugs commonly used for trigeminal neuralgia are anticonvulsants. With inefficiency drug treatment, as well as with serious side effects, surgical methods of treatment are used.

What provokes / Causes of Trigeminal Neuralgia:

Pain in trigeminal neuralgia is associated with irritation of the trigeminal nerve. The cause of pain is usually the contact of an artery and vein with the trigeminal nerve at the base of the skull. In this place, compression of the nerve occurs, which is the cause of pain.

Other causes of trigeminal neuralgia include compression of the nerve by a tumor, multiple sclerosis, which leads to the destruction of the so-called myelin sheath of the nerve. Usually, the development of trigeminal neuralgia in young people is associated with multiple sclerosis.

Pathogenesis (what happens?) during trigeminal neuralgia:

The trigeminal nerve is the fifth of the twelve pairs of cranial nerves. The function of the nerve is to provide sensation in the face. One trigeminal nerve runs on the left side of the face and the other on the right. The trigeminal nerve has three branches:

• The first branch provides the sensitivity of the eye, upper eyelid and forehead skin.
• The second branch provides sensitivity to the lower eyelid, cheeks, nostrils, upper lip and upper gums.
• The third branch provides sensitivity to the lower jaw, lower lip, gums and some chewing muscles.

Symptoms of trigeminal neuralgia:

Most patients note that their pain begins spontaneously, without any reason. In other patients, pain begins after a car accident, a blow to the face, or after dental treatment at the dentist. Although doctors, and even dentists, believe that interventions on the teeth cannot be the cause of neuralgia, and most likely, such patients have already developed pathology, and the intervention of the dentist only served as an impetus for the onset of pain.

The pain often begins in the area of ​​the upper or lower jaw, and many patients believe that these pains are associated with dental problems. However, dental treatment does not provide pain relief.

Pain in trigeminal neuralgia can be typical and atypical. With typical pain characteristic of trigeminal neuralgia, there are certain periods of remission during the course of the disease. The pain is shooting in nature, similar to an electric shock, and is usually provoked by touching certain areas of the face. Atypical pain is usually constant, it captures a larger part of the face. With this course of the disease, there may not be a period of pain relief. Treatment of such neuralgia is more difficult.

Trigeminal neuralgia is a cyclic disease. Periods of exacerbation of pain alternate with periods of subsidence. Usually the pain lasts certain time With short interval between them. In some patients, pain is observed rarely, once a day. For others, pain attacks are observed every hour. Pain often begins as an electric shock, reaching its peak in 20 seconds and then lasting for some time.

Factors provoking the onset of an attack of trigeminal neuralgia:

• Light touch on the skin
• washing
• Shaving
• Teeth cleaning
• blow to the nose
• Light breeze
• Makeup
• Smile
• Talk

Other diseases are similar to the symptoms of trigeminal neuralgia. These include temporal tendinitis, Ernest's syndrome, and occipital neuralgia. With temporal tendinitis, pain captures the cheek and teeth, there is a headache and pain in the neck. Ernest's syndrome is observed when the so-called stylomandibular ligament, which connects the base of the skull to the lower jaw, is damaged. At the same time, there is also a headache, pain in the neck and face. With neuralgia of the occipital nerve, the pain is usually located in front and behind the head and can sometimes spread to the face.

Diagnosis of trigeminal neuralgia:

Usually the diagnosis of trigeminal neuralgia is made on the basis of the patient's complaints and his examination. In the diagnosis of the cause of neuralgia, magnetic resonance imaging is important. It allows you to identify a tumor or signs of multiple sclerosis. However, other causes that can cause trigeminal neuralgia are rarely detected using magnetic resonance imaging.

Treatment for trigeminal neuralgia:

With trigeminal neuralgia, a decrease or cessation of pain can be achieved with the help of the anticonvulsant drug tegretol, the use of which is started with 200 mg per day, then the dose is increased (200 mg 3-4 times a day). Baclofen is also used (5-10 mg 3 times a day). With symptomatic neuralgia caused by the inflammatory process, the use of resolving therapy and physiotherapy procedures is justified.

With the ineffectiveness of drug therapy, there are indications for surgical treatment. For the treatment of neuralgia of the V nerve, many surgical methods have been proposed, both simple and complex: the intersection of the roots of the V nerve, the removal of the Gasser node.

