This book provides an overview of the history, anatomy, epidemiology, diagnosis (HPI, PE, Imaging), non-pharmacological management and medication management of trigeminal nerve pain. Nerve blocks for the trigeminal nerve and branches, Radiofrequency ablation, chemodenervation, cryotherapy, botox injections, neuromodulation infusion therapy, balloon compression gamma knife therapy, decompression surgery, peripheral neurectomy and the psychological impact are also examined with an algorithm for management recommendations included in the final chapter.
Trigeminal Nerve Pain - A Guide to Clinical Management comprehensively covers how to manage patients with this often debilitating pain and is of use to trainees and practising internists, hospitalists, surgeons and anaesthesiologists seeking to increase their understanding of this complex condition.
Author(s): Alaa Abd-Elsayed
Publisher: Springer
Year: 2021
Language: English
Pages: 246
City: Cham
Preface
Contents
1: History
Introduction
Medical Therapies
Percutaneous Approaches
Surgical Interventions
References
2: Anatomy of the Trigeminal Nerve
Trigeminal Nerve Nuclei (Fig. 2.1)
Mesencephalic Nucleus
Principal Sensory Nucleus
Spinal Trigeminal Nucleus
Trigeminal Motor Nucleus
Trigeminal Nerve and Distal Projections (Figs. 2.2 and 2.3a, b)
Ophthalmic Nerve
Frontal Nerve
Nasociliary Nerve
Lacrimal Nerve
Maxillary Nerve
Pterygopalatine Branches
Infraorbital Branches
Facial Branches
Mandibular Nerve
Anterior Division
Posterior Division
Auricotemporal
Lingual Nerve
Inferior Alveolar Nerve
Associated Structures
Otic Ganglion
Submandibular Ganglion
Sphenopalatine Ganglion
References
3: Epidemiology
Introduction
Prevalence and Incidence Rates
Disparities in Management of Trigeminal Neuralgia
References
4: Trigeminal Neuralgia and Other Trigeminal Nerve Conditions
Introduction
Trigeminal Neuralgia
Diagnostic Criteria
Classification
Etiology and Pathophysiology
Clinical Features
Dental Pain
First Bite Syndrome
Painful Trigeminal Neuropathy
Paratrigeminal Oculosympathetic Syndrome (Raeder’s Syndrome)
Burning Mouth Syndrome
Persistent Idiopathic Facial Pain (Previously Known as Atypical Facial Pain)
Central Neuropathic Facial Pain
Neuralgia in the Distribution of Other Cranial Nerves
Headache Disorders that Can Mimic TN
Migraine
Trigeminal Autonomic Cephalalgias
Cluster Headache
Other TACs
Cluster-Tic Syndrome
References
5: Diagnosis of Trigeminal Nerve Conditions
Introduction
Trigeminal Neuralgia
History
As Established by the International Classification of Headache Disorders, Third Edition (ICHD-3), the Diagnosis of Trigeminal Neuralgia (TN) is Established on Clinical Findings [1]
Red Flag Symptoms
Differential Diagnosis
Physical Examination
Neuroimaging
Pediatric Considerations
Painful Trigeminal Neuropathy
Physical Exam
General Inspection
Neurologic Examination
Reflexes
Jaw Jerk
Corneal (Blink) Reflex
Painful Trigeminal Neuropathy Attributed to Herpes Zoster
History
Physical Exam
Neuroimaging
Trigeminal Postherpetic Neuralgia
History
Physical Exam
Neuroimaging
Painful Post-traumatic Trigeminal Neuropathy
History
Physical Exam
Neuroimaging
Painful Trigeminal Neuropathy Attributed to Other Disorder
History
Physical Exam
Neuroimaging
Paratrigeminal Oculosympathetic Syndrome (Raeder’s Syndrome)
History
Physical Exam
Neuroimaging
Supraorbital and Infraorbital Neuralgia
References
6: Non-Pharmacological Management
Introduction
Home Remedies
Vitamin B
Acupuncture
Laser Therapy
Other Therapies
References
7: Physical Therapy and Rehabilitation
Introduction
Physical Therapy and Role on Health Care Team
Regional Interdependence: Health Care Team
Regional Interdependence
Movement System
Physical Therapy Evaluation
Physical Therapy Treatment Interventions
References
8: Medication Management
First-Line Treatments (Table 8.1)
Carbamazepine
Oxcarbazepine
Second-Line Treatments
Baclofen
Lamotrigine
Pimozide
Third-Line Treatments
Levetiracetam
Gabapentin
Pregabalin
Additional Medication Options
Clonazepam
Valproate
Phenytoin and Fosphenytoin
