REKHA RAJU

2ND YR M.Sc NURSING

DEFINITIONTrigeminal neuralgia is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve

AETIOLOGY

PATHOPHYSIOLOGYCompression of blood vessels, especially the superior

cerebellar artery occurs

Chronic irritation of trigeminal nerve at the root entry zone

Increased firing of the afferent or sensory fibers

 

Trigeminal neuralgia

CLINICAL FEATURES

• Excruciating pain -burning, knifelike, or lightning-like shock in the lips, upper or lower gums, cheek, fore-head, or side of nose

• Intense pain, twitching, grimacing and frequent blinking and tearing of the eye

• Facial sensory loss.

DIAGNOSTIC EVALUATION

• History and physical examination• Computerised Tomography• Audio logic evaluation• MRI:-to rule out multiple sclerosis.• Electromyography(EMG)• Cerebrospinal fluid analysis• Arteriography • myelography

PHARMACOLOGICAL MANAGEMENT

• Carbamazepine (tegretal, Apo-carbamazepine, mazepine)

• Phenytoin (dilantin)• Bacofen(lioresal)• Amitriptyline(elavil,meravil)• Diazepam(valium,E-pam)

• Alcohol or phenol may be injected into the affected branch of the trigeminal nerve.

• Injection into the gasserian ganglion

SURGICAL MANAGEMENT

• Janetta procedure

• Balloon compression

• Glycerol injections and radiofrequency rhizotomies

NURSING MANAGEMENT

• Instruct the patient avoid exposing affected cheek to sudden cold.

• Avoid foods that are too cold or too hot.• Chews food in affected side.• Administer Tegretal which relieves and prevent pain.• Serum blood levels of drug are monitored in long term

use.

• Instruct the patient in methods to prevent environmental stimulation of pain.

• Provide emotional support• Provide adequate nutrition in small frequent

meals at room temperature.• Use cotton pads gently , wash face and for oral

hygiene.• Inspection of the eyes for foreign bodies, which

the client not able to feel,should be done several times aday.

• Warm normal saline irrigation of the affected eye 2 or 3 times a day is helpful in preventing corneal infection.

• Dental check up every 6 month is encouraged, since the dental caries not produce pain

• Explain to the client and his family the disease and its treatment.

NURSING DIAGNOSIS

1. Chronic pain related to disease process

2. Imbalanced nutrition less than body requirements related to pain associated with chewing.

3. Fear related to anticipated painful episodes

4. Deficient knowledge of trigeminal neuralgia

COMPLICATIONS

• Toxic side effects of the drugs • Bone marrow and blood disorders • numbness of the face or eye and may lead to

complications such as corneal abrasion• surgical micro vascular decompression may

cause haemorrhage, infection, and brainstem damage

• There may be residual facial numbness, jaw weakness, or corneal numbness following radiofrequency trigeminal gangliolysis.

• Hearing disturbances

Recurrent Trigeminal Neuralgia Attributable to Veins after Microvascular Decompression

• OBJECTIVE: To demonstrate the cause of and optimal treatment for recurrent trigeminal neuralgia (TN) in cases where veins were observed to be the offending vessels during the initial microvascular decompression (MVD) procedure.

• METHODS: An electronic search of patient records from 1988 to 1998 revealed that 393 patients were treated with MVD for TN caused by veins. The pain recurred in 122 patients (31.0%). Thirty-two (26.2%) of these patients underwent reoperations. Clinical presentations, recurrence intervals, surgical findings, and clinical outcomes were analyzed.

• RESULTS: Analysis of 32 consecutive cases of recurrent TN initially attributable to veins revealed a female predominance (female/male = 26:5), with one female patient exhibiting bilateral TN caused by venous compression. Patient ages ranged from 15 to 80 years, with a prevalence in the seventh decade. The V2 distribution of the face was involved more frequently than other divisions. For 24 patients (75%), recurrence occurred within 1 year after the initial operation. At the time of the second MVD procedure, development of new veins around the nerve root was observed in 28 cases (87.5%). After successful subsequent MVD procedures, the pain was improved in 81.3% of the cases.

• CONCLUSION: The recurrence rate for TN attributable to veins is high. If pain reoccurs, it is likely to reoccur within 1 year after the initial operation. The most common cause of recurrence is the development and regrowth of new veins. Even fine new veins may cause pain recurrence; these veins may be located beneath the felt near the root entry zone or distally, near Meckel's cave.  Because of the variable locations of vein recurrence, every effort must be made to identify recollateralized veins. Given the high rate of pain relief after a second operation, MVD remains the optimal treatment for the recurrence of TN attributable to vein regrowth.