general information
The trigeminal nerve consists of sensory and motor fibers. It originates in the structures of the brain and is divided into three branches:
- ophthalmic: responsible for the eye, forehead and upper eyelid;
- maxillary: innervates the area from the lower eyelid to the upper lip;
- mandibular: involves the chin, lower jaw, lips and gums.
With neuralgia, one or more branches of the trigeminal nerve are affected, which determines the main symptoms of the pathology. People over 45 years of age are most susceptible to the disease, and women get sick more often than men.
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The jaw hurts and clicks after prosthetics or dental treatment
Dysfunction of the temporomandibular joint. The lower jaw is connected to the skull by two temporomandibular joints. Impairment of the function of these joints is possible after the installation of a denture, crown, bridge, any treatment or tooth extraction if this leads to malocclusion and/or damage to the temporomandibular joint. This is a typical complication after dental prosthetics. Read more about treating TMJ dysfunction here
Temporomandibular joint dysfunction
The green arrow indicates a healthy joint. The red arrow points to the joint that remains in the “open” position when the mouth is closed. This leads to wear and tear of the articular cartilage, pain and clicking when opening and closing the mouth. One of the reasons is the incorrect position of the upper right “eight” (tooth 1_8 lies horizontally).
How can we help you:
- Anti-inflammatory treatment will help relieve pain. If necessary, we inject anti-inflammatory medication directly into the lower jaw joint . This brings relief within a few minutes .
- Injection of botulinum toxin preparations (for example, Botox or Dysport) into spasmodic muscles. This is relevant in the case of an excessive increase in the tone of the masticatory muscles, if it is the muscles that are the “culprit” of dysfunction of the temporomandibular joint.
- Treatment by an osteopath. An osteopath works with the joints and muscles of the jaw using gentle manual techniques. This way you can solve a lot of problems that cannot be solved in classical dentistry. More about osteopathy
- Introduction of chondroprotectors (medicines for nutrition and restoration of cartilage) into the temporomandibular joint. Read more about cartilage restoration
Causes
The causes of trigeminal neuralgia can be of different nature:
- compression of the entire trigeminal nerve or its branches against the background of: enlargement of the arteries or veins of the brain (aneurysms, atherosclerosis, strokes, increased intracranial pressure due to osteochondrosis, congenital developmental features);
- tumors of the brain or facial tissues in close proximity to nerve fibers;
- congenital anomalies of bone structure, narrowed openings through which nerve branches pass;
- injuries of the skull, facial area: bone fractures, post-traumatic scars of soft tissues;
- proliferation of scar tissue after injury, surgery, inflammation;
The risk of developing trigeminal neuralgia increases significantly:
- over the age of 50;
- against the background of mental disorders;
- with regular hypothermia;
- with insufficient intake of nutrients and vitamins into the body (anorexia, bulimia, malabsorption, etc.);
- with regular overwork, stress;
- for helminthic infestations and other helminthiases;
- for acute infections: malaria, syphilis, botulism, etc.;
- for chronic inflammation in the oral cavity (caries, gingivitis, abscesses, etc.);
- against the background of autoimmune lesions;
- with excessive exposure to allergies;
- for metabolic disorders.
INDICATIONS FOR REMOVAL:
- the molar is impacted (unerupted) or dystopic (occupies an incorrect position in the jaw), which injures the soft tissues and neighboring teeth, interferes with their normal development or contributes to destruction;
- extensive damage by caries, the crown is significantly destroyed (while the tooth itself occupies an incorrect position in the dentition);
- pulpitis, periodontitis; (if access to the root canals is limited and the doctor obviously sees that it is not possible to properly process the canals)
- the presence of chronic inflammation of the mucous membrane of the “hood” - pericoronitis;
- the trigeminal nerve is pinched;
- orthodontic treatment is planned
- cysts or tumor-like neoplasms detected
Symptoms
The main characteristic symptom of trigeminal neuralgia is paroxysmal pain. It comes suddenly and in its intensity and speed of spread resembles an electric shock. Typically, intense pain forces the patient to freeze in place, waiting for relief. The attack can last from a few seconds to 2-3 minutes, after which there is a period of calm. The next wave of pain may come within hours, days, weeks or months.
Over time, the duration of each attack of neuralgia increases, and periods of calm are reduced until a continuous aching pain develops.
The provoking factor is irritation of trigger points:
- lips;
- wings of the nose;
- eyebrow area;
- middle part of the chin;
- cheeks;
- area of the external auditory canal;
- oral cavity;
- temporomandibular joint.
A person often provokes an attack when performing hygiene procedures (combing hair, caring for the oral cavity), chewing, laughing, talking, yawning, etc.
Depending on the location of the lesion, the pain takes over:
- the upper half of the head, temple, orbit or nose if the ophthalmic branch of the nerve is affected;
- cheeks, lips, upper jaw – if the maxillary branch is affected;
- chin, lower jaw, as well as the area in front of the ear - with neuralgia of the mandibular branch.
