An intense painful neurologic condition affecting one or more branches of the 5th cranial nerve (trigeminal nerve)

May experience sudden paroxysm of lancinating or elctric shocklike facial pain.

Pain is precipitated by trigger points that fire when the patient talks, shaves, eats, touches the face, brushes the teeth, or is exposed to cold wind

Trigeminal neuralgia

Unknown cause degenerative or viral origin V1 - opthalmic branch (pain involving eye & forehead) V2 maxillary branch (pain on cheek, upper teeth, upper gums, & nose V3 mandibular branch (pain on lower jaw, side of the tongue, lower teeth, lower gums, extends to ear)

Pathophysiology

 Compression from artery adjacent to the nerve strips myelin fromnerve when it pulsates Loss of myelin acts like an uninsulated wire that fires abnormally in response to stimuli

Sudden, severe episodes of intense facial pain localized to one or more of the branches of the nerve,lasting less than 30 to 60 seconds & ending abruptly. Spontaneous pain or precipated by activattion of trigger point (touching face, talking, chewing, yawning, brushing the teeth, placing pressure on the terminsl end of the branch affected Pain is always unilateral & does not cross the midline. Bilateral sometimes seen w/ MS Some experience numbness, particularly around the mouth.

S/S

Hx of charcateristic symptoms & pattern Neurologic examination CT scan, MRI, skull x-ray to rule out structural lession such as tumor, arteriovenous malformation, MS, or other disorder Important to rule out atypical facial pain, vasomotor, or postherpetic neuralgia, & dental pain Initial response to pharmacologic tx in the major cases

DX Eval

Carbamazepine (Tegretol) - 1st & most effective medication used to treat condition Others mipramine (Tofranil), phenytoin (Dilantin), baclofen (Lioresal), dival proex (Depakote), or gabapentin (Neurotin) may be added or subtituted over time Pain generally respond to medication, gradually becomes refractory over time or patient suffer undesirable adverse effcet

Managemnet

Surgical Alcohol, phenol block, or glycerol injection for pain may last several months after injection Percutaneous radiofrequency trigeminal gangliolysis low voltage stimulation of nerve by electrode inserted through the foramen ovale sensory fucntiom destroyed but preserve motor function; may cause decreased corneal sensation if V1 affected ; paresthesia, jaw weakness undesirable, painful numbness (anaesthesia dolorosa) ----pain may recur as nerve regenerates , necessitating repeat procedure

Mngmnt

Rhizotomy (transection of nerve root at gasserian ganglion) causes complete loss of sensation, other complication include burning, stinging, discomfort in and around the eye, herpetic lesion of face, keratitis, and corneal ulceration. Pain reccur as nerve regenrates

Percutaneous baloon microcompression to selectively injure myelinated fibers that mediate light touch & trigger pain in all three sensory branches of the nerve relieves pain in opthelmic branch while sparing corneal snsation

Microvascular decopression of trigeminal nerve most effcetive form of therapy 75% to 80% are pain free without need for medication long-term after procedure Tx of choice for younger px who are good anaesthesia risk do not want facial numbness & willing to accept craniotomy

Anorexia & weight loss Dehydration anxiety/fear depression/social isolation/suicidal ideation in extreme cases

Complication

Take Hx of pain, including duration, severity, & aggraviating factor Assess nutritional status & hydration Assess for anxiety & depression, including problem with sleep, social interaction, coping ability/ skills

Nursing assessment

Chronic pain related to physiologic changes of the disorder Imbalance nutrition; less than body tempearture related to fear of eating Powerlessness related to lack of control over painful episodes

Nursing Dx

Relieving pain Review potential trigger factors, & develop individualized methods of coping w/ identified triggers Take medication regularly, including rescue medication for breaktrough periods Small, frequent foods to avoid fatigue & pain Nutritional supplments if needed

Nursing management

Maximize nutritional intake, foods and fluid at room temp. , chew to unaffcted part Consult dieticia for meal texture & composition

incresaing control Support px through tx trials Relaxation technique relaxation breathing, progressive muscle relaxation, gieded imagery to relieve tension Encourage participation in support groups & faciliate therapeutic relatioship w/ healthcare provider

Education & health Mx Educate px regarding selfcare after denervation procedure Use mirror, ceheck eye for redness & foreign body 3-4x daily if corneal sensation is impaired Eyedrops 4x/day for loss of corneal sensation Avoid hot liquids using straw Chewing to unaffected side to avoid biting tongue , lips & inside of mouth Avoid denture refitted jaw muscle will regenerate over time

Maintain regular check-up pain will not be felt with carries Instruct to report any changes insensation