Also known as tic douloureux, trigeminal neuralgia is a chronic condition affecting the trigeminal nerve. The nerve provides sensations in the face including the forehead, eyes, mouth, sinus cavities, and jaw.
The condition occurs when a blood vessel compresses on the nerve. It causes pain during face-related activities such as teeth brushing, face washing, eating and drinking, shaving, and putting on makeup. The pain tends to come on suddenly on one side of the face. Areas where the pain often appears are the teeth, cheek, jaw, lips, and gums. Pain around the eye or forehead appears less common.
The severe, shooting, or jabbing pain may last from seconds to minutes. The episodes may last longer and grow more frequent as the condition advances. It’s possible for the attacks to last days, weeks, or months. It’s also possible for the episodes to go away for a period and then return.
How Physicians Diagnose Trigeminal Neuralgia
Like any other medical appointment, the patient will provide a medical history and answer questions. With trigeminal neuralgia, the healthcare provider will ask about the pain level, what the pain feels like, the location of the pain, and what triggers it.
The physician may do a neurological exam to rule out other disorders and to determine the specific part of the nerve causing the pain. This exam involves touching parts of the face to find the origin of the pain and checking reflexes to assess if a compressed nerve produces the symptoms. Other possible tests include an MRI of the head to rule out other causes of the pain.
Microvascular Decompression Treatment for Trigeminal Neuralgia
The physician may recommend radiosurgery or microvascular decompression treatment (MVD). This is a minimally-invasive surgical procedure that treats the cause of nerve disorders relating to the skull. What the procedure does is reduce the amount of pressure on the affected nerve.
If conservative treatments and medications do not relieve trigeminal neuralgia symptoms, then the physician may recommend microvascular decompression. In doing this procedure, the surgeon will relocate or remove the blood vessels in contact with the trigeminal root.
A fixation device properly positions the patient’s head and keeps it in place. The procedure begins with an incision behind the ear on the side experiencing pain. Working through a small hole in the skull, the surgeon moves any arteries in contact with the trigeminal nerve away from the nerve.
The surgeon will place a spongy material between the nerve and blood vessel or remove it if the vein compresses the nerve. But if the arteries aren’t pressing on the nerve, then the surgeon may cut part of the nerve.
Once done, the surgeon will seal and suture the tissue that covers the brain. The skull bone is either replaced and reattached or the surgeon affixes a titanium plate with screws. And finally, the surgeon stitches the skin to close the area.
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