Trigeminal neuritis

True neuritis, according to studies, is actually a rare phenomenon, even post-infectious lesions are more neuroallergic. A more correct and modern name for the pathology is the term “neuropathy,” which is increasingly used nowadays, since the mechanism of the development of the disease and the presence of the inflammatory process are usually not precisely established. However, the final verdict regarding the terms "neuritis - neuropathy" has not been handed down, so the name "trigeminal neuritis" is still in use as a diagnosis of its defeat.

A little bit of anatomy: the trigeminal (trigeminal) nerve is also called mixed, since it has sensitive and motor nerve fibers. Its three main branches (ophthalmic, maxillary and mandibular) emerge from the trigeminal node located in the temporal region and are directed, dividing into increasingly smaller branches, to the sensitive receptors of the skin, mucous membranes, muscles and other anatomical structures of the anterior upper third of the head and face. The ocular and maxillary nerve contain only sensitive fibers, the mandibular - also motor, providing movement of the chewing muscles of the same name. Trigeminal neuritis is an inflammation of one or several peripheral processes of its branches, that is, external, located outside the brain, manifested by excruciating pains that disrupt the rhythm of life, and sometimes by disabilities, impaired autonomic innervation with loss of sensitivity of the affected area, paresis, structural changes in nerve fibers.

Epidemiology

Morbidity statistics classify the damage of the trigeminal nerve as a fairly common pathology - for 100 thousand people from 40 to 50 people suffer from trigeminal neuralgia, among them two women are for every man. Among neuralgia, it dominates. Every year, from two to five people from every ten thousand inhabitants of the planet first complain of pain along the trigeminal nerve.

Secondary pathology accounts for about 4/5 of all cases, the main contingent of patients is patients older than 50 years. [1]

Causes of the trigeminal neuritis

The term "neuritis" indicates that there is inflammation of nerve fibers, they already have anatomical changes in the myelin layer, connective tissue (interstitium), axial cylinders (processes of nerve cells). In the development of the inflammatory process, usually the main role is played by infectious agents - viruses, bacteria, fungi. Each of us has acute infectious diseases, and also - almost all have latent chronic infections (caries, tonsillitis, sinusitis, herpes, etc.). Trigeminal inflammation can occur as a secondary process after an acute illness or exacerbation of a chronic infection. But most often, herpetic ganglioneuritis occurs, the cause of which is (presumably) irritation of Gasser’s node neurons affected by the herpes virus.

Nevertheless, much more often pain along the nerve is caused by inflammatory and destructive processes not so much in the tissues of nerve fibers as in the anatomical structures located next to it. The cause of the pain then is compression and irritation of the nerve fibers by adjacent altered vessels and tumors, injuries and congenital pathologies of the cranial structures, which eventually lead to the appearance of degenerative-dystrophic changes in the nerve (neuropathy). [2]

Traumatic neuritis of the peripheral trigeminal nerve is quite common. Risk factors for their occurrence are quite commonplace. Immediate injury to the nerve and surrounding tissues can be obtained not only in case of accidental fractures of the facial bones of the skull, but also in the dental office. Violation of the integrity of nerve fibers can be the result of complex tooth extractions, getting the filling mass beyond the root of the tooth when filling the canal, surgical manipulations, anesthesia, prosthetics.

Risk factors

Risk factors for compression of the trigeminal nerve are anatomical abnormalities relating to channels, holes, blood vessels along its branches; cysts, benign and malignant neoplasms; injuries metabolic disorders caused by digestive disorders, endocrine and cardiovascular pathologies; multiple sclerosis or atherosclerosis of cerebral arteries with the formation of a plaque localized at the entrance of the trigeminal root, hemorrhage in the basin of the brain stem.

Sometimes bouts of specific pain, the so-called pain tic, are preceded by severe hypothermia and a common cold.

Prolonged neuralgia can be a symptom of nerve inflammation. In advanced cases, in the presence of violations of its structure and loss of sensitivity, they speak of the neuritic stage of neuralgia.