The purpose of the operation is to block impulses that can cause an attack of neuralgia, or to eliminate the very cause of neuralgia (vascular compression of the root), if any.

Usually they start with simpler interventions - blockades of individual branches of the V nerve, in last turn(especially in the elderly) resort to more complex interventions.

Operations on peripheral branches- novocaine or alcohol blockade of the main peripheral branches.

Blockades or exercise (excision) of peripheral branches usually give a temporary effect (6-12 months).

Blockade of the gasser node is produced by effective and low-traumatic puncture injection of phenol, boiling water into the gasser node or by means of its radiofrequency coagulation.

Retrogasseral transection root of the V nerve with an approach from the middle cranial fossa(Spiller-Frezher operation) or with access from the posterior cranial fossa (Dandy operation) is very traumatic and is rarely used at present.

If the above methods of treatment are ineffective, especially in those cases in which pain persists despite the anesthesia in the face area that has come after previous operations, the Shockvist operation can be used - the intersection of the descending nucleus of the trigeminal nerve in the medulla oblongata.

Vascular decompression of the V nerve root. One of the main causes of trigeminal neuralgia is compression of the V nerve root by an atypically located vessel. In old age, sclerosis and elongation of the vessels occur, as a result of which they can compress the nerve at the point of its entry into the bridge.

The purpose of the operation, which is performed through a small burr hole in the scales occipital bone near the pyramid - to find this vessel (most often it is the upper cerebellar artery) and separate it from the nerve with a Teflon sponge or piece of muscle.

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Recurrent lesion of the trigeminal cranial nerve, characterized by shooting paroxysmal prosopalgia. The clinical picture consists of repeated paroxysms of unilateral intense facial pain. Typically, the alternation of phases of exacerbation and remission. Diagnosis is based on clinical data, results neurological examination, additional studies (CT, MRI). The basis of conservative therapy is anticonvulsant pharmaceuticals. Conducted according to indications surgery: root decompression, destruction of the trunk and individual branches.

ICD-10

G50.0

General information

The first description of trigeminal neuralgia dates back to 1671. In 1756, the disease was separated into a separate nosology. In 1773, the British physician J. Fothergill made a detailed report on the pain syndrome characteristic of the disease. In honor of the author of the report, neuralgia was named Fothergill's disease. In modern neurology, the term "trigeminal (trigeminal) neuralgia" is more often used. According to World Organization health care, the incidence is 2-4 people per 10 thousand population. Pathologies are more susceptible to persons over 50 years of age. Women get sick more often than men.

Causes

For the entire period of etiology research this disease by various authors about 50 causative factors were mentioned. It has been established that in 95% of cases the etiofactor is compression of the trunk and branches of the trigeminal nerve. The main causes of compression are the following:

• Vascular pathology. Expansion, tortuosity, aneurysm of the vessel lying next to the nerve trunk leads to irritation and compression of the latter. The result is pain. Predisposing factors are cerebral atherosclerosis, arterial hypertension.
• Volumetric formations. Cerebral tumors, neoplasms of the bones of the skull, localized in the area of ​​​​the exit of the trigeminal nerve from the cerebral trunk or along its branches, as they grow, they begin to compress the nerve fibers. Compression provokes the development of neuralgia.
• Changes in the structures of the skull. Of etiological significance is the narrowing of the bone canals and holes, which occurs as a result of head injuries, chronic sinusitis, otitis media. Change relative position cranial structures is possible with the pathology of bite, deformation of the dentition.

In some cases, damage to the nerve sheath and fibers is due to herpetic infection, chronic infectious process dentition (periodontitis, stomatitis, gingivitis). In some patients, trigeminal neuralgia is formed against the background of a demyelinating disease. The factors provoking the occurrence of pathology include hypothermia, dental procedures, increased chewing load, in the case of an infectious genesis - a decrease in immunity.

