general information
The trigeminal nerve consists of sensory and motor fibers. It originates in the structures of the brain and is divided into three branches:
- ophthalmic: responsible for the eye, forehead and upper eyelid;
- maxillary: innervates the area from the lower eyelid to the upper lip;
- mandibular: involves the chin, lower jaw, lips and gums.
With neuralgia, one or more branches of the trigeminal nerve are affected, which determines the main symptoms of the pathology. People over 45 years of age are most susceptible to the disease, and women get sick more often than men.
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General swelling
Pulmonary heart failure. Under the influence of gravity, edematous fluid accumulates in the lowest part of the body. In bedridden patients, these are the areas of the sacrum and lumbar region. Associated symptoms are shortness of breath, swelling of the neck veins, congestive liver, ascites, hydrothorax and other signs of pulmonary heart failure.
Kidney diseases
With glomerulonephritis, pyelonephritis and other kidney diseases, swelling forms first on the face (on the eyelids), and then on the limbs and torso. With the development of nephrotic syndrome, edema can gradually spread to the entire body, including serous cavities (in this case they speak of edematous syndrome).
Cirrhosis of the liver
In addition to edema, there are other signs of liver cirrhosis - ascites, dilation of the esophageal veins (as determined by EGD), bleeding from the esophagus, dilation of hemorrhoidal veins, and liver failure.
Exhaustion
Edema of a similar origin occurs during fasting, alcoholism and some diseases of the gastrointestinal tract, accompanied by accelerated excretion of proteins from the body. The legs and feet swell, the face becomes puffy (protein-free edema).
Causes
The causes of trigeminal neuralgia can be of different nature:
- compression of the entire trigeminal nerve or its branches against the background of: enlargement of the arteries or veins of the brain (aneurysms, atherosclerosis, strokes, increased intracranial pressure due to osteochondrosis, congenital developmental features);
- tumors of the brain or facial tissues in close proximity to nerve fibers;
- congenital anomalies of bone structure, narrowed openings through which nerve branches pass;
- injuries of the skull, facial area: bone fractures, post-traumatic scars of soft tissues;
- proliferation of scar tissue after injury, surgery, inflammation;
The risk of developing trigeminal neuralgia increases significantly:
- over the age of 50;
- against the background of mental disorders;
- with regular hypothermia;
- with insufficient intake of nutrients and vitamins into the body (anorexia, bulimia, malabsorption, etc.);
- with regular overwork, stress;
- for helminthic infestations and other helminthiases;
- for acute infections: malaria, syphilis, botulism, etc.;
- for chronic inflammation in the oral cavity (caries, gingivitis, abscesses, etc.);
- against the background of autoimmune lesions;
- with excessive exposure to allergies;
- for metabolic disorders.
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.
Why does the face swell in adults?
Swelling on the face can occur at different times of the day - mainly in the morning or late afternoon, or they persist throughout the day, decreasing or increasing.
There are two types of reasons:
- physiological (or natural, not associated with diseases), they are usually not pronounced, not very strong, and disappear quickly;
- pathological, can be very strong, with changes in facial features, signs of inflammation, and are often quite persistent.
Each type of edema has the most typical causes; they occur mainly in the morning or evening hours, or do not depend in any way on the time of day. These characteristics are important for the doctor so that he can identify the leading causes and determine the tactics of examination and treatment.
Diagnostics
A neurologist diagnoses trigeminal neuralgia. During the first visit, he carefully interviews the patient to find out:
- complaints: nature of pain, its intensity and localization, conditions and frequency of attacks, their duration;
- medical history: when pain attacks first appeared, how they changed over time, etc.;
- life history: the presence of chronic diseases, previous injuries and operations is clarified, special attention is paid to dental diseases and interventions.
A basic examination includes assessing the condition of the skin and muscles, identifying asymmetry and other characteristic signs, checking the quality of reflexes and skin sensitivity.
To confirm the diagnosis, the following is carried out:
- MRI of the brain and spinal cord with or without contrast: allows you to identify tumors, consequences of injuries, vascular disorders; sometimes the study is replaced by computed tomography (CT), but it is not as informative;
- electroneurography: study of the speed of nerve impulse transmission through fibers; allows you to identify the fact of nerve damage, assess the level of the defect and its features;
- electroneuromyography: not only the speed of impulse passage along the nerve bundle is studied, but also the reaction of muscle fibers to it; allows you to assess nerve damage, as well as determine the sensitivity threshold of trigger zones;
- electroencephalography (EEG): assessment of the bioelectrical activity of the brain.
Laboratory diagnostics includes only general studies to exclude other causes of painful attacks, as well as to assess the condition of the body as a whole (usually a general blood and urine test is prescribed, as well as a standard set of biochemical blood tests). If the infectious nature of the disease is suspected, tests are carried out to identify specific pathogens or antibodies to them.
Additionally, consultations with specialized specialists are prescribed: ENT specialist (if there are signs of nasopharynx pathology), a neurosurgeon (if there are signs of a tumor or injury), and a dentist.
Treatment of trigeminal neuralgia
Treatment is aimed at:
- to eliminate the cause of damage;
- to alleviate the patient's condition;
- to stimulate the restoration of nerve structures;
- to reduce the excitability of trigger zones.
Properly selected treatment can reduce the frequency, intensity and duration of pain waves, and ideally achieve stable remission.
Drug treatment
Trigeminal neuralgia requires complex treatment using drugs from several groups:
- anticonvulsants (carbamazepine and analogues): reduce the excitability of nerve fibers;
- muscle relaxants (baclofen, mydocalm): reduce muscle spasms, improve blood circulation, reduce pain;
- B vitamins (neuromultivit, milgamma): stimulate the restoration of nerve fibers, have an antidepressant effect;
- antihistamines (diphenhydramine): enhance the effect of anticonvulsants;
- sedatives and antidepressants (glycine, aminazine): stabilize the patient’s emotional state.
