The trigeminal nerve is a ganglion that gives rise to three “branches” that exit directly from the brain stem. Three “branches” reach directly to the human face, supplying it with nerves and connecting it with the central nervous system.
The trigeminal nerve exits the skull through three different foramina. The first “branch” comes out through symmetrical points that are located slightly above the person’s eyebrows (the so-called ocular process). The second, emerging, passes along both sides of the nose (just below the eye area and close to the cheeks) and is therefore called the maxillary, the third “branch” exits in the lower jaw (mandibular) in the direction from the corners of the mouth to its center.
With inflammation of various processes of the trigeminal nerve, pain is observed, localized in various places of the face. When the first “branch” is inflamed, pain occurs above or below the brow ridge, in the forehead and in the front part of the temporal region of the head. When the second and third “branches” of the trigeminal nerve become inflamed, pain occurs in the upper and lower jaws, respectively, which, in turn, causes severe toothache.
Next, we will talk about the types of neuralgia, causes and methods of treatment. But if you are experiencing unbearable pain right now, make an appointment with us. When making an appointment, tell the administrator that you need emergency assistance, and they will find an appointment for you as soon as possible. An appointment with a dentist can be made by calling 8 or using the online appointment form.
Types of trigeminal neuralgia
Trigeminal neuralgia is divided into two types. The first, the so-called true trigeminal neuralgia, is a holistic disease caused in most cases by compression of the nerve or disruption of the blood supply. The second type - secondary trigeminal neuralgia - is a symptom of a general disease of the body. It could be a tumor or a serious infection.
In most cases, doctors diagnose inflammation of one of the processes of the trigeminal nerve, but in some situations inflammation of two or three processes occurs at once. Inflammation can affect either one side of the face or both, and in different combinations.
Symptoms
The main characteristic symptom of trigeminal neuralgia is paroxysmal pain. It comes suddenly and in its intensity and speed of spread resembles an electric shock. Typically, intense pain forces the patient to freeze in place, waiting for relief. The attack can last from a few seconds to 2-3 minutes, after which there is a period of calm. The next wave of pain may come within hours, days, weeks or months.
Over time, the duration of each attack of neuralgia increases, and periods of calm are reduced until a continuous aching pain develops.
The provoking factor is irritation of trigger points:
- lips;
- wings of the nose;
- eyebrow area;
- middle part of the chin;
- cheeks;
- area of the external auditory canal;
- oral cavity;
- temporomandibular joint.
A person often provokes an attack when performing hygiene procedures (combing hair, caring for the oral cavity), chewing, laughing, talking, yawning, etc.
Depending on the location of the lesion, the pain takes over:
- the upper half of the head, temple, orbit or nose if the ophthalmic branch of the nerve is affected;
- cheeks, lips, upper jaw – if the maxillary branch is affected;
- chin, lower jaw, as well as the area in front of the ear - with neuralgia of the mandibular branch.
If the lesion affects all three branches or the nerve itself before it is divided, the pain spreads to the entire corresponding half of the face.
Painful sensations are accompanied by other sensory disturbances: numbness, tingling or crawling sensations. Hyperacusis (increased hearing sensitivity) may be observed on the affected side.
Since the trigeminal nerve contains not only sensory, but also motor pathways for the transmission of impulses, with neuralgia the corresponding symptoms are observed:
- twitching of facial muscles;
- spasms of the muscles of the eyelids, masticatory muscles;
The third group of manifestations of neuralgia are trophic disorders. They are associated with a sharp deterioration in blood circulation and lymph outflow. The skin becomes dry, begins to peel, and wrinkles appear. Local graying and even hair loss in the affected area is observed. Not only the scalp suffers, but also the eyebrows and eyelashes. Impaired blood supply to the gums leads to the development of periodontal disease. At the time of the attack, the patient notes lacrimation and drooling, swelling of the facial tissues.
Constant spasms of muscle fibers on the diseased side lead to facial asymmetry: narrowing of the palpebral fissure, drooping of the upper eyelid and eyebrow, upward movement of the corner of the mouth on the healthy side or drooping on the diseased side.
