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Introduction
Definition
Tic douloureux
Aetiology
Pathogenesis
General characteristics
Clinical characteristics
Diagnosis
Treatment modalities
Management
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asually idiopathic
Demylination of the nerve
Multiple sclerosis
Petrous ridge compression
Post ² traumatic neuralgia
Intracranial tumours
Intracranial vascular abnormalities
Viral etiology
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Incidence: 8 : 1,00,000
Age: 5th ² 6th decade of life
Sex: Female > male ; 1.6 > 1.0
Division of trigeminal
nerve involvement: V3 > V2 > V1
4ain distribution in trigeminal
neuralgia
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anifests as a sudden, unilateral, intermittent
paroxysmal, sharp, shooting, lancinating, shock like
pain, elicited by slight touching superficial ¶trigger
points· which radiates from that point, across the
distribution of one or more branches of the
trigeminal nerve.
Cutaneous Intraoral
Corner of the lips Teeth
Cheek Gingivae
Ala of the nose Tongue
Lateral brow
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MEDICAL SaRGICAL
TENS- [
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It is the first line approach for most of the patients.
CARBAMAZEPINE:
Trade name: Tegretol
Carbitrol
Dosage: 100 ² 2000 mg/day
Side effects: visual blurring
dizziness
skin rashes
rarely hepatic dysfunction, leukemia,
thrombocytopenia, aplastic anemia
PHENYT IN:
It is a GABA agonists.
These drugs reduces the central projection painful
afferent impulses.
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(B) ALC H L INÚECTI N:
0.5 ² 2 ml of 95 % absolute alcohol can be used
to block the peripheral branches of the
trigeminal nerve.
Aim is to destroy the nerve fibres.
It produces total numbness in the region of
distribution of the nerve that was
anaesthetized.
Complication:
Necrosis of the adjacent tissue
jibrosis
Alcohol induced neuritis
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PERIPHERAL GLYCER L INÚECTI N;-
1. swellings
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PERIPHERAL NEaRECT MY (NERVE AVaLSI N):
Oldest & most effective peripheral nerve destructive method
Can be repeated & relatively reliable technique.
It acts by interrupting the flow of a significant number of
afferent impulses to central trigeminal apparatus.
4erformed commonly on infraorbital, inferior alveolar, mental
and rarely lingual.
Disadvantage:
ay produce
full anaesthesia
deep hypoesthesia
INFRA RBITAL NEaRECT MY:
ëi) Conventional intraoral approach
ëii)Braun·s transantral approach
Ä
. loss of sensation
2. edema
3. bruising
CRY THERAPY:
Barnard first used cryotheraphy in 1981 for
the treatment of the trigeminal neuralgia.
After identifying the affected nerve , it is
then exposed to the cryoprobe intraorally.
Direct application of cryotheraphy probe at
temperatures colder than -60 C are known to
produce Wallerian degeneration without
destroying the nerve sheath itself.
Nerve is exposed for 2 mins freeze followed
by 3 mins thaw cycle.
The freeze ² thaw cycle is repeated at least 3
times.
ahnama and Gaweda used peripheral cryotherapy
as a first line procedure if TENS and
pharmacotherapy were not effective. However ,
cryotherapy is usually performed in patients who
wish to avoid VD or whom VD is contraindicated.
- Other complications ²
- brainstem infarction
- ipsilateral deafness of neural origin
- leak of CSj
GASSERIAN GANGLI N PR CEDaRES:
Technique:
The patient is sedated with a short
acting sedative and vital signs are
monitored.
The electrode is inserted through the
cheek under fluoroscopy into foramen
ovale.
The patient is awakened briefly to
accurately locate the position of the
electrode.
Indication:
Toxicity of drugs
jailure of response to the other modalities
Dependence on the drugs for life time.
Elderly patients
edically compromised patients
Advantages:
Simple technique
Lower incidence
of anaesthesia
dolorosa
Complication:
Technique:
A no. 4 jogarthy·s catheter is introduced with
fluoroscopic guidance.
A 0.7 mm balloon is inflated for 1 ² 2 minutes.
STERE TACTIC RADI SaRGERY (GAMMA KNIFE):
Indications:-
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