Pathogenesis

The above etiofactors potentiate morphological changes in the sheath of the trigeminal nerve. Studies have shown that structural changes in the myelin sheath and axial cylinders develop 3-6 months after the onset of the disease. Local microstructural disorders provoke the formation of a peripheral generator of pathologically enhanced excitation. Excessive impulsation, constantly coming from the periphery, causes the formation of a central focus of hyperexcitation. There are several theories explaining the relationship between local demyelination and the occurrence of a focus of hyperexcitation. Some authors point to the possibility of transverse interaxonal transmission of impulses. According to another theory, pathological afferent impulses cause damage to the trigeminal nuclei of the cerebral trunk. According to the third theory, at the site of injury, axon regeneration proceeds in the opposite direction.

Classification

Of practical importance is the systematization of the disease in accordance with the etiology. This principle underlies the determination of the most appropriate treatment tactics (conservative or surgical). According to the etiological aspect, trigeminal neuralgia is divided into two main forms:

• Idiopathic (primary). It is caused by vascular compression of the trigeminal root, more often in the region of the brain stem. Due to the difficulties in diagnosing pathological vessel-nerve relationships, idiopathic neuralgia is assumed after the exclusion of other causes of trigeminal pain syndrome.
• Secondary (symptomatic). Becomes the result of neoplasms, infections, demyelinating pathology, bone changes. It is diagnosed according to neuroimaging data, tomography of the skull.

Symptoms

The clinical picture consists of paroxysms of prosopalgia (facial pain), characterized by a series of intense pain impulses coming from the side of the face to the center. Patients describe the pain syndrome as "electric shock", "lumbago", "electric discharge". The attack lasts up to two minutes, repeats many times. Localization of pain depends on the location of the lesion. With the pathology of individual branches, pain impulses occur in the supraorbital region, along the zygomatic arch, and the lower jaw. Damage to the trunk leads to the spread of pain to the entire half of the face. Characteristic is the behavior of patients at the time of paroxysm: they freeze in place, afraid to move, speak. Despite the high intensity of pain, patients do not scream.

Trigeminal paroxysm is potentiated by various external influences: wind, cold air and water, shaving. Since the load on the facial and chewing muscles can act as a provoking factor, patients avoid opening their mouths wide, talking, laughing, and eating hard food. Trigeminal neuralgia is characterized by a recurrent course. There are no paroxysms during the period of remission. Subsequently, symptoms of loss of the function of the trigeminal nerve appear - a decrease in the sensitivity of the skin of the face. The symptomatic form proceeds with a combination of typical pain attacks and other neurological symptoms. Possible nystagmus, symptoms of damage to others cranial nerves, vestibular syndrome, cerebellar ataxia.

Complications

The fear of provoking a neuralgic paroxysm forces patients to chew only with the healthy half of the mouth, which leads to the formation of seals in the muscles of the contralateral part of the face. Frequent paroxysms reduce the quality of life of patients, negatively affect their emotional background, impair performance. Intense excruciating pain, constant fear of another paroxysm can cause the development of neurotic disorders: neurosis, depression, hypochondria. Progressive morphological changes (demyelinization, degenerative processes) cause a deterioration in the functioning of the nerve, which is clinically manifested by sensory deficit, some atrophy of the masticatory muscles.

Diagnostics

In typical cases, trigeminal neuralgia is easily diagnosed by a neurologist. The diagnosis is established on the basis of clinical data and the results of a neurological examination. Main diagnostic criterion the presence of trigger points corresponding to the exit of the nerve ramifications in facial area. The presence of a neurological deficit testifies in favor of the symptomatic nature of the pathology. To clarify the etiology of the lesion, the following instrumental studies are used:

• CT scan of the skull. Allows you to detect changes in size and relative position bone structures. Helps to diagnose the narrowing of the holes and channels through which the trigeminal nerve passes.
• MRI of the brain. Produced to exclude mass formation as a cause of compression nerve trunk. Visualizes tumors, brain cysts, foci of demyelination.
• MR angiography. It is used for targeted verification of the vascular genesis of compression. Informative enough big size vascular loop or aneurysm.

Trigeminal neuralgia differentiates with prosopalgia of the vascular, myogenic, psychogenic nature. The presence of a pronounced vegetative component (lacrimation, swelling, redness) indicates the vascular nature of the paroxysm, typical for cluster headache, paroxysmal hemicrania. Psychogenic facial pain characterized by variability in the duration and pattern of pain paroxysm. To exclude ophthalmogenic, odontogenic and rhinogenic pain syndromes, consultation with an ophthalmologist, dentist, otorhinolaryngologist is required.

