Neuropathy of the branches of the trigeminal nerve

Neuropathy of the trigeminal nerve is one of the forms of the pathology of the trigeminal system. In this form of pathology, the intestinal tissue undergoes degenerative changes. There are numerous transformations, as well as functional changes. Myelin fibers and axial cylinders also undergo changes. It is a serious problem with which modern neurology is increasingly faced. It significantly reduces the quality of life of a person, complicates it. An unpleasant phenomenon is pain, also significantly reduced sensitivity, there is numbness, loss of many functionalities. The most dangerous is paresthesia of the face, paralysis.

Damage to the nerve is fraught with serious consequences, as there is a violation of many structures. Accordingly, their functions are also violated. The innervation of many organs and systems is violated. The triple nerve is formed by three branches, which ensure the transmission of the nerve impulse from the innervated organs to those structures that are responsible for the processing of the nerve impulse. The triple nerve is responsible for the innervation of the face and oral cavity. Also under the zone of innervation are skin, teeth, tongue, nerves, eyes. This nerve provides motor reflexes, and is also responsible for various vegetative reactions.

The causes of neuropathy can be many. This can be both structural and functional disorders. Most often there is a violation of a separate branch of the nerve. Violation of the first branch is a rather rare form of pathology, while the most common form is the violation of the second branch. All three branches are extremely infringed. These are isolated cases in all neurological practice. The peculiarity of this form of the disease is that it can develop long enough. Often the disease develops from several months or more.

[1], [2]

Epidemiology

At the moment, the frequency of manifestations is 25 to 10000. Pathologies are equally susceptible to both men and women.

[3], [4], [5], [6]

Causes of the neuropathy of the trigeminal nerve

Primary pathology develops if the nerve is directly, directly affected. It can be squeezing the nerve with bony projections, ligaments, pathological displacements of tissues. This can be direct damage to the nerve as a result of impact, compression, stretching.

Secondary causes are represented by a list of factors that led to inflammation or nerve damage. Thus, secondary causes are a consequence of pathological phenomena occurring in the body that affect the structural and functional state of the nerve.

As secondary causes of the development of pathology, leprosy, various neoplasms are considered. Both benign and malignant neoplasms affect both the trigeminal nerve negatively as they exert mechanical pressure on the trigeminal nerve. Negatively reflected and squeezing the nerve pathologically altered vessels, which occur during the development of the tumor. Also dangerous are changes, deposits in blood vessels, blood clots. Atherosclerosis is one of the causes of the pathology, as plaques form inside the vessel, which can also put pressure on the nerve. A particular danger is a plaque that forms in the region of the sensitive nucleus of the trigeminal nerve.

For the main reasons, we must also include hereditary factors that ensure the predisposition of the nerve to pathological changes. Negatively reflected pathological phenomena, observed during pregnancy, during intrauterine development. Especially dangerous are birth trauma, as well as various injuries sustained after birth, especially in the early infancy.

Increasingly, neuropathies develop after surgical surgeries, cosmetic procedures, invasive manipulations, during which the nerve is damaged. Often the nerve is injured by dentures, as well as during various dental procedures. Craniofacial, craniocerebral injuries also often result in neuropathies. Often the nerve is damaged by toxic substances, factors of an allergic, autoimmune nature. Many viruses, bacteria, protozoa, and even hidden infections, can cause damage to the nerve. Toxic effects can be provided by various plastics, prosthesis, iron structures, which are used in dentistry.

The cause of nerve damage can become even ordinary hypothermia. Especially it is easy to damage the nerve in a draft, at low temperatures, in the wind. Negative impact has a sharp temperature change, as well as air conditioners, fans, heaters, working indoors. The danger is also that such influences can reduce immunity and resistance of the organism, as a result of which the nerve becomes more vulnerable and prone to negative influences. The nerve in this state is more susceptible to infection, inflammation, and even mechanical damage. The various exhaust gases, toxins from the environment, nicotine can damage the nerve.

Do not neglect and the impact of such severe inflammatory and infectious diseases as typhoid fever, measles, rubella. The defeat of the nerve can develop as a result of inflammation in the region of the ear, nose, throat. Herpesvirus infection, inflammation of the lymph nodes, sinusitis, caries, sinusitis often lead to nerve damage. Often the symptoms of these diseases are so close to nerve damage that they are confused with neuropathy. Therefore, differential diagnosis may be required. The cause of defeat of the trigeminal nerve can be a general damage to the nervous system, the brain and spinal cord, as well as other parts of the nervous system, in which the pathological process spreads to other parts and nerves. The paralysis of nerve endings, both the trigeminal nerve and other nerves, paresis and brain tumors can also lead to nerve damage and other complications. Even careless treatment, in which the patient does not follow the doctor's recommendations, is self-medicated, may result in inflammation. Even such abstract problems as syphilis, tuberculosis, purulent-septic pathologies, can lead to neuropathy.