For severe pain, narcotic analgesics may be prescribed. Previously, drug blockades (injecting the problem area with anesthetics) were actively used, but today this method of treatment is almost never used. It contributes to additional damage to nerve fibers.
Treatment of the root cause of the disease is mandatory: elimination of dental problems, taking medications to improve cerebral circulation, etc.
Physiotherapy and other non-drug methods
Non-drug methods complement drug therapy well and help stabilize patients’ condition. Depending on the condition and concomitant diseases, the following may be prescribed:
- ultraviolet irradiation: inhibits the passage of impulses along nerve fibers, providing an analgesic effect;
- laser therapy: reduces pain;
- UHF therapy: improves microcirculation and prevents muscle atrophy;
- electrophoresis with analgesics or antispasmodics to relieve pain and relax muscles;
- diadynamic currents: reduce the conductivity of nerve fibers, significantly increase the intervals between attacks;
- massage of the face, head, cervical-collar area: improves blood circulation and lymph outflow, improving tissue nutrition; must be carried out with caution so as not to touch trigger zones and provoke an attack; the course is carried out only during the period of remission;
- acupuncture: helps relieve pain.
Surgery
The help of surgeons is indispensable when it is necessary to eliminate nerve compression. If indicated, the following is carried out:
- removal of tumors;
- displacement or removal of dilated vessels pressing on the nerve (microvascular decompression);
- expansion of the bone canals in which the branches of the nerve pass.
A number of operations are aimed at reducing nerve fiber conductivity:
- exposure to a gamma knife or cyber knife;
- balloon compression of the trigeminal node: compression of the node using an air-filled balloon installed in close proximity to it, followed by death of the nerve fibers; surgery often leads to partial loss of sensation and decreased muscle movement;
- resection of the trigeminal node: rarely performed due to the complexity and large number of complications.
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When is surgery used?
The help of a surgeon in treating the disease is needed only when other methods do not help. This happens infrequently, because with timely treatment the disease is well treated.
If surgery is prescribed, the surgeon’s actions involve destruction of the facial nerve. Special drugs are injected into the site of nerve damage to reduce its sensitivity and susceptibility.
Nerve fiber decompression is performed in difficult cases. During this, the doctor changes the position of the arteries located near the nerve. After this procedure, the discomfort does not go away immediately, but only after a few months.
Surgery should be resorted to only in extreme cases. It has negative features:
- Not every patient can tolerate general anesthesia;
- After the operation, a scar remains.
Complications
Without treatment, trigeminal neuralgia gradually progresses. Over time, a pathological pain focus forms in one of the parts of the brain. As a result, the pain covers the entire face, is provoked by any minor irritant and even the memory of an attack, and subsequently becomes permanent. Vegetative-trophic disorders progress:
- irreversible atrophy of the facial muscles is formed;
- teeth become loose and begin to fall out due to advanced periodontal disease;
- baldness is increasing.
Due to constant pain, the patient's sleep is disturbed and severe depression develops. In severe cases, patients may commit suicide.
Types of disease
- Epidemic parotitis - in this case, intoxication of the body occurs due to viruses.
- Otitis media – Otitis media leads to perforation of the eardrum, causing infection in the facial nerve.
- Hunt's syndrome - a herpetic rash occurs on the anterior part of the tongue and ear. Due to the penetration of microbes, the salivary glands become inflamed, resulting in compression of the facial nerve.
- Merkenson-Rosenthal syndrome is a rare type of neuritis that is hereditary.
Prevention
Prevention of trigeminal neuralgia is a set of simple measures that significantly reduce the risk of developing pathology. Doctors recommend:
- undergo regular preventive examinations;
- at the first signs of the disease, seek help (the sooner treatment is started, the greater its effect will be);
- eat right, get the required amount of vitamins, minerals, unsaturated fatty acids;
- regularly engage in light sports and gymnastics;
- get enough sleep and rest;
- minimize stress and physical overload;
- avoid hypothermia and harden yourself;
- to refuse from bad habits.
Treatment at the Energy of Health clinic
If you or your relative are bothered by severe pain in one or another part of the face, the neurologists of the Health Energy clinic will come to the rescue. We will conduct a full diagnosis to identify the causes of the pathology and prescribe comprehensive treatment. At your service:
- modern drug regimens to reduce the frequency and intensity of attacks;
- physiotherapeutic procedures: magnetotherapy, laser therapy, electrophoresis, phonophoresis, etc.;
- delicate therapeutic massage;
- acupuncture;
- help from a psychologist if necessary.
Types of neuritis
A distinction is made between local neuritis and polyneuritis.
Local neuritis
is an inflammation of any one nerve (facial, auditory, oculomotor, glossopharyngeal, radial, sciatic, peroneal, femoral, etc.).
Polyneuritis
is multiple inflammation of the nerves. If the effect of the factor that caused the inflammation is local, only one nerve is affected. Polyneuritis develops under the influence of a systemic factor, which, as a rule, leads to degeneration of the nerve sheath and nerve fibers.
Advantages of the Health Energy Clinic
The Health Energy Clinic is a multidisciplinary medical center where every patient has access to:
- screening diagnostic programs aimed at early detection of diseases and pathologies;
- targeted diagnostics using modern equipment and laboratory tests;
- consultations with experienced specialists, including foreign ones;
- modern and effective comprehensive treatment;
- necessary certificates and extracts;
- documents and appointments for spa treatment.
Trigeminal neuralgia is a serious pathology that can seriously disrupt a person’s normal lifestyle. Don't let pain and fear take over your thoughts, get treatment at Health Energy.