If the lesion affects all three branches or the nerve itself before it is divided, the pain spreads to the entire corresponding half of the face.
Painful sensations are accompanied by other sensory disturbances: numbness, tingling or crawling sensations. Hyperacusis (increased hearing sensitivity) may be observed on the affected side.
Since the trigeminal nerve contains not only sensory, but also motor pathways for the transmission of impulses, with neuralgia the corresponding symptoms are observed:
- twitching of facial muscles;
- spasms of the muscles of the eyelids, masticatory muscles;
The third group of manifestations of neuralgia are trophic disorders. They are associated with a sharp deterioration in blood circulation and lymph outflow. The skin becomes dry, begins to peel, and wrinkles appear. Local graying and even hair loss in the affected area is observed. Not only the scalp suffers, but also the eyebrows and eyelashes. Impaired blood supply to the gums leads to the development of periodontal disease. At the time of the attack, the patient notes lacrimation and drooling, swelling of the facial tissues.
Constant spasms of muscle fibers on the diseased side lead to facial asymmetry: narrowing of the palpebral fissure, drooping of the upper eyelid and eyebrow, upward movement of the corner of the mouth on the healthy side or drooping on the diseased side.
The patient himself gradually becomes nervous and irritable, and often limits himself to food, since chewing can cause another attack.
Pain due to inflammation
In addition, a disease such as inflammation or neuritis of the facial trigeminal nerve makes itself felt with attacks of pain of a very diverse nature:
- cutting,
- burning,
- pricking,
- tearing
- shooting, etc.
In this case, the area of pain does not always correspond to the area of innervation and can spread to the lower jaw, cheeks and chin.
Pain may be accompanied by:
- muscle spasms (facial, chewing),
- the appearance of nasal discharge,
- development of hypersalivation,
- increased lacrimation.
Lack of sensation in the tongue, lips and chin
With inflammatory damage to the trigeminal nerve, not only the entire nerve can be damaged, but also its individual branches. This is why numbness and pain can occur in various areas of the face. For example, when the lingual branch of the nerve is inflamed, patients complain of pain and sensitivity disturbances in the anterior part of the tongue, and when the mental branch is damaged, in the area of the lips and chin.
Pain when laughing, chewing, brushing teeth and shaving
Pain due to neuritis of the maxillary trigeminal nerve can intensify with touching, chewing, laughing and with changes in temperature. That is why patients, trying to prevent the recurrence of painful attacks, avoid excessive mobility and prolonged conversations, and refuse brushing their teeth and shaving.
Diagnostics
A neurologist diagnoses trigeminal neuralgia. During the first visit, he carefully interviews the patient to find out:
- complaints: nature of pain, its intensity and localization, conditions and frequency of attacks, their duration;
- medical history: when pain attacks first appeared, how they changed over time, etc.;
- life history: the presence of chronic diseases, previous injuries and operations is clarified, special attention is paid to dental diseases and interventions.
A basic examination includes assessing the condition of the skin and muscles, identifying asymmetry and other characteristic signs, checking the quality of reflexes and skin sensitivity.
To confirm the diagnosis, the following is carried out:
- MRI of the brain and spinal cord with or without contrast: allows you to identify tumors, consequences of injuries, vascular disorders; sometimes the study is replaced by computed tomography (CT), but it is not as informative;
- electroneurography: study of the speed of nerve impulse transmission through fibers; allows you to identify the fact of nerve damage, assess the level of the defect and its features;
- electroneuromyography: not only the speed of impulse passage along the nerve bundle is studied, but also the reaction of muscle fibers to it; allows you to assess nerve damage, as well as determine the sensitivity threshold of trigger zones;
- electroencephalography (EEG): assessment of the bioelectrical activity of the brain.
Laboratory diagnostics includes only general studies to exclude other causes of painful attacks, as well as to assess the condition of the body as a whole (usually a general blood and urine test is prescribed, as well as a standard set of biochemical blood tests). If the infectious nature of the disease is suspected, tests are carried out to identify specific pathogens or antibodies to them.
Additionally, consultations with specialized specialists are prescribed: ENT specialist (if there are signs of nasopharynx pathology), a neurosurgeon (if there are signs of a tumor or injury), and a dentist.
Treatment of trigeminal neuralgia
Treatment is aimed at:
- to eliminate the cause of damage;
- to alleviate the patient's condition;
- to stimulate the restoration of nerve structures;
- to reduce the excitability of trigger zones.
Properly selected treatment can reduce the frequency, intensity and duration of pain waves, and ideally achieve stable remission.
Drug treatment
Trigeminal neuralgia requires complex treatment using drugs from several groups:
- anticonvulsants (carbamazepine and analogues): reduce the excitability of nerve fibers;
- muscle relaxants (baclofen, mydocalm): reduce muscle spasms, improve blood circulation, reduce pain;
- B vitamins (neuromultivit, milgamma): stimulate the restoration of nerve fibers, have an antidepressant effect;
- antihistamines (diphenhydramine): enhance the effect of anticonvulsants;
- sedatives and antidepressants (glycine, aminazine): stabilize the patient’s emotional state.