Primary neuropathy of the trigeminal nerve

Primary pathology occurs quite often as a consequence of an infectious and inflammatory process that develops as a result of hypothermia, trauma, compression and mechanical damage to the nerve, against a background of reduced immunity. Also, the primary pathology can develop as a result of direct nerve damage during operations, dental manipulation. Congenital anomalies, in which the nerve is damaged, also serve as a factor that causes the direct development of neuropathy. There are no significant differences in the clinical picture between the primary and secondary forms of pathology.

[7],

Secondary neuropathy of the trigeminal nerve

The secondary form of neuropathy also occurs frequently. It is a consequence of the development of various pathological processes in the body. For example, nerve damage can develop as a result of the development of viral and bacterial infections in the body. Often brain tumors, various congenital pathologies, atherosclerotic deposits, spasms entail nerve damage. Often, neuropathies develop against a background of diseases such as tuberculosis, syphilis, herpesvirus infection. Sinusitis, caries, pulpitis also often lead to nerve damage.

Neuropathy of the trigeminal nerve after tooth extraction

The most common pathology in dentistry is an acute toxic lesion of the trigeminal nerve, in which the lower alveolar nerve is injured, as well as the chin nerve that occurs when the filling material enters the mandibular canal. This happens in the treatment of pulpitis. Especially often this pathology is observed in the treatment of pulpitis premolars (first and second). Treatment of the teeth of the lower jaw is often accompanied by an inflammatory process in the area of the lower jaw. A characteristic sign of such damage is severe pain, which first arises during the procedure, and then accompanies the person during the recovery period.

Later, this pain remains dull and aching, nevertheless, rather exhausting the person and requires the use of strong painkillers, sometimes even hospitalization for further complex measures. The emergence of acute pain during the treatment of the tooth requires the provision of urgent emergency care, during which the mandatory decompression of the channel. To do this, use dexamethasone, a solution of euphyllin and a solution of glucose. These funds are administered intravenously, by a jet method. At the same time intramuscularly administered dimedrol and furosemide. This will prevent the most dangerous damage to the nerve. In the future, treatment is required, during which drugs are used to normalize microhemocirculation. Neuroprotectors, desensitizers are also used.

A frequent consequence of nerve damage during dental manipulation is the neuropathy of the buccal nerve, which is often intertwined with inflammation of the trigeminal nerve and entails its inflammation. The pain is acute, is relatively constant, it is quite easy to distinguish it.

Often observed and the defeat of the upper alveolar nerve. Recognize it for acute pain and numbness in the area of the upper jaw. The mucous membrane of the cheek and gum is also damaged.

Risk factors

People who suffer from dental diseases get into the risk group, especially if it is a lesion of deep layers, for example, deep caries, pulpitis, periodontitis. The risk factor is the presence in the body of a chronic foci of chronic infection, recently transferred acute infectious diseases, tumors. The risk group includes people who are constantly exposed to toxic substances, supercooled, work under air conditioners and extractors.

The risk of developing the disease in people suffering from atherosclerosis, tumors, vascular pathologies, congenital anomalies and genetic defects in development is significantly increased.

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Pathogenesis

At the heart of pathogenesis is the disruption of the normal functioning of the body fibers. In this case, their function is often violated, and not the structure. Often observed pathological phenomena in receptors that perceive irritation, as well as numerous pathologies in the field of the reflex arc, which supports the path from the innervation zone and to the brain, and also in the reverse order.

The concomitant factor of this pathology is pain, which in most cases develops subacute. Pain syndrome can be short-lived. Often it is accompanied by a spasm of chewing musculature. Pain and spasm are permanent, increasing in intensity, the intensity is also constantly increasing. Painful sensations are accompanied by numbness and paresthesia, in which a person feels pain and tingling in the corresponding area of innervation. Also there are creeps and tingling.

[11], [12], [13], [14], [15], [16]

Symptoms of the neuropathy of the trigeminal nerve

Various disorders are indicated for the defeat of the trigeminal nerve. Their localization corresponds to the affected area. Recognize the damage is simple enough, because it is accompanied by a sharp acute reaction of a constant character and almost does not abate. At night, it is noisy, burning, and becomes an acute, unbearable day. Also, pain can be given to other sites.

A distinctive feature is what she gives to the area of hair, chin, ear, eyes. Often the pain is accompanied by a strong spasm. First of all, the spasm is affected by chewing musculature. There is a feeling of impossibility to lower the lower jaw. Over time, a person can not really omit it. An acute pain may develop, and then an inflammatory process in the ear. With pressure, pits are formed and soreness increases.

