Trigeminal Nerve Pain: A Guide to Clinical Management

Preface
Contents
1: History
	Introduction
	Medical Therapies
	Percutaneous Approaches
	Surgical Interventions
	References
2: Anatomy of the Trigeminal Nerve
	Trigeminal Nerve Nuclei (Fig. 2.1)
		Mesencephalic Nucleus
		Principal Sensory Nucleus
		Spinal Trigeminal Nucleus
		Trigeminal Motor Nucleus
	Trigeminal Nerve and Distal Projections (Figs. 2.2 and 2.3a, b)
		Ophthalmic Nerve
			Frontal Nerve
			Nasociliary Nerve
			Lacrimal Nerve
		Maxillary Nerve
			Pterygopalatine Branches
			Infraorbital Branches
			Facial Branches
		Mandibular Nerve
			Anterior Division
			Posterior Division
				Auricotemporal
				Lingual Nerve
				Inferior Alveolar Nerve
	Associated Structures
		Otic Ganglion
		Submandibular Ganglion
		Sphenopalatine Ganglion
	References
3: Epidemiology
	Introduction
	Prevalence and Incidence Rates
	Disparities in Management of Trigeminal Neuralgia
	References
4: Trigeminal Neuralgia and Other Trigeminal Nerve Conditions
	Introduction
	Trigeminal Neuralgia
		Diagnostic Criteria
		Classification
		Etiology and Pathophysiology
		Clinical Features
	Dental Pain
	First Bite Syndrome
	Painful Trigeminal Neuropathy
	Paratrigeminal Oculosympathetic Syndrome (Raeder’s Syndrome)
	Burning Mouth Syndrome
	Persistent Idiopathic Facial Pain (Previously Known as Atypical Facial Pain)
	Central Neuropathic Facial Pain
	Neuralgia in the Distribution of Other Cranial Nerves
	Headache Disorders that Can Mimic TN
		Migraine
		Trigeminal Autonomic Cephalalgias
			Cluster Headache
			Other TACs
			Cluster-Tic Syndrome
	References
5: Diagnosis of Trigeminal Nerve Conditions
	Introduction
	Trigeminal Neuralgia
		History
			As Established by the International Classification of Headache Disorders, Third Edition (ICHD-3), the Diagnosis of Trigeminal Neuralgia (TN) is Established on Clinical Findings [1]
			Red Flag Symptoms
			Differential Diagnosis
		Physical Examination
		Neuroimaging
		Pediatric Considerations
	Painful Trigeminal Neuropathy
		Physical Exam
			General Inspection
			Neurologic Examination
				Reflexes
					Jaw Jerk
					Corneal (Blink) Reflex
		Painful Trigeminal Neuropathy Attributed to Herpes Zoster
			History
			Physical Exam
			Neuroimaging
		Trigeminal Postherpetic Neuralgia
			History
			Physical Exam
			Neuroimaging
		Painful Post-traumatic Trigeminal Neuropathy
			History
			Physical Exam
			Neuroimaging
		Painful Trigeminal Neuropathy Attributed to Other Disorder
			History
			Physical Exam
			Neuroimaging
	Paratrigeminal Oculosympathetic Syndrome (Raeder’s Syndrome)
		History
		Physical Exam
		Neuroimaging
	Supraorbital and Infraorbital Neuralgia
	References
6: Non-Pharmacological Management
	Introduction
	Home Remedies
	Vitamin B
	Acupuncture
	Laser Therapy
	Other Therapies
	References
7: Physical Therapy and Rehabilitation
	Introduction
	Physical Therapy and Role on Health Care Team
	Regional Interdependence: Health Care Team
	Regional Interdependence
		Movement System
	Physical Therapy Evaluation
	Physical Therapy Treatment Interventions
	References
8: Medication Management
	First-Line Treatments (Table 8.1)
		Carbamazepine
		Oxcarbazepine
	Second-Line Treatments
		Baclofen
		Lamotrigine
		Pimozide
	Third-Line Treatments
		Levetiracetam
		Gabapentin
		Pregabalin
	Additional Medication Options
		Clonazepam
		Valproate
		Phenytoin and Fosphenytoin
	Special Considerations
	References
9: Nerve Blocks for the Trigeminal Nerve and Branches
	Indications for Trigeminal Nerve Blocks
	Type of Injectate
	Selection of Nerve Blocks
	Techniques for Nerve Blocks
	Landmark-Guided Nerve Blocks of Superficial Branches
	Landmark-Guided Nerve Blocks of Deep Branches
	Ultrasound-Guided Nerve Blocks
	Ultrasound-Guided Nerve Blocks of Deep Branches