Treatment of trigeminal neuralgia

Basic therapy is aimed at stopping peripheral and central focal hyperexcitation. First line drugs are anticonvulsants (carbamazepine). Treatment begins with a gradual increase in dose until the optimum is reached. clinical effect. Maintenance therapy is carried out for a long time for several months, followed by gradual decline dosages. In the absence of paroxysms, it is possible to cancel the pharmaceutical preparation. To increase the effectiveness of treatment anticonvulsants additional medications are used. Complementary therapies include:

• Means that potentiate the effect of anticonvulsants. Antihistamines can help reduce swelling. Antispasmodics contribute to the relief of pain paroxysm. Microcirculation correctors ( a nicotinic acid, pentoxifylline) provide increased oxygenation and nutrition of the nerve trunk.
• Therapeutic blockades. Introduction local anesthetics, glucocorticoid hormones are carried out at trigger points. Medical procedure gives a good analgesic effect.
• Physiotherapy. Effective use of galvanization with novocaine, ultraphonophoresis with hydrocortisone, diadynamic currents. The procedures provide a decrease in the severity of inflammation, have an analgesic effect.

The presence of intracranial formation, insufficient effectiveness of pharmacotherapy are indications for surgical intervention. The expediency of the operation is determined by the neurosurgeon. The basic techniques of neurosurgical treatment are:

• Microsurgical decompression. It is carried out in the area of ​​​​the exit of the nerve from the brain stem. It is necessary to remember about big risk application of the technique in elderly patients, patients with aggravated premorbid background.
• Percutaneous radiofrequency destruction. A modern alternative to open interventions with the intersection of trigeminal branches. A significant disadvantage of the method is the relatively high percentage of relapses.
• Stereotactic radiosurgery. The operation consists in the destruction of the sensory root by directed local gamma radiation. Side effects include loss of sensitivity in the zone of innervation of the destroyed root.

Forecast and prevention

Trigeminal neuralgia does not pose a threat to life, but the attacks of the disease are excruciatingly debilitating. The outcome is determined by the etiology, premorbid background, the duration of the disease. For the first time, trigeminal neuralgia in young patients with adequate treatment has a favorable prognosis. Relapses after surgery are 3-15%. Primary prevention lies in timely therapy inflammatory pathologies of the dentition, ear, paranasal sinuses. Measures secondary prevention are regular monitoring by a neurologist, exclusion of exposure to trigger factors, prophylactic use of anticonvulsants for colds.

The trigeminal nerve is responsible for the sensitivity of most of the human head: the mucous membranes of the nose, mouth, teeth, facial tissues and partially the skull, dura mater.

It got its name because of the branching into 3 main zones: the upper and lower jaw, the eye area. At the same time, the fiber provides not only sensations, but also promotes the movement of a number of muscles.

Certain causes can affect the work of the trigeminal nerve, and the symptoms of a lesion of the trigeminal nerve can cause a powerful pain syndrome.

When considering the reasons disease-causing roots and tissues, the dual nature of the nerve should be taken into account. So, the damage to the fiber responsible for sensitivity occurs through the fault of:

• inflammation of the meninges;
• pressure on the tissues from the vessels;
• tumors of the cerebellum, pituitary gland;
• pathology of the rhomboid brain;
• neuromas;
• multiple sclerosis;
• failures metabolic processes in the body (for example, in diabetes);
• colds;
• atherosclerosis;
• head injury;
• errors in dental procedures;
• oral infections and paranasal sinuses, as well as the body as a whole (tuberculosis, syphilis, etc.).

The motor functions of the trigeminal nerve suffer due to:

• leptomeningitis;
• brain tumors;
• tetanus.

At the same time, damage to the nerve roots signals a malfunction with the help of neuralgia, and physical activity nerve is a predominantly painless condition.

Trigeminal neuralgia is sometimes manifested by unbearable pain. Methods of treatment of the disease are considered in the review.

The main symptoms of the lesion

With the defeat of the roots belonging to the trigeminal nerve, it manifests itself:

• soreness radiating to various zones along the path of the damaged tissue;
• lack of sensitivity of certain areas of the face, mouth;

In addition, hearing impairment and visual reactions, herpetic eruptions are possible.