First signs

First of all, there is a feeling of pain, which is aching. The pain is initially localized in the eyebrow area, above the eyes. Gradually, it can spread to other sites. Especially the pain intensifies in the cold season. A distinctive feature of such pain is its development by short-term attacks of acute pain, which are accompanied by calm, aching pain. The most common localized pain is only one side. In this case, it becomes more intense at night, shoots. Later spasm of the face, lips develops. The pain increases during movements.

Also, many people note the pressure in the areas of the cheeks, ears, nose, eyes. Gradually, sensations can spread to the back of the head. Some even feel pain in the thumb, which often covers the index finger.

[17], [18], [19], [20]

Edema with a trigeminal nerve neuropathy

Neuropathy can be accompanied by edema, since normal metabolism is disturbed, both in the nerve itself and in surrounding tissues. Appears hyperemia, in a compressed and inflamed area, blood circulation is disrupted, swelling and tissue swelling develop. The cause is also a fluid retention and a violation of excretion of metabolic products from damaged tissues.

[21], [22], [23]

Neuropathy of the 1st branch of the trigeminal nerve

Cases of the first branch of the trigeminal nerve are extremely rare. This practically does not occur in medical practice. More often occurs a combined lesion of the first and second branches of the trigeminal nerve. In this case, damage is most often accompanied by an inflammatory process that occurs in the brain area. The adhesive process develops. Often other structures, for example, the maxillary and frontal sinuses, are involved in the inflammatory process.

Often there is a constant aching pain that pulsates. Especially the pulsation develops in the region of innervation of the trigeminal nerve. The process is accompanied by numbness, a feeling of crawling. Many people have their teeth reduced, which is often explained by the defeat of the motor part of the nerve. Patients can not perceive the movements of the jaw. They either become involuntary, or the person in general practically ceases to move the jaw. It also becomes difficult to eat and talk. In the oral cavity and on the face it is impossible to determine the trigger zones of this process.

Diagnosing pathology is not difficult. In most cases, a qualitative objective and subjective examination is required to establish a diagnosis. Often the diagnosis is made based on anamnesis of the disease - the main diagnostic sign, indicating the development of pathology, is the very fact of the occurrence of severe pain in the dental system, which occurred during dental and surgical intervention.

This disease is characterized by a prolonged clinical course, as well as a significant duration of pain, its high intensity. A high level of clinical polymorphism is also characteristic. Exacerbation is often observed against a background of hypothermia, in the winter cold season, and also after overwork, after stress and nervous overexertion. Exacerbation can occur and against the background of other somatic pathologies.

A rather dangerous sign is the formation of scarring on the nerve, or its retraction into the soft tissues that occurs during the healing of injuries and injuries. Especially high risk of such lesions in the presence of congenital or acquired defects and anomalies of the jaw, bones.

Neuropathy 2 branches of the trigeminal nerve

Note the pain of a short-term nature, which manifests itself as severe attacks, lasting approximately 1-2 minutes. Between painful attacks there is a painless period, which is then replaced by intense pains of an acute nature. Often there is an unexpected, shooting pain, which many compare with a knife or a strong electric shock.

Pain can arise spontaneously and unexpectedly, or is provoked by other factors, for example, abrupt movements, pressure. Also, an attack of pain can occur during eating, running, running, swallowing, talking and even touching. It should be noted that all the zones that trigger pain are localized in the face area, especially in its central departments. The pain wave spreads to the area of anatomical innervation of the nerve. In this case, the spread occurs on the region of 1,2,3 branches of the nerve.

A characteristic sign of the defeat of the second branch is the irradiation of pain along the entire reflex arc of the trigeminal nerve. The pain wave spreads quite quickly. In this case the pain is of the nature of a multineuron process. In this case, the entire nerve system is affected. There is a certain polymorphism within which different clinical forms are distinguished. Basically, significant differences are observed between neuralgia of the central and peripheral genesis.

Importance is given to the topical diagnosis, because it underlies the selection of the optimal method of treatment. It should be noted that pain is always one-sided and intensified during the day. Most often the pain is paroxysmal. Outside the attack, the pain does not bother the person. Often there are trimeses, which are often confused with the symptoms of tetanus, rabies.

The defeat of the second branch is most affected by older people. Their pain can be long, permanent. It is characterized as blunt and aching, which spills over the entire area of the affected nerve. Often accompanied by a violation of taste, smell. In the course of objective examination, it is possible to detect the absence or partial decrease in sensitivity in the face area, as well as along the entire length of the nerve.

