Trigeminal neuralgia, Seminar ENT Block 5.6, College of Medicine, King Faisal University, Al-Ahsa, Saudi Arabia

1. Trigeminal Neuralgia
Abdullatif Sami Al Rashed
ENT Block 5.6
College of Medicine, KFU
Al-Ahsa, Saudi Arabia

2. Anatomy of Trigeminal Nerve

3. Introduction
 Idiopathic trigeminal neuralgia is marked by
paroxysms of intense, stabbing pain on one
side of the face (tic douloureux).

4. Clinical Features
 recurrent episodes of sudden onset, excruciating
unilateral paroxysmal shooting “electric” pain in
trigeminal root territory (V3>V2>>V1)
 may have normal sensory exam
 pain lasts seconds/minutes over days/weeks; may
remit for weeks/months
 triggers:
 touching face, eating, talking, cold wind, shaving,
applying make-up

5. Etiology
 classic TN: idiopathic
 secondary TN: compression by tortuous blood
vessel (superior cerebellar artery),
cerebellopontine angle tumor (5%), MS (5%)

6. Epidemiology
 F>M; usually middle-aged and elderly

7. Diagnosis
 clinical diagnosis
 investigate for secondary causes, which are
more likely if bilateral TN or associated
sensory loss:
 MRI to rule out structural lesion, MS, or
vascular lesion

8. Treatment
 first line: carbamazepine or oxcarbazepine
 second line: baclofen or lamotrigine
 narcotics not generally recommended
 if medical treatment fails:
 Gasserian ganglion percutaneous technique,
 gamma knife,
 invasive percutaneous denervation
(radiofrequency/glycerol),
 percutaneous balloon microcompression,
 microvascular decompression

10. THANK YOU 