If the diagnostic examination does not detect any diseases, trigeminal neuralgia is considered an essential or primary, independent disease. If a vascular pathology, tumor, metabolic disorder, inflammatory process or trauma is detected, then a nerve lesion is treated as secondary (symptomatic).

Neuritis of smaller peripheral branches of the trigeminal - lunar (alveolar) nerves is more common than inflammatory lesions of the main branches. They can be triggered by infectious, for example, osteomyelitis, and colds, accidental injuries of the jaw bones, and also are often the result of dental interventions.

The lower pit nerve can be damaged when the third lower molars are removed, in the treatment of pulpitis of premolar and lower jaw molars (when filling the canal, an excessive amount of filling material can get to the top of the tooth), sometimes the nerve is damaged when conducting conduction anesthesia. The upper one is damaged due to chronic sinusitis and surgical interventions related to them, periodontal inflammation, pulpitis, prosthetics, anesthesia, blockade, tooth extraction (alveolar branches, innervating canines and second premolars are more often damaged), etc. Violation of the sensitivity of the superior typhoid nerves is difficult to treat, which takes several months, and sometimes it cannot be restored at all.

Complicated tooth extraction of the upper jaw can lead to neuritis of the anterior palatine process of the nerve, and the lower to neuropathy of the lingual or buccal nerve.

Pathogenesis

The pathogenesis of neuritis is multifactorial. The integrity of nerve structures is affected not only by the direct mechanical damaging factor, but also by intoxication, metabolic disorders, and vascular transformations. And if everything is clear with traumatic lesions of the branches of the trigeminal nerve, then other theories are still hypothetical in nature. There are several assumptions about its nature, built on the basis of clinical data, but not reliably confirmed. One of the most common versions is the hypothesis that the defeat of one of the branches of a nerve in a certain area leads to local damage to the myelin sheaths. Nerve fibers are “exposed”, generating ectopic excitation waves (impulses) in a given place that provoke bouts of pain (peripheral theory). A long-existing situation leads to deeper damage, the formation of a focus of pain and impaired sensitivity.

Another hypothesis, based on the fact that the drug of choice for the treatment of neuralgia is the anticonvulsant carbamazepine, considers the central origin of pain and neuralgia itself as a disease similar to partial epilepsy.

Symptoms of the trigeminal neuritis

Manifestations of trigeminal neuritis - pain, of varying intensity, are often not as acute as with pure neuralgia, but aching. They can be paroxysmal and persistent. There is necessarily a weakening or loss of sensitivity in the affected areas, and with damage to the motor fibers of the third branch, there are also motor disorders.

The pain with trigeminal neuritis is felt in the vast majority of cases on the one hand, right-sided lesion is 2.5 times more likely, although the nerve is paired, it is located symmetrically to the left and right. Bilateral pain is not typical, but it is impossible to exclude such a case. Sometimes patients complain that a pain impulse is given to the index finger of the left hand. Basically, one branch of the trigeminal nerve is affected - pain is felt in the region of its autonomous innervation, both deep sensitivity and superficial sensitivity can be disturbed.

At the peak of an attack of pain, some patients noticeable reduction in facial muscles of the face (tic) or chewing muscles (trismus).

Neuritis of the first branch of the trigeminal nerve, ophthalmic, is much less common than the other two branches. It leaves the temporal node upward, is located in the thickness of the lateral wall of the cavernous sinus (above the eyebrows) and leaves the orbit, previously bifurcated directly into the ocular and tentorial branch, extending back to the cerebellum. In the orbit, part of the nerve is divided into three branches: frontal, lacrimal, and nasociliary, branching further. The first branch of the trigeminal nerve innervates the skin of the forehead and about 1/3 of the frontal surface of the head under the scalp, the corresponding meninges, skin and mucous membrane of the upper eyelid, eyeball, lacrimal glands, upper back of the nose and the mucous membrane of the “ceiling” of the nasal passage, frontal and ethmoid bosom. Pain syndrome occurs along the branch at any place of innervation where the nerve is affected. Depending on the location of the lesion, the upper part of the head to the crown of the head and face, eye area, back and nasal cavity may hurt. Additionally, there may be lacrimation, discharge of mucus from the nose, loss of smell and numbness. The patient may have impaired reflex closure of the eyelids: when a hammer hits the inner edge of the superciliary arch (orbicular reflex) and / or when touching the surface of the cornea (corneal reflex). [3]