Similar to the defeat of the trigeminal nerve, symptoms also occur with other anomalies: Charlene's syndrome, Slader's neuralgia, migraine neuralgia, Kosten's syndrome, etc.

If the problem arises with the motor functions of the nerve, then there are failures in the act of chewing food, weakening or excessive compression of the muscles of the jaws. In this case, there are also a number of ailments, with similar symptoms, for example, Thomsen's myotonia.

However, the most frequent complaint when the trigeminal nerve is affected, it is still a pain syndrome. It provokes an attack by touching the so-called trigger zones, which are located individually for each patient, but most often in the area:

• inner corner of the eye;
• nasolabial fold, back or wing of the nose;
• eyebrows
• corner of the mouth;
• buccal mucosa, gums.

call sharp painful feelings able not only to press or lightly touch the skin in the area of ​​​​responsibility of the affected root, but also laughter, a breath of wind, speech, loud noise and even bright light.

The frequency of occurrence of excruciating attacks is unpredictable.

In addition, seizures may be accompanied by additional symptoms:

• discoloration of the epidermis (redness, pallor);
• secretion of physiological fluids (snot, tears).

The more advanced the neuralgia, the stronger the discomfort and the more difficult the treatment to eliminate it.

The pain syndrome in this pathology is characterized by periods of remission, during which there is a feeling that the disease has receded. However, this is a short lull.

Ways to relieve pain

Therapy of pain syndrome in case of damage to the trigeminal nerve - involves not only the elimination of the cause of the pathology (tumor, infection, etc.), but also the elimination of the inflamed fiber. For this are used:

• medicines;
• physiotherapy procedures;
• surgical methods.

The doctor selects an option based on the cause of the anomaly, the degree of its neglect and general condition patient.

Conservative treatment

The leading place in the drug therapy of trigeminal neuralgia is occupied by Carbamazepine. This tool has been used to relieve pain in this pathology since 1962. In addition, it is included in the list of vital drugs approved by the Government of the Russian Federation.

Therapy begins with the use of 0.2 g per day (2 doses of 0.1 g).

Then the dose is increased daily by 0.1 g until reaching 0.6-0.8 g.

After elimination of discomfort, just as slowly, the amount of carbamazepine taken is reduced to 0.1-0.2 g: in this volume, the drug is taken more for a long time after the removal of the pain syndrome, in order to avoid the return of the pathology.

In addition, for the treatment of trigeminal neuralgia, the following are used:

• Baclofen 0.05-0.1 g 3 times a day;
• Amitriptyline 0.25-1 g per day;
• medicines based on Gabapentin (Gabagamma, Tebatin, Katena, etc.) up to 3600 mg / day;
• monamine oxidase inhibitors (for example, Phenelzine).

Drugs may also be used to improve cerebral circulation, sedatives and vitamin complexes.

Physiotherapy

This type of treatment is aimed not only at relieving pain, but also at restoring the normal functioning of the circulatory system, as well as the neuromuscular fiber.

Applicable:

• electrophoresis using analgesics;
• TES-therapy;
• laser radiation;
• acupuncture and reflexology.

As an independent type of treatment, physiotherapy is not used, but is in addition to the drug effect on the pathology.

Surgery

At physiological reasons occurrence of trigeminal neuralgia, apply operational methods therapy:

1. microvascular decompression. The essence of the procedure is the surgical separation of the compressed nerve root and the vessel acting on it, establishing a Teflon gasket between them. The method is effective, but traumatic and with the risk of side effects (hearing loss, stroke, etc.).
2. Destruction of the inflamed nerve with electric current- percutaneous stereotaxic rhizotomy. The needle electrode is inserted into the desired location and a discharge is applied.
3. In a similar way, percutaneous glycerin rhizotomy is performed, which relieves pain through the elimination of nervous tissue with glycerin.
4. Radiosurgery using cyber or gamma knife. Advantages of the operation: painlessness, no hospitalization, quick recovery.
5. Percutaneous balloon compression - the destruction of the nervous tissue by inflating a hollow plane that breaks the inflamed fiber. Produced under the control of CT or MRI.

Unfortunately, even surgical intervention in some cases, it can only have a short-term effect.

