TRIGEMINA

L
NEURALGI
Presented by: Dayrit, Erica M. & Olivas
Melencio

A
OBJECTIVES:
• To understand Trigeminal Neuralgia and its
signs and symptoms.
• To Familiarize the anatomy of the affected
Nerve and its Pathophysiology.
• To Determine the nursing intervention and
to know the pharmacological Management
and Surgical Management.
SYNONYMS:

• TRIFACIAL
NEURALGIA
• FOTHERGRILL'S
DISEASE
• TIC-DOLOUREUX
TRIGEMINAL
NEURALGIA
-It is a Chronic Neuro facial pain disorder due to
the trigeminal Nerve.

Incidence : 4 out of 100, 000

"The Suicidal Disease"

TRIGEMINAL
NERVE
ANATOMY
• OPTHALMIC (V1)
• MAXILLARY (V2)
• MANDIBULAR (V3)
Classifications:
International Headache Society (IHS)
classified trigeminal neuralgia into Two
types:
• Classical /idiopathic/typical
• Symptomatic
Classifications:
• Classical /idiopathic/typical
-It is a unilateral disorder characterized by brief
electric, shock- like pains.
• Symptomatic
-Pain is similar to classical type, but it is
caused by a demonstrable structural lesion other
than vascular compression
 Possible causes:

ETIOLOGY: Nerve Compression

Space Occupying lesions
UNKNOWN Multiple Sclerosis
Demyelination
Immunological Factors
Genetic History
 Risk Factors:
Non-Modifiable: Modifiable:
• Age • Person with Multiple Sclerosis
• Gender • Hypertension
• Genetic History • Deformity in the arteries and veins
• Nerve compression
• Damage to the trigeminal nerve
PATHOPHYSIOLOGY
General
Characteristics :
• Age: Middle age
• Sex: Female > Male
• Affliction for side: Right > Left
Assessment
Clinical
Manifestations:
• Maxillary division more commonly involved
• Ophthalmic division is rarely involved.
• Pain occurs in areas of the face where the trigeminal nerve
supplies normal sensation: cheek, jaw, teeth, gums and
lips, and sometimes the eye or forehead.
• Manifests as sudden, unilateral, intermittent, paroxysmal,
sharp, shooting, lancinating pain, elicited by slight touch.
• Sudden sharp electrifying pain.
 Clinical
Manifestations :
• Patient usually complains of electric shock/lightening
like pain.
• Pain lasts for few seconds to minutes, the cycle of pain
(5 to 10 times a day).
• Unilateral (predominantly right side).
• Precipitated by trigger zones.
• Extreme cases ‘frozen or mask like face’.
• Most occur commonly in women over the age of 50
years old.
 TRIGGER
ZONE & Central Nasolabial
POINT portion of fold
the face

V2- skin of upper lip, cheeks

Around
and upper gums Lips
nose
V3- Lower lip, teeth or gums of and mouth
of lower jaw

Tongue
V1- Supraorbital ridge
 TRIGGERS THE
TRIGEMINAL
NEURALGIA

Eating and Weather Stress and Tilting and

Chewing Tiredness Bending Head

Talking, Smiling, Teeth cleaning Touching, Shaving

Laughing ETC and Hair brushing Washing the face
Diagnosis:
History Taking &
Physical Examination

Diagnostic
Microneurography
Nerve Blocking

Trigeminal Nerve Magnetic Resonance

Examination Imaging
MEDICAL
MANAGEMENT
Pharmacological Therapy:

• Carbamazepine
• Tegretol
• Phenol
MEDICAL
MANAGEMENT
Surgical Management:
•Rhizotomy
•Microvascular Decompression of the Trigeminal
Nerve
•Radiofrequency Thermal Coagulation
•Percutaneous Balloon Microcompression
•Percutaneous radio-frequency trigeminal
gangliolysis
NURSING
MANAGEMENT:
• Assessment of pain level and characteristics of pain.
• Assess patient's knowledge of triggers and pain management.
• Provide emotional support
• Provide adequate nutrition in small frequent meals at room
temperature.
• Provide a calm and safety environment
• Administer pain medication as ordered.
• Instruct pt. avoid exposing affected cheek to sudden cold
 NURSING
MANAGEMENT:
• Instruct pt. to avoid foods that are too Cold or too Hot
• Use cotton pads gently, wash face and for oral hygiene.
• Instruct the patient to rinse with mouthwash after eating if
toothbrushing causes pain
• Instruct the pt. to take food and fluids at room temperature,
and to chew on the unaffected side
• Advice pt. try not to touch or wash their faces, shave, or do
anything else that might cause an attack
Nursing
DIAGNOSIS:
• Pain (acute / chronic) r / t trigeminal nerve
compression and inflammation of the
temporal artery.
• Imbalanced Nutrition : Less than Body
Requirements r / t pain during chewing.
• Ineffective individual coping r / t severe
pain, excessive threat to the self-alone.
Nursing
DIAGNOSIS:
• Anxiety r / t prognosis of disease and changes
in health.
• Risk for injury to the eye r / t the risk factors:
possible reduction in corneal sensation.
• Risk for Suicide.
THANK YOU!
 REFERENCE
Marina, B., & Madeleine, A. (2017, November). What's trigeminal neuralgia? Retrieved from
https://www.nursingcenter.com/journalarticle?Article_ID=4376892&Journal_ID=54016&Issue_ID=437
6671

Nurmikko, T., & Eldridge, P. (2001, July 01). Trigeminal neuralgia-pathophysiology, diagnosis and
current treatment. from https://academic.oup.com/bja/article/87/1/117/304237

Wood, S. (2019, August 01). Aetiology, signs, symptoms and treatment of trigeminal neuralgia.
Retrieved from
https://www.nursingtimes.net/clinical-archive/pain-management/aetiology-signs-symptoms-and-treatme
nt-of-trigeminal-neuralgia-13-04-2004/

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