Neuritis of the second branch of the trigeminal nerve, maxillary, is felt as pain in the triangular part of the cheek, which is under the eye. The vertices of the conditional triangle of pain localization are located in the temple area, in the upper part of the nose wing, under the middle of the upper lip. Branches of this nerve are numerous, the largest - meningial, infraorbital and zygomatic, which in turn are divided into smaller branches, providing innervation of the dura mater in the middle cranial fossa, the outer corner of the eye, skin and mucous membranes of the lower eyelid, nose, maxillary sinus, upper cheek in the above region, upper lip, jaw and teeth. The external exit of the second branch of the trigeminal nerve is the infraorbital canal. The maxillary branch is affected most often. Pain and hyposthesia (paresthesia) may be accompanied by lacrimation, nasal discharge, and salivation.

Neuritis of the lower branch of the trigeminal nerve is manifested by pain localized from the temples along the back of the face, the lower part of the cheek and the front - the chin. Pain can be felt in the ear, tongue, and lower jaw. This branch leaves the skull through the chin hole of the lower jaw, exits under the fourth and fifth lower teeth from the center. The lower (third) branch includes sensitive nerve fibers innervating the skin surface of the back side of the face, lower cheek and front of the chin, the corresponding mucous membranes, structures of the lower jaw (gums, teeth), two thirds of the tongue from its tip, so and motor, innervating chewing muscles, the defeat of which causes its partial paralysis. It is manifested by weakened muscle tension during chewing movements, asymmetry of the face shape, sagging on one side of the lower jaw, violation of the chin reflex - reflex closing of the lips with a hammer on the chin. With paresis (paralysis) of the temporal muscle, the retraction of the temporal fossa is visually noticeable. [4]

In addition to neuropathies of the three main branches of the trigeminal nerve, lesions of its smaller branches innervating the teeth, quite common inflammation of the dimples, lower and upper are of clinical importance. The main clinical manifestations of their lesions are pain and a decrease (complete absence) of all types of sensitivity in the corresponding gum, adjacent mucous membrane of the cheek, lip. The electrical excitability of the pulp of the teeth in the affected area is markedly reduced or completely absent. In the acute stage, paresis and trismus of the chewing muscles from the affected side can be observed.

Quite rarely observed neuritis of the chin nerve - the terminal branch of the lower hole of the nerve. The localization zone of sensory impairment covers the lower lip and chin.

Of practical importance is neuritis of the lingual nerve. Sensory impairment (decreased tactile and lack of pain sensitivity, burning, tingling, pain) is localized in the area of the anterior two-thirds of the corresponding half of the tongue. It can be either isolated or combined with neuropathy of the lower alveolar process of the nerve.

Neuritis of the buccal nerve proceeds without pain, only hypo- or anesthesia is observed in the area of the inner side of the cheek and the corresponding angle of the mouth. Virtually no isolated lesion is found, as a rule, the lower alveolar process of the nerve is also affected.

Herpetic trigeminal neuritis develops with lesions of the trigeminal (gasser, trigeminal) node by the herpes simplex virus of the first type, as well as Varicella zoster. Ganglioneuritis - damage to the nerve cells of the trigeminal ganglion (node) manifests itself with acute pain and a characteristic herpetic rash in the innervation zone more often than any one branch of the trigeminal nerve, much less often - all at once. This is accompanied by swelling of the affected side of the face and pain localized at three points of the trigeminal nerve exit.

