The main manifestations of trigeminal neuralgia The trigeminal nerve, as its name implies, includes three branches, namely the ophthalmic nerve, the maxillary nerve and the mandibular nerve. Pain can occur in one or more branches. Ophthalmic neuralgia is distributed in the frontal and parietal regions; maxillary neuralgia is distributed in the cheek region below the fissure of the eye and above the corner of the mouth; mandibular neuralgia is distributed in the cheek region below the corner of the mouth. The most characteristic feature of trigeminal neuralgia is the pain in the face, which comes and goes without aura, like lightning, and the pain is severe and unbearable, like cutting, burning, needling or electric shock, and there are often particularly sensitive areas in the upper lip, corners of the mouth, nose, palate or buccal mucosa (medically called “trigger points or board points”). In order to prevent painful attacks, patients are often afraid to talk, eat, brush their teeth and wash their faces, which seriously affects their daily life. Trigeminal neuralgia can be caused by many reasons, and can be divided into primary trigeminal neuralgia and secondary trigeminal neuralgia according to the different causes. Secondary trigeminal neuralgia refers to trigeminal neuralgia caused by organic diseases. Common causes include trigeminal radiculitis, skull base arachnoiditis, skull base malformation, skull base tumor (cholesteatoma, meningioma, trigeminal neuroma), etc. Primary trigeminal neuralgia refers to trigeminal neuralgia of unknown etiology, which is also the most common type in clinical practice. However, it was later found that most of this trigeminal neuralgia is caused by compression of intracranial blood vessels, and the pain can be relieved by decompression of blood vessels, so some people also classify trigeminal neuralgia caused by blood vessel compression as secondary trigeminal neuralgia. In conclusion, according to the current examination methods, the cause of most trigeminal neuralgia can be clarified, which makes the radical treatment of trigeminal neuralgia possible. Diagnosis of trigeminal neuralgia The effective treatment of any disease depends on the correct diagnosis. Similarly, before choosing a treatment method, it must be clear whether this facial pain is really trigeminal neuralgia and what the cause of the pain is. Otherwise, it is easy to seek medical treatment in a hurry and eventually not get satisfactory results. The diagnosis of trigeminal neuralgia is mainly based on the typical clinical manifestations: a short, sharp, lightning-like and severe pain in the face, not daring to press with the hand during the pain attack, or even not daring to wash the face, shine the teeth, speak or eat in order to prevent the pain from attacking. Based on these characteristics, it is easy to distinguish migraine, cervical spine headache, tension headache, headache caused by oral and five sensory diseases. For example, migraine is a throbbing headache that occurs in the head and face, with a predominantly distending pain, a long duration of each attack, ranging from minutes, hours or days, and often accompanied by nausea and vomiting in severe cases. All odontogenic pains have clear dental disease, pain episodes are clearly related to the activity of the teeth, and an oral examination can make a clear diagnosis. Paranasal sinusitis, for example, can also cause facial pain, although this pain is often persistent and patients have a history of paranasal sinusitis, and the pain mostly does not interfere with face washing, tooth shining, speech, or eating. Before treatment, the cause of trigeminal neuralgia also needs to be clarified. Currently, it is mainly based on MRI. Conventional MRI can clarify the presence or absence of cholesteatoma, meningioma, trigeminal neuroma, auditory neuroma, etc., but cannot show vascular compression, while 3D TOF MRI can clearly show the presence or absence of vascular compression, and can even suggest the origin of blood vessels. examination.