For severe pain, narcotic analgesics may be prescribed. Previously, drug blockades (injecting the problem area with anesthetics) were actively used, but today this method of treatment is almost never used. It contributes to additional damage to nerve fibers.
Treatment of the root cause of the disease is mandatory: elimination of dental problems, taking medications to improve cerebral circulation, etc.
Physiotherapy and other non-drug methods
Non-drug methods complement drug therapy well and help stabilize patients’ condition. Depending on the condition and concomitant diseases, the following may be prescribed:
- ultraviolet irradiation: inhibits the passage of impulses along nerve fibers, providing an analgesic effect;
- laser therapy: reduces pain;
- UHF therapy: improves microcirculation and prevents muscle atrophy;
- electrophoresis with analgesics or antispasmodics to relieve pain and relax muscles;
- diadynamic currents: reduce the conductivity of nerve fibers, significantly increase the intervals between attacks;
- massage of the face, head, cervical-collar area: improves blood circulation and lymph outflow, improving tissue nutrition; must be carried out with caution so as not to touch trigger zones and provoke an attack; the course is carried out only during the period of remission;
- acupuncture: helps relieve pain.
Surgery
The help of surgeons is indispensable when it is necessary to eliminate nerve compression. If indicated, the following is carried out:
- removal of tumors;
- displacement or removal of dilated vessels pressing on the nerve (microvascular decompression);
- expansion of the bone canals in which the branches of the nerve pass.
A number of operations are aimed at reducing nerve fiber conductivity:
- exposure to a gamma knife or cyber knife;
- balloon compression of the trigeminal node: compression of the node using an air-filled balloon installed in close proximity to it, followed by death of the nerve fibers; surgery often leads to partial loss of sensation and decreased muscle movement;
- resection of the trigeminal node: rarely performed due to the complexity and large number of complications.
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Complications
Without treatment, trigeminal neuralgia gradually progresses. Over time, a pathological pain focus forms in one of the parts of the brain. As a result, the pain covers the entire face, is provoked by any minor irritant and even the memory of an attack, and subsequently becomes permanent. Vegetative-trophic disorders progress:
- irreversible atrophy of the facial muscles is formed;
- teeth become loose and begin to fall out due to advanced periodontal disease;
- baldness is increasing.
Due to constant pain, the patient's sleep is disturbed and severe depression develops. In severe cases, patients may commit suicide.
Prevention
Prevention of trigeminal neuralgia is a set of simple measures that significantly reduce the risk of developing pathology. Doctors recommend:
- undergo regular preventive examinations;
- at the first signs of the disease, seek help (the sooner treatment is started, the greater its effect will be);
- eat right, get the required amount of vitamins, minerals, unsaturated fatty acids;
- regularly engage in light sports and gymnastics;
- get enough sleep and rest;
- minimize stress and physical overload;
- avoid hypothermia and harden yourself;
- to refuse from bad habits.
Prevention of inflammation
To prevent the risk of developing inflammation of the trigeminal nerve, it is recommended to follow a number of measures:
- monitor oral hygiene and consult a dentist in a timely manner;
- do not stay in the cold for a long time or protect your face from freezing with a scarf;
- do not self-medicate otitis media.
At the first manifestations of pain on the face, you should immediately consult a doctor. This will stop the development of inflammation. In addition, early diagnosis allows for conservative treatment methods.
Treatment at the Energy of Health clinic
If you or your relative are bothered by severe pain in one or another part of the face, the neurologists of the Health Energy clinic will come to the rescue. We will conduct a full diagnosis to identify the causes of the pathology and prescribe comprehensive treatment. At your service:
- modern drug regimens to reduce the frequency and intensity of attacks;
- physiotherapeutic procedures: magnetotherapy, laser therapy, electrophoresis, phonophoresis, etc.;
- delicate therapeutic massage;
- acupuncture;
- help from a psychologist if necessary.
Our doctors
Clinic director, implant surgeon, orthopedist
Berezin Pavel Nikolaevich
Chief physician, therapist, periodontist
Sakhnova Galina Leonidovna
Dentist-therapist
Lizunova Anfisa Pavlovna
all Doctors
Advantages of the Health Energy Clinic
The Health Energy Clinic is a multidisciplinary medical center where every patient has access to:
- screening diagnostic programs aimed at early detection of diseases and pathologies;
- targeted diagnostics using modern equipment and laboratory tests;
- consultations with experienced specialists, including foreign ones;
- modern and effective comprehensive treatment;
- necessary certificates and extracts;
- documents and appointments for spa treatment.
Trigeminal neuralgia is a serious pathology that can seriously disrupt a person’s normal lifestyle. Don't let pain and fear take over your thoughts, get treatment at Health Energy.