	Fluoroscopic-Guided Nerve Blocks
	CT-Guided Nerve Blocks
	References
10: Radiofrequency Ablation
	Introduction
	History
	Criteria for Patient Selection
	Procedure
	Ultrasound-Guided Technique Via the Pterygopalatine Fossa
	Complications After RF
	Efficacy
	References
11: Chemodenervation of Trigeminal Nerve
	Introduction
	Patient Selection
	Procedural Technique
	Risks and Complications
	Advantages
	Disadvantages
	Mechanism of Pain Relief from Chemodenervation
	Types of Injectant
		Glycerol
		Phenol and Alcohol
	References
12: Cryotherapy of the Trigeminal Nerve
	Introduction
	Description of Cryo Procedure
	Literature Review of Efficacy of Cryotherapy for Paroxysmal Trigeminal Neuralgia
	References
13: Botox Injections
	Background
	Mechanism of Action
	Migraines
	Trigeminal Neuralgia
	References
14: Regenerative Medicine for Trigeminal Nerve Pain
	Introduction
	Mechanism of Action
		Platelet-Rich Plasma
		Stem Cell Therapy
	Mechanism of Regenerative Therapies on Neuropathic Pain
	Use in Trigeminal Nerve Conditions
	Use of Regenerative Therapies in Other Peripheral Nerve Diseases
	References
15: Neuromodulation for the Trigeminal Nerve
	Introduction
	Patient Selection
	Techniques
		Deep Brain Stimulation
		High Cervical Spinal Cord Stimulation
		Gasserian Ganglion Stimulation
		Sphenopalatine Ganglion Stimulation
		Trigeminal Nerve Stimulation
		Occipital Nerve Stimulation
		Vagal Nerve Stimulation
		Peripheral Nerve Field Stimulation
	Discussion
	References
16: Infusion Therapy
	Introduction
	Intravenous (IV) or Subcutaneous (SQ) Lidocaine
	Other Agents
		Ketamine
		Phenytoin and Fosphenytoin
		Magnesium
		Chlormethiazole
	References
17: Balloon Compression of the Trigeminal Nerve
	Introduction
	History of the Procedure
	Indications
	Contraindications
	Pre-procedural Preparation
	Techniques
	Surgical Procedure
		Foramen Ovale Cannulation
		Balloon Inflation
	Risks and Complications
	Post-procedural Care
	Clinical Pearls and Trouble Shooting
	Outcome and Recurrence
	Factors Affecting Outcome
	Review of Literature
	References
18: Radiosurgery for Treatment of Trigeminal Neuralgia
	Introduction
	Historical Advent
	Radiosurgical Modalities for Treatment of Trigeminal Neuralgia
	Radiosurgical Technique in the Treatment of Trigeminal Neuralgia
	Dose
	Head Fixation
	Targeting
	Outcomes of Radiosurgery for Trigeminal Neuralgia
	Measurement Scales in Radiosurgical Studies
	Time to Pain Relief
	Freedom from Pain
	Recurrence
	Complications
	References
19: Microvascular Decompression for Treatment of Trigeminal Neuralgia
	Introduction
	Historical Advent and Surgical Views on the Etiology of Pain
	Patient Selection
		Pain Character
		Preoperative Imaging
	Procedure
	Outcomes
	Complications
	References
20: Peripheral Neurectomy for Treatment of Trigeminal Neuralgia
	Introduction
	History
	Pathogenesis of Hyperexcitability of the Peripheral Branches of the Trigeminal Nerve
	Indications
	Contraindications
	Anatomic Considerations
	Pre-procedural Preparation
	Technique
		Supraorbital Neurectomy (Branch of the Ophthalmic Division)
		Infraorbital Neurectomy (Branch of the Maxillary Division)
		Inferior Alveolar Neurectomy (Branch of the Mandibular Division)
	Post-procedural Care
	Complications
	Recurrence
	References
21: The Psychological Impact and Management of Trigeminal Neuralgia
	Pain Psychology
	Psychiatric and Psychological Comorbidities
	Mental Status Screening
	Referral to Care
	Psychological Treatment Modalities
	Alternative Modes of Support
	References
22: Algorithms for Management Recommendations
	Trigeminal Neuralgia
	Trigeminal Neuropathic Pain
	Medical Therapy for Trigeminal Neuralgia
	Acute Exacerbations
	Percutaneous Rhizotomy
	Botulinum Toxin Type A
	Neuromodulation
	Headache Disorders that Can Mimic TN
	References
Index