The patient himself gradually becomes nervous and irritable, and often limits himself to food, since chewing can cause another attack.
Causes of inflammation of the trigeminal nerve
Doctors believe that the main cause of inflammation of the trigeminal nerve is compression of it either inside the skull or outside it. Inside the skull, the trigeminal nerve can be compressed as a result of the formation of tumors, in most cases resulting from some kind of head injury.
Also a fairly common cause of inflammation of the trigeminal nerve is internal venous or arterial displacement.
Other causes of trigeminal neuralgia include:
- the presence of a chronic inflammatory process, viral or bacterial infection in the body;
- herpes infection (herpes);
- a brain tumor;
- scarring in the brain stem;
- failure of anesthesia during treatment or tooth extraction.
Most often, inflammation of the trigeminal nerve affects women at pre-retirement and retirement age (usually from fifty to seventy years). If trigeminal neuralgia is diagnosed in a young man or girl, then most likely its cause is a change in the arteries of a sclerotic nature or a strong dilatation of blood vessels.
Neuralgia and trigeminal neuritis
Neuritis and neuralgia are different diseases, although (as in the case of the trigeminal and facial nerves) some “specialists” combine them or replace one with the other. The main difference lies in the nature of their occurrence. Neuritis is always associated with an inflammatory process, hence its name: the ending -itis - from Lat. -itis always denotes inflammatory diseases. Neuralgia is irritation of the nerve as a result of concomitant diseases or exposure to external factors. Unlike neuritis, neuralgia does not cause changes in the structure of the nerve.
Most doctors consider neuritis to be a much more dangerous disease, since the inflammatory process affects the inner part of the nerve. At an advanced stage, the disease causes nerve damage and spreads to the auditory nerve, and can also lead to ataxia, a motor disorder. In this case, neuritis and neuralgia can occur together and have some similar symptoms. First of all, these are painful sensations, which, however, vary in nature and intensity.
How does inflammation of the trigeminal nerve manifest?
The main symptom of inflammation of the trigeminal nerve is severe pain that occurs in the facial part. The pain really has a powerful force and shooting character, so it is very difficult for the patient to calmly endure painful attacks. The pain intensifies when performing the slightest actions with the facial muscles and jaws - yawning, chewing, laughing, and performing daily oral hygiene. At the same time, the sensitivity of the skin on the inflamed side of the face decreases.
The next painful attack is accompanied by a rapid dilation of the patient’s pupils and the same rapid contraction of facial muscles. Increased tear production may begin.
Pain with trigeminal neuralgia is severe, but not constant. The pain occurs for a few seconds and is interrupted for a while. But if the intervals between painful attacks are short, then it seems that the pain is constant. Trigeminal neuralgia is dangerous because the interval between attacks can be several weeks, and sometimes even several months. But after this period, the pain will certainly return. A long break does not mean that the disease has passed, so if you have already noticed symptoms of neuralgia once, you should immediately consult a doctor.
Prevention of inflammation
To prevent the risk of developing inflammation of the trigeminal nerve, it is recommended to follow a number of measures:
- monitor oral hygiene and consult a dentist in a timely manner;
- do not stay in the cold for a long time or protect your face from freezing with a scarf;
- do not self-medicate otitis media.
At the first manifestations of pain on the face, you should immediately consult a doctor. This will stop the development of inflammation. In addition, early diagnosis allows for conservative treatment methods.
Why do teeth hurt when the trigeminal nerve is inflamed?
How is inflammation of the trigeminal nerve related to teeth? The connection here is the most direct. Firstly, severe pain during attacks “radiates” to the upper or lower jaw (depending on which nerve extension is inflamed), and sometimes to both jaws. This causes severe and unbearable toothache.
Secondly, those nerves that are found in the upper and lower teeth and gums are directly connected to the trigeminal nerve. The second branch of the trigeminal nerve innervates the upper teeth and gums, and the third, respectively, the lower jaw and gums.
The trigeminal nerve can also be damaged during a number of dental manipulations. Unsuccessful tooth extraction or improper filling, surgical intervention in the jaw structure that ended unsuccessfully, and injuries can cause trigeminal neuralgia.
