Pain characteristics of trigeminal neuralgia
Sudden, intense with an excitation point, no signs before onset, sudden intense pain in the distribution area of the trigeminal nerve, generally the maxillary branch and mandibular branch are more common. The pain is like electric shock, knife cut, pinprick, throbbing pain, throbbing pain, corner of the mouth tilt, each attack lasts for a few seconds to 1-2 minutes, recurrent, severe pain, accompanied by lacrimation, conjunctival congestion, etc. In the interval, light touch on a part of the oral and maxillofacial area can trigger a pain attack, i.e. excitation point or trigger point.
1. Classification of trigeminal neuralgia
Primary trigeminal neuralgia refers to recurrent, transient and severe pain in the distribution area of the facial trigeminal nerve, without signs of trigeminal nerve damage, the cause of which is not yet fully understood, while secondary trigeminal neuralgia refers to signs of trigeminal nerve damage or other signs of cranial nerve damage and limb dysfunction caused by a clear cause.
2.Where is the pain site of trigeminal neuralgia? Which branch does it often occur?
Branch I: upper eyelid, eyebrow, forehead, etc. Branch II: lower eyelid, nasolabial folds (nasal wings), upper lip below the nostril or in the corner of the mouth, upper gums, upper jaw, palate foramen, etc. Branch III: lower lip corner of the mouth area, lower gingiva, ear screen area, tongue and jaw, and other areas. Trigeminal neuralgia often attacks unilaterally, and can be single branch damage on one side, or double or triple branch damage. Most often, the Ⅱ branch (mainly buccal, upper lip, upper gingiva) and the Ⅲ branch (lower lip, lower gingiva) are attacked simultaneously; secondly, the Ⅱ branch alone or the Ⅲ branch is attacked; again, the three branches are attacked simultaneously, the Ⅰ and Ⅱ branches are attacked simultaneously, and the Ⅰ branch alone is rarely attacked. The pain can occur on the left and right side respectively, and bilateral is rare.
3.The nature of trigeminal neuralgia pain
Trigeminal neuralgia attacks are often without aura, and come and go as soon as they are said. The pain starts from a certain focal point and rapidly radiates to the entire affected nerve area, which may radiate to the occipital or shoulder region, and some may be accompanied by lacrimation and runny eyes. Due to the painful cracking, patients often rub the affected area with their hands, resulting in skin abrasion, thickening, and even loss of eyebrow hair. Some patients, when the pain attacks, constantly do a variety of actions such as sucking lips, chewing in order to relieve pain.
4.Who is prone to trigeminal neuralgia? What is the current incidence rate?
Trigeminal neuralgia has a wide age of onset, from 10 to 90 years old. According to the statistics, the incidence rate of trigeminal neuralgia is about 2 per 1,000. (According to domestic epidemiological statistics, the prevalence rate can be as high as 182.8/100,000 people).
5. Causes of trigeminal neuralgia
The cause of primary trigeminal neuralgia is still unknown, but it is mainly thought to be the neurovascular impulse theory, that is, the intracranial trigeminal nerve is compressed by the adjacent blood vessels for a long time, which causes the nerve to produce demyelination reaction and abnormal nerve impulse conduction, resulting in paroxysmal facial pain attacks controlled by the trigeminal nerve. Secondary trigeminal neuralgia is usually caused by tumors in the pontocerebellar horn region.
6. Treatment of trigeminal neuralgia: At present, there are more methods to treat trigeminal neuralgia, which are generally divided into two categories: conservative treatment and surgical treatment.
The comparison is as follows.
Advantages
Disadvantages
Drug treatment, acupuncture
Convenient, simple and effective for a short time
Allergy, dizziness, weakness and other drug reactions
Sealing
Easy to operate, effective for a short time
Easy to recur, will have facial numbness
Radiofrequency
Simple operation, effective for a short time
Easy to relapse, will have facial numbness
Peripheral avulsion
Effective for a short time
Easy to recur, will have facial numbness
Gamma knife
Low efficiency, about 40-60%
Recurrence prone, facial numbness
Microvascular decompression (MVD)
Effective rate of about 98% No sequelae