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Blockage of branches of the trigeminal nerve in the face

The trigeminal nerve is the largest of the 12 pairs of cranial nerves (5η Brain conjugation) and is the main nerve that gives sensory neurosis to the face, while the motor part of the nerve (coming only from the third branch of the trigeminal), innervates the muscles of mastication (masseter, rattlesnake, inner and outer pterygoid) It starts from the brain stem, then the ganglion of the nerve is formed inside the skull, and from it the three main branches of the nerve start:

1ous branch, Optic nerve (V1)

2ous branch, Upper Maxillary (V2)

3ous branch, mandibular (V3)

Trigeminal Neuralgia is a very painful condition that has a predilection for the female gender. It is a dysfunction of the nerve, which can be due to:

  • pressure from a neighbouring vessel or tumour
  • neurological diseases such as multiple sclerosis 
  • dental work (implant extraction)
  • Infection (metherapy neuralgia)
  • none of the above, so we are talking about Idiopathic Trigeminal Neuralgia, i.e. without a specific cause, which is a fairly common condition.   

 It has very severe pain in the lower 2/3 of the face, (usually in the 2ο  and 3ο  branch of the trigeminal) , unilaterally , and patients typically report feeling as if an electric current is running through them. It has a short duration and sharp onset, and is triggered by minor daily activities such as, chewing food brushing teeth, washing with water on the face even by simple touch or the blowing of air. It alternates with pain free intervals and patients do not have a good quality of life at all.

The three trigeminal branches reach the face through grooves and small holes in the skull, which we can feel with our fingers, while at the same time they are also sites of pain when we press them, in case of neuralgia. These locations are :

Supranasal command (1ous branch of the trigeminal nerve - supraspinous nerve )

Suborbital fissure (2ous trigeminal branch - suboccipital nerve)

Genital rupture (3ous trigeminal branch -genital nerve)

In the clinic we apply therapeutic injections with a small amount of local anesthetic (xylocaine or Procaine) to these points. This is a safe technique. The patient must first have an MRI scan to rule out serious causes of neuralgia (tumors, neurological diseases).

The patient is lying down and after we have identified the pain manifestation points (which branches of the nerve are concerned, V1 V2V3), then we palpate the corresponding points, the area is antiseptic and the treatment is applied with slow administration of a small amount of medicine.

For the second and third branches of the trigeminal canal, the infiltration can also be done through the mouth. It hurts less than the dentist's local injection. Immediately afterwards, pressure is applied to the injection site with gauze to avoid any haematoma but also for better dispersion and absorption of the drug. It does not take long and the sessions needed for permanent results will depend on the patient's progress.

If the damage is due to pressure from a neighbouring vessel or pressure from a tumour then the treatment needed is neurosurgery.     

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