It is very important to distinguish inflammation of the trigeminal nerve from other diseases of the oral cavity, in particular pulpitis - inflammation of the internal dental tissues. A characteristic sign of inflammation of the trigeminal nerve is that, despite severe pain, the sensitivity of the teeth does not increase when they come into contact with cold and hot foods, and hypothermia or heating does not provoke the onset of a new pain attack. Acute tooth sensitivity is a symptom of pulpitis.
When the trigeminal nerve is damaged in the jaw area, acute toothache, pain in the chin, ears and sometimes in the lower lip occurs. The pain may become increasingly intense, and often the patient continues to feel a dull ache after the attack.
Treatment methods
Depending on what caused the inflammation, a course of treatment is prescribed. For bacterial lesions, the emphasis is on antibacterial therapy through systemic administration of drugs.
However, regardless of the reasons, the doctor prescribes painkillers to relieve pain and reduce inflammation. It could be:
- ibuprofen;
- paracetamol;
- analgin;
- ketorol;
- diclofenac.
All of the listed drugs can be prescribed either in the form of tablets for oral administration, or prescribed in the form of solutions for intramuscular administration.
When conservative methods are not possible, the help of a surgeon may be needed. This primarily concerns abscesses due to the eruption of wisdom teeth, pulpitis or other dental diseases. In this case, the abscess will be opened, pus will be removed, the wound will be treated with antiseptic, and the tooth will be removed, if necessary. If a pinched nerve occurs as a result of pathologies in the structure of the skull, the surgeon will perform an operation to correct the situation and free the nerve bundles.
As a complex therapy, massage, heating or exposure to a magnetic field and electric current can be prescribed. You cannot massage or warm the inflamed area yourself, because this can lead to complications associated with rupture of the purulent capsule, blood poisoning and paralysis of the facial nerve.
Separately, you may need to consult a neurologist who will determine the cause of the inflammation if other specialists have not found obvious foci of infection and abscesses.
Traditional methods of treatment are permissible only as an addition to the main therapy. For example, rinsing with chamomile decoction will relieve inflammation and reduce swelling. But you can resort to such procedures only with the permission of the attending physician.
Treatment of inflammation of the trigeminal nerve
The first stage of treatment for inflammation of the trigeminal nerve is medication. It is aimed at reducing the strength and frequency of pain in the patient. Most often, doctors prescribe anticonvulsants to a patient suffering from trigeminal neuralgia. Sedatives are also used.
Physiotherapeutic procedures, as well as resorption therapy to relieve the inflammatory process, have a good therapeutic effect. Next, the doctor may recommend the use of laser treatment, in which the laser is directed cutaneously to the area where the processes of the trigeminal nerve exit the skull.
Our clinic is located in the same building as the multidisciplinary clinic “Diamed on Shchelkovskaya”, where special conditions for receiving physiotherapeutic procedures are organized for dental patients. The clinic’s physiotherapy room is equipped with modern equipment, including a laser physiotherapy device, with which you will feel relief after the first procedure. The pain will go away and you can return to normal eating. Make an appointment with a dentist by calling 8 or using the online appointment form. The doctor will make an accurate diagnosis and refer you for treatment.
If you are in severe pain, but for some reason you have not yet made an appointment with us, then it can be relieved with folk remedies. Take one tablespoon of yarrow, pour a glass of boiling water, let it brew for one hour and strain. The tincture should be taken one tablespoon before meals three to four times a day.
Symptoms of facial neuritis
The development of the inflammatory process always begins acutely, but before the main clinical picture reveals itself, the patient may feel discomfort in the back of the head and pain symptoms in the eye. The main symptoms of trigeminal facial neuritis:
- the affected side of the face becomes immobilized and takes on the appearance of a mask;
- the eye on the affected side is wide open;
- the corner of the mouth is lowered;
- nasolabial folds are smoothed;
- speech becomes slurred;
- special sensitivity to sounds;
- increased dry mouth.
Over time, as the disease progresses and in the absence of treatment, paresis of the facial nerve develops - the face becomes asymmetrical, the patient cannot fully smile or control his own facial expressions.
