The “trigeminal nerve” means that this nerve has three “forks.” The first “fork” is called the ophthalmic nerve. The first “fork” is called the ophthalmic nerve, which is mainly responsible for the sensation of the orbits, the eyeballs, the upper eyelids, the root of the nose, and the skin on the top of the forehead; the second “fork” is called the maxillary nerve, which is mainly responsible for the sensation of the teeth of the upper jaw, the gums, the skin between the eyes and the upper lip, and the mucous membranes of the mouth and the nasal cavity. The third “fork” is called the mandibular nerve, mainly responsible for the mandibular teeth, tongue, ear temporal area, the lower lip below the skin sensation, in addition, unlike the other two forks, it also innervates the movement of the masticatory muscles, allowing people to complete the chewing action. Manifestations of Trigeminal Neuralgia Various causes of irritation to the trigeminal nerve can lead to painful episodes in the area innervated by the trigeminal nerve, and we call it trigeminal neuralgia. The manifestations of this disease are very characteristic, and it is on the basis of its characteristics that doctors make the diagnosis in most cases. The main ones are: 1. It is common in people over 40 years old. 2. It occurs more often in women than in men. 3, Most of them have typical pain episodes. 4, the frequency and severity of pain episodes have a tendency to gradually aggravate. 5. The effect of drug treatment decreases with the progress of the disease. 6, Clinical self-healing is extremely rare. The main features are explained below. The most important manifestation of trigeminal neuralgia is pain. This pain, very intense, often unbearable, once someone described it as “the world’s first pain”, some people can not stand the pain and light, its intensity is evident. The majority of pain episodes have obvious triggering factors, and a few cases can have pain episodes without triggering factors. Common triggering factors include chewing, brushing, washing, shaving, talking, yawning, mechanical stimulation of the face, opening the mouth, laughing, tongue activity, eating, drinking, wind, sound, light stimulation. There are also some patients who can trigger pain when stimulating a certain part of the body, just like pulling the trigger on a gun, which doctors call “trigger points”. Common trigger points include the upper and lower lips, nose, nasolabial folds, gums, cheeks, corners of the mouth, tongue, eyebrows, and whiskers. Trigeminal nerve pain episodes occur in the distribution area of the trigeminal nerve, the vast majority of the pain is one-sided, a few bilateral, to one side of the second and third branch of the distribution area of the most common pain, followed by the second or third branch of the distribution area of the pain, alone the first branch of the distribution area of the pain is rare. The vast majority of patients describe the nature of the pain as intolerable electric shock-like, knife-like, tear-like, burning pain, accompanied by a characteristic facial expression of extreme pain. The pain is paroxysmal, and most pain lasts from a few seconds to several minutes, usually 1 to 5 minutes, and rarely more than half an hour. The pain may disappear in the intervals between episodes, and the intervals are shortened as the disease progresses, usually ranging from tens of minutes to hours. In severe cases, attacks can occur every minute. Seizures are more frequent during the day and less frequent at night, or they may occur day and night without stopping. When the pain attack often suddenly stop talking, eating and other activities, frowning and clenching teeth, open mouth and cover the eyes, or use the palm of the hand to rub the face so that the skin is abnormally thickened, rough, eyebrow loss, the expression is extremely painful, often accompanied by paroxysmal spasms of the facial muscles and muscles of mastication (i.e., the “painful convulsions”), conjunctival congestion, tearing and salivation. Diagnosis of Trigeminal Neuralgia Through the above introduction, you should be impressed by the typical trigeminal neuralgia, because its characteristics are very prominent. However, this is not enough for the diagnosis of trigeminal neuralgia. Because, there are many causes of trigeminal neuralgia. Depending on the cause, doctors generally categorize them into two main groups. One category is secondary trigeminal neuralgia, which is secondary to trigeminal nerve damage caused by various intracranial and extracranial organic diseases. Common causes include: ① tumors in the cerebellar angle of the pontine brain, such as cholesteatoma (epidermoid cyst), meningioma, acoustic neuroma, hemangioma, etc.; ② tumors of the trigeminal nerve, such as trigeminal nerve sheath tumors, ganglion cell tumors, etc.; ③ primary or metastatic tumors at the base of the skull, such as meningiomas, nasopharyngeal carcinomas, etc.; ④ arachnoiditis of the brain; ⑤ other diseases, such as teeth, sinuses, and so on. The other category is called primary trigeminal neuralgia, which refers to a disease with transient episodes of severe pain in the distribution area of the trigeminal nerve, and there is no organic damage to be found clinically. Most of our common patients with trigeminal neuralgia belong to this category. There is a difference in treatment for patients with different conditions, so when doctors see patients, they often recommend a cranial CT or MRI, as this is currently the preferred method of identifying secondary trigeminal neuralgia from primary trigeminal neuralgia. Because these tests are expensive, we often encounter patients who refuse to undergo them, and for safety reasons, we hope that patients will cooperate. An example will help you understand. For example, a meningioma in the cerebellar angle of the bridge, when it is relatively small, only shows symptoms of trigeminal neuralgia, which is impossible to diagnose without the use of imaging tests. In addition, there is another situation often encountered in clinical work, trigeminal neuralgia patients who have had their teeth extracted, this is because trigeminal neuralgia is sometimes very similar to toothache, and many patients and even doctors mistakenly think that it is a toothache and perform tooth extraction, and then realize that it is trigeminal neuralgia only after the tooth is extracted and the pain is still not relieved. In order to minimize this situation, to give you two suggestions: First, the toothache is often persistent pain, lasting longer, more often combined with swelling of the gums and cheeks. Because the diseases that cause toothache are mostly infectious, there are often signs of toxicity when the inflammation is severe: chills, fever, poor spirit and appetite, and so on. First, if you encounter stubborn toothache, you may want to visit the neurosurgery department, so that the doctor can help diagnose it. Treatment of Trigeminal Neuralgia In the clinic, we see more primary trigeminal neuralgia, and the treatment for this group of patients is much more complicated. Generally speaking, the common treatment methods are medication and surgery. Medication When a patient is diagnosed with trigeminal neuralgia, the first treatment is often medication. Early trigeminal neuralgia can be effectively relieved by medication, and the efficacy of the treatment is still good. However, long-term patients with severe trigeminal neuralgia who rely solely on medication are unable to achieve effective pain control, and require a combination of methods of treatment. The most widely used and effective drug is carbamazepine, which is often used as the first choice of treatment. If its therapeutic effect is not good, or its efficacy diminishes, or intolerable side effects occur, the treatment can be changed to phenytoin sodium. When taking such drugs for a long period of time or in too high a dose, patients may experience discomfort such as headaches, dizziness, drowsiness, abnormal sensations, difficulty in urination, lack of concentration, unresponsiveness, confusion, depression, hallucinations, and sleep disorders. Hematopoietic system and liver function damage may also occur, therefore, patients should pay attention to routine blood and liver function tests during the medication period, in order to detect problems and adjust the treatment in time. Surgery is performed using microvascular decompression of the trigeminal nerve root. When we performed trigeminal nerve surgery, we found that many patients who could not find the cause of the disease before the operation had the compression of adjacent blood vessels at the trigeminal nerve root, and after separating the blood vessels from the nerves, the patients’ pain was relieved, and the clinical effectiveness rate of microvascular decompression in treating trigeminal neuralgia was 98%. The biggest advantage of microvascular decompression surgery over nerve rhizotomy is that it does not destroy the nerve structure, and there are fewer complications such as facial numbness after surgery.