A Patient's Guide to Trigeminal Neuropathies

The following article provides information about trigeminal neuropathies, how it develops, manifests in the body, and possible diagnosis and treatments.

Trigeminal neuralgia (TN) is a condition in which seemingly innocuous activities can bring excruciating pain for the patient. The pain has the potential to exhaust a person physically and emotionally. Imagine going about your morning routine of washing your face, brushing your teeth, or drinking your coffee when suddenly you get a stabbing pain in your face. The discomfort is most prominent along lower face or jaw, but it can manifest in the nose, mouth, or the area surrounding the eye. Individual attacks can last up to two minutes and occur multiple times daily.

What is Trigeminal Neuropathy?

Trigeminal neuropathies (TN), is a severe form of pain experienced in one side of the face. In most cases, the discomfort is localized in the lower cheek and jaw, although it can sometimes spread to the region around the nose and above the eye. Irritation of the trigeminal nerve, which has branches that run to the forehead, face, and lower jaw, is the root cause of this excruciating pain that cuts like a knife and feels like an electric shock. Something as mundane and inconsequential as brushing your teeth, eating, or even a breeze could trigger the pain. Trigeminal neuralgia can steadily deteriorate one’s health if not treated, although initial attacks may be moderate and relatively brief.

There is presently no known cure for trigeminal neuralgia; however, there are therapies that can help lessen the excruciating pain caused by the condition. Medications that prevent seizures are typically effective for TN. Surgery is another viable treatment option for patients do not respond to prescribed medications or experience severe adverse effects from prescribed drugs.

What is the Trigeminal Nerve?

The word "trigeminal" comes from the Latin words "tria," meaning three, and "genius," meaning twin. Every one of these nerves divides into three separate parts. After leaving the brain and traveling inside the skull, the trigeminal nerve splits into three smaller branches responsible for controlling feelings throughout the face. One of the sets of cranial nerves found in the head is called the trigeminal nerve. The nerve supplies the face with feeling. The right side of the head is served by one branch of the trigeminal nerve, whereas the other branch administers the left side. These branches are as follows:

The ophthalmic nerve manages sensation in the eye, upper eyelid, and forehead.

The maxillary nerve manages sensation in the, nostril,upper lip, upper gum, cheek, lower eyelid, and upper lip.

The mandibular nerve manages sensation in the, lower gum, some of the muscles used for chewing, lower lip, and jaws.

How Does Trigeminal Neuralgia Feel Like?

It can be there for a bit and goes away, or it can be persistent, depending on how well it's controlled or how long it's developed. The pain appears like the sensation of a hot poker jabbed in your face; it's a burning, scorching ache. Some women have compared the pain of TN to that of childbirth, while some males have compared it to the discomfort of having a broken bone.

Unlike other pains, it is not clear why or when the pain starts. Yadav & Shrestha (2017) stated that some people blame the discomfort on the aftermath of a vehicle accident, a facial injury, or dental surgery. However, few dentists believe dental procedures can induce TN. In most cases, the condition developed before it was triggered by a dental practice or an accident. TN pain may initially be confused with dental or jaw pain. However, TN pain is distinguished from pain experienced in the dentist's chair by several characteristics, including piercing and electric-like spasms. Han et al. (2020) stated that TN patients might experience ten to fifty separate episodes of discomfort per day, with each episode lasting from a few seconds to two minutes. Although t you might not feel any discomfort between episodes, some people might experience what is described as a "continuous low level of moderate to severe background pain."

Cause of Trigeminal Neuralgia

It is unknown what causes TN; nevertheless, many specialists believe it is caused by contact between a healthy artery and the trigeminal nerve. Kipp et al. (2017) observed that this contact causes inflammation, resulting in nerve damage because it loses its myelin coating. The myelin sheath is an insulation surrounding the nerves and enables electrical impulses to transport signals along with nerve cells efficiently and swiftly. Hanani & Spray (2020) stated that damage to the myelin sheath cause an increase in electrical activity in the trigeminal nerve, which in turn activates the parts of the brain that process pain.

Less common root of trigeminal neuralgia includes a tumor that presses on the trigeminal nerve. The pressing causes the myelin sheath of the TN to deteriorate, leading to abnormality in the blood vessels in the brain, or a stroke.

Diagnosis

Because no test can conclusively indicate whether or not a person has TN, you can draw the diagnosis from the excruciating pain. However, it is essential to determine the cause of your discomfort because therapies for various forms of facial pain can differ. To conclude, your primary care physician, neurologist, neurosurgeon, and oral surgeon will pay close attention to how you describe your symptoms, compile a comprehensive medical and family history, and complete a neurological exam. Your physician may also arrange a CT scan or an MRI to rule out other possible diagnoses. It will ensure that you do not have a tumor pushing on the trigeminal nerve or any other medical condition that can cause TN.

How to Treat Trigeminal Neuralgia

The discomfort caused by a pinched trigeminal nerve can be alleviated with medication, although the effects of the drug may become less effective over time. Because many medicines work by slowing down the electrical conduction of pain, they can also influence your thinking and walking, making you tired. It is one of the potential side effects. You need to make sure that your doctors are aware of any adverse effects that may be caused by your medicine.

Medications can perform effectively for a short period before losing their effectiveness entirely; the medicines don't affect the mechanism generating the nerve pain in some people.

Surgical Treatment

Although neurosurgery treatments for TN have proven clinical effectiveness in roughly 60–90 per cent of instances, patients may experience problems or eventual pain return after undergoing these procedures. As a stand-alone treatment for TN, MVD has an 80 per cent success rate over the long term despite being the most intrusive surgical procedure available to treat TN.

Conclusion

If you decide to undergo surgical treatment for TN, choose a medical professional who cares for your pain situation. Trigeminal neuralgia cannot be cured or prevented by lifestyle changes or adopting a healthier diet. However, lifestyle change can enable the patient to cope with TN pain and regular discomfort effectively. Notably, several other conditions might manifest as TN. Therefore, if you experience sharp episodes of excruciating pain, you must seek medical advice to ascertain the type of pain you experience.

References

Han, A., Montgomery, C., Zamora, A., Winder, E., Kaye, A., Carroll, C., ... & Kaye, A. (2022).             Glossopharyngeal Neuralgia: Epidemiology, Risk factors, Pathophysiology, Differential             diagnosis, and Treatment Options. Health Psychology Research, 10(3).

Hanani, M., & Spray, D. C. (2020). Emerging importance of satellite glia in nervous system             function and dysfunction. Nature Reviews Neuroscience, 21(9), 485-498.

Kipp, M., Nyamoya, S., Hochstrasser, T., & Amor, S. (2017). Multiple sclerosis animal models:   a clinical and histopathological perspective. Brain pathology, 27(2), 123-137.

Yadav, S. K., & Shrestha, S. (2017). A study on posttraumatic experience of road traffic accident             afflicted maxillofacial trauma patient at tertiary hospital. Journal of natural science,             biology, and medicine, 8(1), 40.