The nervous system is usually divided into two sections - peripheral and central. The brain and spinal cord are classified as central, the nerves of the back and head are directly connected with the central nervous system and represent peripheral department. Nerve impulses from all parts of the body are transmitted precisely through the central nervous system to the brain, and feedback is also carried out.

Anatomy of the trigeminal nerve

There are twelve pairs of cranial nerves in the human body. The trigeminal nerve system is the fifth pair and is divided into three branches, each of which is directed to a specific area - the forehead, lower jaw and upper. The main branches are divided into smaller ones, which are responsible for transmitting signals to parts of the face. The anatomy of the trigeminal nerve looks like a system of nerve endings that originates from the pons. The sensory and motor roots form the main trunk directed towards the temporal bone. The branch layout looks like this:

1. orbital;
2. branch upper jaw;
3. mandibular;
4. trigeminal ganglion.

With the help of these branches, impulses are transmitted from the nose, eyes, oral mucosa and skin to the main nerve trunk.

Where is the nerve located: layout on the face

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Originating in the cerebellum, the trigeminal nerve has many small branches. They, in turn, connect all the muscles of the face and the areas of the brain responsible for them. Control various functions and reflexes is carried out with the help of close connection with spinal cord. The trigeminal nerve is located in temporal region- smaller branching endings diverge from the main branch in the temple area. The branching point is called the trigeminal node. All small branches connect the organs of the anterior part of the head (gums, teeth, tongue, mucous membranes of the nasal and oral cavities, temples, eyes) with the brain. The location of the nodes of the trigeminal nerve on the face is shown in the photo.

Functions of the facial nerve

Sensory sensations are provided with the help of impulses that transmit nerve endings. Thanks to the fibers nervous system a person is able to feel touch, feel the temperature difference environment, control facial expressions, carry out various movements with lips, jaws, eyeballs.

If we consider in more detail what the trigeminal nerve system is, we can see the following picture. The anatomy of the trigeminal nerve is represented by three main branches, which are further divided into smaller ones:

Neuralgia as the main pathology of the nerve

What is trigeminal inflammation? Neuralgia, or as it is commonly called - facial neuralgia, denote the development of inflammatory processes in the tissues of the trigeminal nerve.

The causes of pathological processes affecting the branches and branches of the trigeminal nerve can be viral and bacterial diseases, such as herpes, poliomyelitis, HIV, sinusitis, diseases of the upper respiratory tract.

The exact factors for the occurrence of pathology have not yet been studied, although the main causes of the disease are known:

1. infectious diseases that provoke the formation of adhesive processes in the tissues;
2. the formation of scars on the skin, on the temporal and jaw joints as a result of injuries;
3. development of tumors at the points of passage of nerve branches;
4. congenital defects in the location and structure of the vessels of the brain or cranial bones;
5. multiple sclerosis leading to partial replacement nerve cells connective tissue;
6. pathologies of the spine (for example, osteochondrosis), provoking an increase in intracranial pressure;
7. violation of the function of blood circulation of the vessels of the head.

Symptoms of inflammation

Inflammatory process branches of the trigeminal nerve affects the nerve fibers individually or several together, pathology can affect the entire branch as a whole or only its sheath. The facial muscles acquire excessive sensitivity and react even to a light touch or movement with bouts of burning acute pain. Frequent symptoms inflammation of the trigeminal facial nerve are:

• exacerbation pain and increased frequency of attacks in the cold season;
• attacks most often begin suddenly and last from two to three to thirty seconds;
• pain syndrome occurs in response to various stimuli (brushing teeth, chewing movements, touching);
• the frequency of attacks can be the most unpredictable - from one or two a day to the onset of severe pain every 15 minutes;
• a gradual increase in pain and an increase in the occurrence of seizures.

The most common is unilateral inflammation of the trigeminal nerve. With the rapid growth of wisdom teeth, pressure is exerted on nearby tissues, and neuralgia may be the result. There is an involuntary profuse salivation, secretion of mucus from the sinuses, convulsive contractions of the facial muscles. Patients try to avoid eating or talking so as not to provoke the onset of another attack. In some cases, its onset is preceded by a feeling of numbness and tingling of the facial muscles, paresthesia occurs.

