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Trigeminal neuralgia What is it and how to treat it?

The trigeminal nerve is part of the so-called cranial nerves, being the largest of them all. Its name comes from the fact that it is composed of three divisions called ophthalmic nerve, maxillary nerve and mandibular nerve.

The trigeminal nerve provides motor innervation and sensitivity to the muscles involved in mastication (mixed function nerve), but it also has an important role in transmitting nerve stimuli to the musculature in charge of middle ear ventilation. This is the reason why an involvement of the jaw musculature can also affect the ear.

As it is a voluminous nerve, it has a great implication in different symptomatological processes in the cervical, cranial and mandibular regions.

What is trigeminal neuralgia?

Also known as tic pain, trigeminal neuralgia is characterized by persistent facial pain with a burning sensation. Generally, the pain is unilateral, that is, it affects only one side of the face, and although in its first manifestations the pain is mild and occasional, if the disorder is not treated, the episodes become more frequent and the pain more intense.

Trigeminal neuralgia is a severe facial pain syndrome, and is the most frequent type of facial pain, with a prevalence of 4 to 13 cases per 100,000 inhabitants. It directly and clearly affects the quality of life of sufferers, who often present depressive syndromes. It usually occurs after the age of 50 years, and is more frequent in women than in men in a ratio of 1.5 to 1.

Although the pain caused by the disorder may be spontaneous and intense, constant and localized, or spasmodic, depending on the case, over time, any movement of the face may trigger a new painful episode.

Causes of trigeminal neuralgia

It is usually caused by contact between the trigeminal nerve and a blood vessel. This causes pressure on the nerve and its dysfunction.

Triggering causes also include facial trauma or stroke.

Treatment of trigeminal neuralgia

The first line of action for the management of trigeminal neuralgia is pharmacological treatment. There are different drugs that have demonstrated their efficacy, such as carbamazepine or oxcarbazepine, but in many cases pharmacological treatment is insufficient to treat the pain.

On these occasions, different surgical techniques can be considered, such as vascular myodecompression or other techniques such as radiofrequency thermocoagulation or rhizolysis, these being the most common in elderly people or those with a high surgical risk.

Vascular microdecompression

A retrosigmoid craniotomy (incision behind the ear) is performed to separate the trigeminal nerve from the blood vessel it contacts, using a synthetic material. In more than 70% of cases, lasting symptomatic relief is achieved.

Rhizolysis by glycerol injection

Gliecrol is injected through a needle and by means of fluoroscopic visualization of the cistern of Gasser’s ganglion. The results are positive in 75-96% of cases, but the recurrence of pain three years after the operation is around 50%.

Radiofrequency thermocoagulation

A percutaneous puncture guided by fluoroscopy is performed, and the nerve is sensitively stimulated by means of an electrode. Its objective is the lesion of the nerve fibers responsible for pain transmission. This technique is very effective in terms of pain relief (clinical improvement in 97% of cases), although the recurrence rate after 10 years is 48%.

Treating your trigeminal neuralgia

Trigeminal neuralgia has a direct effect on the quality of life of those who suffer from it. If left untreated, episodes of pain become progressively more frequent and intense. Fortunately, there are different procedures to treat the disease. Our multidisciplinary team will evaluate your case and recommend the best treatment for you, so that the pain does not prevent you from continuing to enjoy your daily life.