Trigeminal neuralgia is caused by compression of trigeminal nerve root and it leads to demyelination gradually. It was almost idiopathic and occurred unexpected. The upper cervical spinal cord contains the spinal trigeminal tract and nucleus. Fibers with cell bodies in the trigeminal ganglion enter in the upper pons and descend caudally to C2 level. We experienced a rare patient with facial pain, which was paroxysmal attack with severe pain after a clear event, cervical spinal injury (C2). So, this case reminds us of a possible cause of trigeminal neuralgia after a trauma of the head and neck.
Cell Body ; Cervical Cord ; Demyelinating Diseases ; Facial Pain ; Head ; Humans ; Neck ; Odontoid Process ; Pons ; Spinal Cord ; Spinal Injuries ; Trigeminal Ganglion ; Trigeminal Nerve ; Trigeminal Neuralgia

Trigeminal neuralgia (TGN) is a relatively well-known disorder with characteristic brief attacks of shooting pain in the facial regions. Atypical signs like constant pain and/or sensory abnormalities can develop as the disease progresses. Some cases begin with atypical signs and later develop all the hallmarks of TGN. The atypical forms of TGN can be misdiagnosed as other pain disorders. We present a patient with facial pain who demonstrated a transformation in signs of glossopharyngeal neuralgia into typical trigeminal neuralgia. A 71 year-old man was referred for sharp episodic pain in his right side of the face and neck. The pain was mainly in the neck, which was worsened especially by swallowing. The condition was initially diagnosed as a glossopharyngenl neuralgia. While controlling the pain conservatively with a sympathetic blockade, the neck pain disappeared suddenly and lower jaw pain triggered by speaking and chewing became prominent, which are the characteristic signs of trigeminal neuralgia.
Aged ; Carbamazepine ; Deglutition ; Facial Pain ; Glossopharyngeal Nerve Diseases* ; Humans ; Jaw ; Mastication ; Neck ; Neck Pain ; Neuralgia ; Trigeminal Neuralgia*

Tolosa-Hunt syndrome is a rare self-limiting disease that's characterized by painful ophthalmoplegia. It has a relapsing and remitting course, and the pain responds promptly to systemic corticosteroid therapy. Yet it is diagnosed by the exclusion of other major causes involving the superior orbital fissure or cavernous sinus, including trauma, neoplasm, aneurysm and inflammation. Further, the associated ophthalmoplegia may follow days to weeks after the onset of orbital or hemifacial pain. Hence, this condition is often misdiagnosed as atypical facial pain, and so improper management could result in unnecessary suffering of the patient. The following case describes a patient suffering with hemifacial pain associated with ipsilateral abducens nerve palsy, which was evident 2 weeks after the onset of pain, and this was misdiagnosed as trigeminal neuralgia and atypical facial pain.
Abducens Nerve Diseases* ; Abducens Nerve* ; Aneurysm ; Cavernous Sinus ; Facial Pain ; Humans ; Inflammation ; Ophthalmoplegia ; Orbit ; Tolosa-Hunt Syndrome ; Trigeminal Neuralgia

Trigeminal neuropathy os characterized by unremitting facial pain, no evident trigger point and facial sensory change. According to Jannetta, in trigeminal neuropathy, the offending artery is not necessarily in contact with the root entry zone(REZ) but any site of the nerve. We have recently experienced a 48-year-old woman with symptoms and signs compatible with trigeminal neuropathy and explored the CP angle. SCA was crossing just anterior to the trigeminal root and one small arterial loop was lying on the pons close to the root entry zone(REZ) but neither of them was in diirect contact with the nerve. Teflon felt was inserted between the arteries and nerve and secured with silk and beriplast for fear that they should contact by changing position. Immediately after the operation the facial pain and pre-existing facial sensory change were completely gone.
Arteries ; Deception ; Facial Pain ; Female ; Fibrin Tissue Adhesive ; Humans ; Microvascular Decompression Surgery* ; Middle Aged ; Polytetrafluoroethylene ; Pons ; Silk ; Trigeminal Nerve Diseases* ; Trigeminal Neuralgia ; Trigger Points

Background and Objective of the Study : Trigeminal neuralgia (TN) affects 4-5 people per 100,000 population. Because of its key feature - sudden intense facial pain, immediate and long-term treatment is warranted. The newly validated Penn Facial Pain Scale (PFPS) is of great value for assessment of how trigeminal pain and its treatment affect our patients’ lives. This study translated the PFPS to a Filipino version which can be used with ease in our setting. Methodology Study Design Validity Study Methods : Forward translation was carried out by an expert. The initial output was sent to 10 Neurologists for content and face validity. The experts rated each item’s relevance and through item level content validity index, items which scored >0.80 were accepted and those that scored lower were subjected to discussion by the investigators. The revised questionnaire was then administered to 8 TN patients for face validity. The fi nal output was back translated and compared to the original PFPS. Results Content and face validity as assessed by 10 neurologists showed that all questions were relevant. Some words were edited according to their suggestions. Eight TN patients voluntarily answered the edited version of the questionnaire for face validity and cognitive debriefi ng. No further changes were made to the edited questionnaire which was then back translated. The back translation was found to be similar to the original PFPS. Conclusion The Filipino version is similar to the original PFPS and can be used in evaluation of TN. A Phase 2 reliability study should be ideally done prior to utilization in clinical setting.
Trigeminal Neuralgia ; Facial Pain ; Pain Measurement