Complications

If you ignore the signs of the onset of trigeminal nerve disease, over time you can get a number of complications:

Diagnostics

Diagnosis of inflammation of the trigeminal nerve is carried out by a specialist and includes an anamnesis and examination with an assessment of the localization of pain. According to the results initial examination, the doctor decides on the need for comprehensive examination, directing the patient to undergo computer diagnostics and MRI (magnetic resonance imaging). Electroneuromyography or electroneurography may be prescribed. It is recommended to get advice from an ENT specialist, dentist and surgeon.

Of great importance is the frequency of occurrence of seizures, as well as the actions, direction and strength of their provoking. The place where the main nerve passes plays the most important role. Examination is carried out by a doctor both during remission and during exacerbation. This is done to more accurately determine the state of the trigeminal, dental and other nerves of the face, which branches of the trigeminal nerve are most affected. An important factor is the assessment of the mental state of the patient, the state skin, the presence or absence of muscle cramps, pulse and blood pressure readings. Neuralgia can be provoked by painful and traumatic removal of a wisdom tooth.

Ways to treat neuralgia

For successful treatment of trigeminal inflammation, a comprehensive A complex approach. It is necessary not only to eliminate the symptoms, but also to get rid of the factors that provoked the onset of pathology. The complex of measures includes treatment with medicines, massotherapy and a course of physiotherapy.

• Therapy medicines implies a blockade intramuscular injections reducing muscle spasm.
• At viral nature inflammation of the trigeminal nerve are prescribed antiviral tablets.
• To reduce discomfort and relieve pain, the doctor prescribes painkillers.
• The complex of drug therapy includes the use of non-steroidal anti-inflammatory drugs that act specifically on the inflammation process.
• To relieve convulsive syndrome and other discomfort anticonvulsant tablets, muscle relaxants, antihistamines, antidepressants and sedatives are used.
• We must not forget about the support of immunity weakened by the disease and the central nervous system. It is necessary to take a complex of vitamins, special attention is paid to B vitamins, which have a strengthening effect on the nervous system.

The course of physiotherapy is carried out using the following procedures:

With the help of magnetic fields and high-frequency currents, the function of blood circulation is restored, muscles are relaxed. The use of electrophoresis with drugs has proven itself well in the fight against inflammation of the trigeminal nerve.

In addition to physiotherapy and drug therapy, a specialist may decide that therapeutic massage is necessary. The course of massage makes it possible to return the lost tone to the muscles and achieve their maximum relaxation. The massage course for inflammation of the trigeminal nerve consists of 14-18 procedures that should be performed every day.

Traditional medicine offers its own methods of treatment in the event that inflammation occurs. Inflamed triple (ternary) ganglion causes the patient not only discomfort, but may also lead to the development various complications. The scheme of treatment with folk remedies is the use of compresses, rubbing, therapeutic applications on the affected area. It is not recommended to warm the triple inflamed area, so all products should be cooled to room temperature before use. Warming up is recommended only during remission. To do this, heat the salt in a tissue bag and apply it to the site of inflammation.

Used to prepare medicines fir oil, marshmallow root, chamomile flowers. If the chewing teeth are inflamed, during the period of remission, a treatment method is used using chicken egg. It should be understood that the treatment of serious diseases should be carried out under the supervision of a specialist, the use traditional medicine possibly as a helper method.

The trigeminal nerve is one of the largest cranial nerves, extending to the area of ​​​​the teeth, touching most of the face. It happens that by various reasons this nerve can be affected, resulting in a disease, usually neuritis, which significantly reduces its functionality. It is worth being aware of the symptoms of trigeminal nerve injury that may occur.

Anatomy of the trigeminal nerve

It is worth talking a little about what the trigeminal nerve is. It's a nerve mixed type: from the trigeminal node, located at the level of the temple, three main branches emerge, the ophthalmic, maxillary and mandibular nerves. Three branches provide normal sensitivity to most of the tissues of the face, part of the tissues of the cranial vault, mucous membranes of the mouth and nose.

In addition, the nerve has a motor part, which provides chewing and a number of other muscles with nerve cells. Thus, the trigeminal nerve plays a large role in ensuring the normal functioning of the face. For a number of reasons, branches can experience failures that cause various symptoms. If treatment is not started on time, disruptions in work can become permanent.