When palpation, soreness is detected. Especially sensitive in this respect are the points of nerve exit. The primary cause is primary damage to the nerves by various factors, including mechanical damage. Often becomes a consequence of vibration sickness and chronic poisoning. Diabetes mellitus can also lead to nerve damage. Inflammations in neighboring organs and infection often involve the inflammatory process and the nerve itself. It can also develop as a consequence of inflammation of the brain, a tumor, an inflammatory process in other nerves located along the periphery.

Often, a prolonged course of the disease leads to a change in the main symptom complex. The defeat of the nerve requires urgent care. In the course of assisting necessarily use of anticonvulsants, which eliminate convulsive tension and promote relaxation. Antineurotic therapy is used.

For preventive maintenance, the oral cavity is sanitized in a timely manner, it increases immunity, observes the regime of the day, and avoids stress and overwork. Neuropathy of the trigeminal nerve  can be completely cured only if all the recommendations of the doctor are followed and the complex effect on the body.

Complications and consequences

The consequences are severe pain, loss of sensitivity, up to complete muscle atrophy. Gradually, the atrophic process can affect other nerves. Developed plexia, paresis, paralysis, which are accompanied by a pronounced loss of sensitivity and violation of innervation. The final stage is complete paralysis and brain damage.

[24], [25], [26]

Diagnostics of the neuropathy of the trigeminal nerve

For the diagnosis is required to be examined by a doctor. The doctor conducts examination and questioning of the patient, conducts a general and specific physical examination, during which both traditional clinical methods of research (palpation, auscultation, percussion) and special (sensitivity determination, functional tests, assessment of the main reflexes) are used. In most cases, the diagnosis can be made on the basis of survey and survey data. It is also not difficult to determine the cause of the pathology and to eliminate it. But sometimes this is not enough, then the doctor appoints laboratory and instrumental studies.

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Analyzes

In general, laboratory studies are extremely rare, because they are not informative in this case. More informative can be instrumental methods and functional tests. In rare cases, a clinical or biochemical blood test is appointed, which may indicate the presence of an inflammatory process, or an allergic reaction. Immunogram or rheumatic tests can be used to confirm or disprove the autoimmune nature of the pathological process.

In the usual clinical analysis of blood, the values of the leukocyte formula can be significant. So, the increase in eosinophils in the blood can speak about the development of an allergic reaction, helminthiases, the action of toxic substances, rheumatism, neuroses, which can cause the development of neuropathy. A decrease in the number of basophils can occur with acute infections, hyperthyroidism, pregnancy, stress, Cushing's syndrome, which can also lead to damage to the trigeminal nerve. An increase in the number of monocytes can talk about the development of tumors, sarcoidosis.

[29], [30], [31]

Instrumental diagnostics

Instrumental methods are basic. They are appointed when it is necessary to obtain additional information, and if the diagnosis was not made during the examination. The main methods of instrumental research include X-ray study, computer or magnetic resonance imaging. They are very informative and complementary.

So, with the help of an X-ray, it is easiest to diagnose bone pathologies, because it radiates well the bone tissue. You can find out the reason for the development of neuropathy. It can be a nerve pincer, its inflammation, displacement, damage as a result of a fracture or dislocation of the bone, which is very clearly displayed in the picture. You can also notice the pinching of the nerve, bone spur, arthritis, and even inflammation in the nerve. With the help of computer and magnetic resonance imaging, you can consider soft tissues. Muscles, ligaments, tendons, and even cartilages are also well visualized. In rare cases, there is a need for ultrasound (ultrasound). This method makes it possible to track the processes in dynamics.

Differential diagnosis

In most cases, neuropathies are clearly differentiated after examination and instrumental diagnosis. The further essence of differential diagnostics consists in revealing the reason of a pathology on the basis of which the affiliation to this or that kind of neuropathies is revealed. Most often differentiate traumatic, inflammatory compression neuropathy.

Prevention

For prevention of neuropathies, it is necessary to maintain a high level of physical activity: perform dynamic exercises, and if possible, exclude statics and monotonous work. It is also necessary to ensure that the body receives everything necessary for proper functioning: proteins, carbohydrates, lipids, vitamins and minerals. Especially for professional athletes: you need to carefully monitor the hygiene of joints, change periodically the types of load, take the necessary complexes and vitamins. It is necessary to undergo medical examinations in time, and if any pathologies are revealed, treat them.

[32], [33], [34]

Forecast

If the pathology is discovered in time and the treatment is started, the prognosis may be favorable. Usually the trigeminal nerve neuropathy is cured completely. But the treatment is rather labor-intensive and long-lasting, so you will have to be patient. If not treated, the disease progresses, and then the prognosis will be unfavorable, up to paralysis and complete disability. 

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