NUR 149 2nd SEMESTER

A.Y. 2022-2023 TN
TRIGEMINAL NEURALGIA

TRIGEMINAL NEURALGIA
– a.k.a. Tic douloreux, prosopalgia, the Suicide
Disease or Fothergill’s Disease
– condition of the 5th Cranial Nerve that is
characterized by paroxysms of pain in the face
– Has 3 branches –
✓ OPTHALMIC,
✓ MAXILLARY,
✓
✓ MANDIBULAR (mostly affected:
MAXILLARY AND MANDIBULAR)

Diagnostics:
• X-rays of the skull,
• teeth and sinuses
• MRI

Medical Management:
Causes:
PHARMACOLOGIC THERAPY
• vascular compression and pressure ❖ Antiseizure agents i.e., Carbamazepine
o as the brain changes with age, a loop of (Tegretol)
a cerebral artery or vein may compress – most commonly used: FIRSTLINE;
the nerve root entry point – Serum levels: 5-12 mcg/mL

OCCURRENCE: ❖ relieve pain by reducing the transmission of

o occurs most often before 35 years of age impulses at certain nerve terminals
o more common in women – Should be taken with meals
o common in people with MS compared – Serum levels should be monitored
with the general population – Monitor for bone marrow depression
during long- term therapy
– s/e: nausea, dizziness, drowsiness
Clinical Manifestations: and aplastic anemia
– Muscle relaxants i.e.
• episodes of sudden, intense, "stabbing" or ✓ Gabapentin (Neurontin),
"shocklike" facial pain ✓ Baclofen (Lioresal)
• pain typically felt on one side of the jaw or – used for pain control
cheek – Sedatives
• intense flashes of pain can be triggered by – Antidepressants
vibration or contact with the cheek such as
when shaving, washing the face or applying
makeup, brushing teeth, eating, drinking, Surgical Management
talking, or being exposed to the wind
• cheek twitch
• a tearing eye or salivation on the same side IF PHARMACOLOGIC MANAGEMENT FAILS TO
of the face RELIEVE PAIN.
• Pain is INTRACTABLE • Microvascular decompression of the
• Pain is UNILATERAL trigeminal nerve
– Air draft can trigger pain (AVOID – artery loop is lifted from the nerve
WALKING SWIFTLY near the patient) using silicon foam

MS LEC NEURO, TCGGUILLERMO

1
• Radiofrequency thermal coagulation
– Produces thermal lesion on the
trigeminal nerve
• Percutaneous balloon microcompression
– Disrupts large myelinated fibers in all
three branches of the trigeminal nerve

Surgical Management
• Retrogasserian Rhizotomy- Sensory root
of CNV is surgical severed
• Radiosurgery with stereotactic technique
– uses GAMMA KNIFE to severe CNV 5
• Alcohol or phenol block
– injection of alcohol into a CN5 branch
for pain relief (transient: 1 yr)

Nursing Management
PREVENTING PAIN
• Instruct the client to avoid hot or cold foods
and fluids
• Providing room temperature water for rinsing
• Avoid jarring of the patient’s bed or chair
• Instruct the patient to rinse with mouthwash
after eating if tooth brushing causes pain
• Perform personal hygiene during freepain
intervals
• Instruct the client to chew on the unaffected
side and ingest soft food

PROVIDING POSTOPERATIVE CARE

– Instruct the client not to rub the eye
– Assess eye for irritation or redness
– Artificial tears may be prescribed in the
affected eye
– Patient is cautioned not to chew on the
affected side
– Observe patient for any difficulty in eating or
swallowing foods of different consistencies

MS LEC NEURO, TCGGUILLERMO