With the defeat of one of the branches or several, a condition called neuralgia immediately occurs. Most often, neuralgia is caused by compression, which can occur for the following reasons:

• various brain tumors and other neoplasms;
• an aneurysm, a lack of normal expansion of an artery adjacent to a nerve
• misalignment of blood vessels leading to squeezing certain parts organ.

Compression is a common, but not the main cause of neuralgia. There are also various injuries infectious lesions And side effect some medicines.

Lesion after tooth extraction or any other manipulation in the oral cavity is also common. In addition, during dental treatment, bacterial infection capable of provoking the development of neuralgia.

Other infections that can cause neuralgia or neuritis include tetanus and meningitis. There is also a lesion of the trigeminal nerve with herpes, the virus is able to be in the sensitive ganglia of the nervous system, affecting the facial branches as well.

Trigeminal nerve injury on the face after chemotherapy is a less common condition, but can act as a complication, side effect treatment. Also, disturbances in functioning can be provoked by other drugs if taken inappropriately.

Important! Sometimes exact reason lesions can only be established by a specialist after a complete examination.

Symptoms

The location of pain and other symptoms in neuralgia depends on which branch was affected. With the defeat of several branches at once, the symptoms may be combined. You should pay attention to the following signs, movement disorders with damage to the trigeminal nerve, they manifest themselves in this way.

1. When the first branch is affected, the sensitivity of the skin of the forehead and scalp in front is disturbed, the sensitivity of the eyelid, the eyeball from the side of the lesion is disturbed. The brow reflex decreases, facial expressions become less pronounced.
2. When the second branch is affected, the sensitivity of the skin of the lateral part of the face, the lower eyelid and corner of the eye, the teeth of the upper jaw, and the mucous membrane in the lower part of the nasal cavity is disturbed.
3. With the defeat of the third branch, there are violations of sensitivity in the lower jaw, lower lip and skin of the chin, disorders in the functioning of the facial muscles. There is paralysis of the masticatory muscles, atrophy may develop, as a result of which the face may lose its usual contours.

There may also be convulsions in the jaw area, muscle paralysis. If the sensitive part of the nerve is damaged, acute pain may occur, spreading along the affected branch.

When diagnosing a disease, they check sensitivity, press on the nodes facial nerves checking if soreness is present. When examining violations in motor function see if it moves lower jaw when opening the mouth. Additional methods for assessing the condition of nerve branches and muscles can be used.

It is also important to identify the cause of the lesion of the trigeminal nerve, the subtleties of treatment may depend on this. If obvious reason there is no pain, paralysis and numbness, additional studies are required. You may need a blood test, X-ray, MRI and others.

Important! If you do not treat the lesion in time, it will be extremely difficult to restore muscle tone.

Treatment

Depending on the causes that provoked nerve damage, treatment is selected. It may include taking medications, physiotherapeutic procedures, surgical intervention.

First of all, they try to apply various drugs, relieving cramps and pain, if present. These medicines are available for treatment at home after consultation with a specialist, are used following groups drugs:

1. Anticonvulsants. They reduce the activity of nerve cells, resulting in reduced pain and other symptoms. Usually prescribed Carbamapezin, Difenin, drugs based on valproic acid.
2. Pain-relieving anti-inflammatory drugs. Usually used in the form of tablets and injections. The most common are Diclofenac, Tramadol, Voltaren.
3. B vitamins. They help to quickly restore muscle activity and normal functioning nerve.

Depending on the concomitant diseases may be appointed additional drugs. For better assimilation of anticonvulsants and painkillers, antihistamines are used, for circulatory pathologies - drugs that improve cerebral circulation.

If the disease occurs in a child, care should be taken with the selection of drugs. In children, they try to treat this disease with physiotherapy and reduce the amount of medication to a minimum.

Various physiotherapeutic procedures can be recommended: novocaine electrophoresis, ultrasound, acupuncture and others. They are designed to improve blood circulation, relieve inflammation and pain. IN rare cases to relieve pain, it is necessary to resort to surgical intervention, this is done if drug therapy and physiotherapy do not bring a visible result.

It is also worth preparing for the fact that the treatment of a lesion of the trigeminal nerve can be quite long, the functions of the facial muscles and sensitivity will return gradually. It is necessary to follow all the recommendations of the doctor so that the treatment leads to noticeable results.