Trigeminal Neuralgia: Etiology, Diagnosis, and Treatment
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MEDICINE
Trigeminal Neuralgia: Etiology, Diagnosis, and Treatment Michael Silva 1 & Aviv Ouanounou 2 Accepted: 13 July 2020 # Springer Nature Switzerland AG 2020
Abstract Trigeminal neuralgia (TN), the most common of the facial neuralgias, is an extremely debilitating disorder that is characterized by severe electric shock-like neuropathic pain that is localized to one or more branches of the trigeminal nerve. It can have a serious impact on an individual’s life and is often first encountered by dentists and general practitioners. Although a treatable and usually manageable condition, appropriate diagnosis remains a factor that plagues this disease. The objective of this article is to summarize the current literature surrounding the classification, epidemiology, presentation, and pathophysiology of TN while also including the current and evidence-based knowledge on the diagnosis and treatment options. It provides a baseline from which dental and medical colleagues alike can help manage patients suffering from this devastating neuralgia. Keywords Trigeminal neuralgia . Tic douloureux . Pain management . Treatment . Diagnosis . Pathophysiology
Introduction Trigeminal neuralgia (TN), also known as “tic douloureux,” is an extremely painful nerve disorder that is often difficult to diagnose [1]. It has been characterized as one of the most physically and psychologically painful conditions that one can potentially suffer from [2]. In addition, it is known to be the most common and most serious of the facial neuralgias [3]. TN typically presents as electric shock-like neuropathic pain that is localized to the distribution of the trigeminal nerve [3]. The trigeminal nerve is the fifth of twelve cranial nerves, and it is considered to be mixed, providing both sensory and motor innervation [4, 5]. It can be divided into three branches, namely, V1 (ophthalmic), V2 (maxillary), and V3 (mandibular), which correspond to three different dermatomes. While the two formers are solely sensory, the latter also provides motor innervation to the muscles of mastication [5, 6]. Chronic pain is a serious problem that affects many people. In the orofacial region, a long differential diagnosis can be
This article is part of the Topical Collection on Medicine * Aviv Ouanounou [email protected] 1
Faculty of Dentistry, University of Toronto, Toronto, Canada
2
Department of Clinical Sciences, Pharmacology & Preventive Dentistry, Faculty of Dentistry, University of Toronto, 124 Edward Street Room 513, Toronto, ON M5G 1G6, Canada
made when considering TN as a potential culprit. A list of potential diagnoses that might be considered, but is not limited to, can be found in Table 1. We can appreciate that there are therefore a variety of conditions that can cause chronic pain in the orofacial region. For example, in cluster headache patients, TN was the condition in which they were most frequently misdiagnosed [7]. Thus, it is important for dentists as well as physicians, which often represent the first point of consultatio
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