Special Considerations
References
9: Nerve Blocks for the Trigeminal Nerve and Branches
Indications for Trigeminal Nerve Blocks
Type of Injectate
Selection of Nerve Blocks
Techniques for Nerve Blocks
Landmark-Guided Nerve Blocks of Superficial Branches
Landmark-Guided Nerve Blocks of Deep Branches
Ultrasound-Guided Nerve Blocks
Ultrasound-Guided Nerve Blocks of Deep Branches
Fluoroscopic-Guided Nerve Blocks
CT-Guided Nerve Blocks
References
10: Radiofrequency Ablation
Introduction
History
Criteria for Patient Selection
Procedure
Ultrasound-Guided Technique Via the Pterygopalatine Fossa
Complications After RF
Efficacy
References
11: Chemodenervation of Trigeminal Nerve
Introduction
Patient Selection
Procedural Technique
Risks and Complications
Advantages
Disadvantages
Mechanism of Pain Relief from Chemodenervation
Types of Injectant
Glycerol
Phenol and Alcohol
References
12: Cryotherapy of the Trigeminal Nerve
Introduction
Description of Cryo Procedure
Literature Review of Efficacy of Cryotherapy for Paroxysmal Trigeminal Neuralgia
References
13: Botox Injections
Background
Mechanism of Action
Migraines
Trigeminal Neuralgia
References
14: Regenerative Medicine for Trigeminal Nerve Pain
Introduction
Mechanism of Action
Platelet-Rich Plasma
Stem Cell Therapy
Mechanism of Regenerative Therapies on Neuropathic Pain
Use in Trigeminal Nerve Conditions
Use of Regenerative Therapies in Other Peripheral Nerve Diseases
References
15: Neuromodulation for the Trigeminal Nerve
Introduction
Patient Selection
Techniques
Deep Brain Stimulation
High Cervical Spinal Cord Stimulation
Gasserian Ganglion Stimulation
Sphenopalatine Ganglion Stimulation
Trigeminal Nerve Stimulation
Occipital Nerve Stimulation
Vagal Nerve Stimulation
Peripheral Nerve Field Stimulation
Discussion
References
16: Infusion Therapy
Introduction
Intravenous (IV) or Subcutaneous (SQ) Lidocaine
Other Agents
Ketamine
Phenytoin and Fosphenytoin
Magnesium
Chlormethiazole
References
17: Balloon Compression of the Trigeminal Nerve
Introduction
History of the Procedure
Indications
Contraindications
Pre-procedural Preparation
Techniques
Surgical Procedure
Foramen Ovale Cannulation
Balloon Inflation
Risks and Complications
Post-procedural Care
Clinical Pearls and Trouble Shooting
Outcome and Recurrence
Factors Affecting Outcome
Review of Literature
References
18: Radiosurgery for Treatment of Trigeminal Neuralgia
Introduction
Historical Advent
Radiosurgical Modalities for Treatment of Trigeminal Neuralgia
Radiosurgical Technique in the Treatment of Trigeminal Neuralgia
Dose
Head Fixation
Targeting
Outcomes of Radiosurgery for Trigeminal Neuralgia
Measurement Scales in Radiosurgical Studies
Time to Pain Relief
Freedom from Pain
Recurrence
Complications
References
19: Microvascular Decompression for Treatment of Trigeminal Neuralgia
Introduction
Historical Advent and Surgical Views on the Etiology of Pain
Patient Selection
Pain Character
Preoperative Imaging
Procedure
Outcomes
Complications
References
20: Peripheral Neurectomy for Treatment of Trigeminal Neuralgia
Introduction
History
Pathogenesis of Hyperexcitability of the Peripheral Branches of the Trigeminal Nerve
Indications
Contraindications
Anatomic Considerations
Pre-procedural Preparation
Technique
Supraorbital Neurectomy (Branch of the Ophthalmic Division)
Infraorbital Neurectomy (Branch of the Maxillary Division)
Inferior Alveolar Neurectomy (Branch of the Mandibular Division)
Post-procedural Care
Complications
Recurrence
References
21: The Psychological Impact and Management of Trigeminal Neuralgia
Pain Psychology
Psychiatric and Psychological Comorbidities
Mental Status Screening
Referral to Care
Psychological Treatment Modalities
Alternative Modes of Support
References
22: Algorithms for Management Recommendations
Trigeminal Neuralgia
Trigeminal Neuropathic Pain
Medical Therapy for Trigeminal Neuralgia
Acute Exacerbations
Percutaneous Rhizotomy
Botulinum Toxin Type A
Neuromodulation
Headache Disorders that Can Mimic TN
References
Index