The Onyx liquid embolic system is a relatively safe and commonly used treatment for vascular malformations, such as arteriovenous fistulas and arteriovenous malformations. However, studies on possible complications after Onyx embolization in patients with vascular malformations are limited, and the occurrence of cranial nerve palsy is occasionally reported. Here we report the progress of two different types of cranial nerve palsy that can occur after embolization. In both cases, Onyx embolization was performed to treat vascular malformations and ipsilateral oculomotor and facial nerve palsies were observed. Both patients were treated with steroids and exhibited symptom improvement after several months. The most common types of neuropathy that can occur after Onyx embolization are facial nerve palsy and trigeminal neuralgia. Although the mechanisms underlying these neuropathies are not clear, they may involve traction injuries sustained while extracting the microcatheter, mass effects resulting from thrombi and edema, or Onyx reflux into the vasa nervorum. In most cases, the neuropathy spontaneously resolves several months following the procedure.
Arteriovenous Fistula ; Arteriovenous Malformations ; Cranial Nerve Diseases* ; Cranial Nerves* ; Edema ; Facial Nerve ; Humans ; Paralysis ; Steroids ; Traction ; Trigeminal Neuralgia ; Vasa Nervorum ; Vascular Malformations*

Orofacial neuropathic pain is initiated by extraction of teeth or nerve injury from trauma in the trigeminal nerve that innervates the facial area. In the experiment, orofacial neuropathic pain usually occurred following injury of peripheral trigeminal nerve including infra-orbital nerve, inferior alveolar nerve, or mental nerve. In addition, pathology from trigeminal nerve root or ganglion is involved in orofacial neuropathic pain. This study introduced various animal models that help us study the underlying mechanisms of development or maintenance of orofacial neuropathic pain. One of the most typical symptoms of orofacial neuropathic pain is hypersensitivity to the innocuous mechanical stimuli. Our study presents a novel method to evaluate mechanical allodynia in rats with orofacial neuropathic pain. Recently, accumulate evidence support participation of central glial cells in the development or maintenance of orofacial neuropathic pain. Signaling molecules in glial cells also play an important role in neuropathic pain in the orofacial area.
Animals ; Facial Pain ; Ganglion Cysts ; Hyperalgesia ; Hypersensitivity ; Mandibular Nerve ; Models, Animal ; Neuralgia ; Neuroglia ; Rats ; Tooth ; Trigeminal Nerve ; Trigeminal Neuralgia

Recently the cause of hemifacial spasm and trigeminel neuralgia is known to be vascular compression-distortion in the root exit and entry zone of each nerve. The microvascular decompression of the 5th and 7th cranial nerves is a method of refined and non-traumatic surgical treatment of these disabling diseases. 33 patients with intractable hemifacial spasm and 7 patients with trigeminal neuralgia were treated by microvascular decompression and the follow-up results were evaluated. The surgical results in 33 cases of hemifacial spasm were as follow: Excellent-18, Good-7, Fair-6, Poor-2. Disturbance of hearing as a complication appeared in 6 cases, but improved gradually except one case. The surgical finding and results in 7 cases of trigeminal neuralgia were as follow: In 6 cases the causative vessel was SCA and in one case SCV indented the nerve root. All 7 patients with trigeminal neuralgia were relieved from facial pain after surgery.
Cranial Nerves ; Facial Nerve* ; Facial Pain ; Follow-Up Studies ; Hearing ; Hemifacial Spasm ; Humans ; Microvascular Decompression Surgery* ; Neuralgia ; Trigeminal Neuralgia

Trigeminal neuralgia (TN) is a chronic disorder of the trigeminal nerve characterized by repeated electrical shock-like sensations on one side of the face. It can cause severe pain in the face and disrupt or impair quality of life in patients. Options for the management of TN consist of pharmacological and surgical treatments, including Gamma Knife radiosurgery (GKRS). GKRS has been used for TN for a long time because of its low rate of complications and high success rate. Moreover, GKRS can be of use for drug-resistant TN patients who are poor surgical candidates due to medical comorbidities, patients of older age, or patients who refuse invasive therapy. We reviewed the rationale, effects, safety, and current treatment policies of GKRS for TN in view of our institution's results and a review of the literature to date.]]>
Comorbidity ; Facial Pain ; Humans ; Quality of Life ; Radiosurgery ; Sensation ; Trigeminal Nerve ; Trigeminal Neuralgia

Trigeminal neuralgia (TN) is characterized by recurrent paroxysms of unilateral facial pain that typically is severe, lancinating, and activated with cutaneous stimulation. There are two types of TN, classical TN and atypical TN. The pain nature of classical TN are the same as those described above, whereas atypical TN is characterized by constant, burning pain. We describe the case of a 49-year-old male presenting with right-sided facial pain. The patient was diagnosed with temporomandibular joint disorder at a dental clinic and was on medical treatment, but his symptoms worsened gradually. He was referred to our pain clinic for further evaluation. Radiologic evaluation, including MRI, showed a parapharyngeal tumor. For the relief of TN, a right mandibular nerve (V3) root block was performed at our pain clinic, and then he was scheduled for radiation and chemotherapy.
Burns ; Dental Clinics ; Facial Pain ; Humans ; Male ; Mandibular Nerve ; Pain Clinics ; Temporomandibular Joint Disorders ; Trigeminal Neuralgia