If the herpes virus has spread in the maxillary or mandibular branches, then during an exacerbation period a herpetic rash appears not only on the surface of the skin of the face, but also inside, on the mucous membranes of the corresponding half of the hard and soft palate, palatine curtain, gums and cheeks. The nasal mucosa can often be free of rashes, but this is not necessary. Branches that provide innervation of the mucous membranes can be affected to a greater extent than the skin. Then the rashes are more plentiful on the inner surfaces. Maybe the other way around.

The ocular form of trigeminal ganglioneuritis is distinguished (4% of all cases) - the infection spreads to the first branch of the trigeminal nerve. A manifestation of this direction is herpetic conjunctivitis and keratitis, as a rule, with ulceration. Hutchinson's symptom, when herpetic vesicles are observed on the wings or tip of the nose, indicates the development of complications - inflammation of the cornea, iris, episclera or optic nerve with its subsequent atrophy.

Pain in the area of innervation of all branches can also immediately indicate damage to the sensitive roots of the trigeminal nerve at the entrance to the brain stem.

Forms

There is no specific classification of trigeminal neuritis. Peripheral lesions are distinguished when sensitivity, deep or superficial, is disturbed along one branch or smaller branches (neuritis of the alveolar nerves). It is also called typical.

And total (atypical), when the whole half of the head and neck hurt. It is rarely diagnosed with bilateral pathology.

The localization and nature of the pain in each patient has individual characteristics, since the location of the branches in different people may vary. In addition, the zones of innervation of the branches of the trigeminal nerve overlap one another.

By the origin of the pathology, an independent disease is distinguished - essential neuralgia (primary, idiopathic), when the cause of the pain cannot be determined, and symptomatic (secondary).

Complications and consequences

The neuritic stage of neuralgia in itself is already a complication, since a loss of sensitivity and paresis are already added to the attacks of pain, indicating damage to nerve fibers.

In addition, the patient, for a long time experiencing a feeling of pain, trying to avoid an attack, develops the so-called protective type of behavior. For example, he chews food, mainly with the healthy part of his mouth, avoids making certain movements, taking poses, because of this the muscles on the sick side suffer, degenerative changes occur in it over time.

Against the background of such behavior, not only physical changes appear, but also mental pathologies - a phobia often develops. The patient, constantly waiting for an attack, becomes anxious and irritable, often prefers voluntary isolation, which leads to the progress of a mental disorder.

Complications are possible from closely located vessels (trophic disturbances), facial, optic and auditory nerves. The disease takes a chronic form, it is already problematic to cure it completely. The consequence of a late call for help may be partial paralysis of the facial muscles, for example, drooping on the affected side of the corner of the mouth or eyelid (ptosis), depletion of facial expressions, mismatch of movement of various muscle groups of the face (ataxia); decreased vision and / or hearing.

With a prolonged course of trigeminal neuritis, it can be complicated by a cerebellar hematoma.

Although the disease does not carry an immediate threat to life, its quality suffers very much.

Diagnostics of the trigeminal neuritis

Complaints of intense facial pain, loss of sensation, and disruption of the jaw muscles require a comprehensive examination of the patient. In addition to a physical examination and questioning, the doctor prescribes a clinical and biochemical blood test, tests for the detection of herpes virus. Usually, this is a polymerase chain reaction, an enzyme immunoassay or an immunofluorescence reaction. Depending on the underlying underlying disease, blood glucose tests, autoantibody levels, etc., may be prescribed.

The patient must be examined for the presence of odontogenic diseases, pathologies of the visual and ENT organs, a consultation with a neurosurgeon, maxillofacial surgeon and other specialists is prescribed if necessary.

Classical instrumental diagnostics - radiography and magnetic resonance imaging as the most informative methods for visualizing bone structures and soft tissues. Additional studies may include electroencephalography, electroneuromyography, computed tomography, ultrasound, puncture of the spinal cord, and other studies depending on the presumed etiological factor of neuritis. [5]

Differential diagnosis

Differential diagnosis is carried out with glaucoma (with this disease, acute pain is felt in the innervation zone of the ocular branch of the trigeminal nerve); sinusitis sinusitis; calculous formations in the salivary glands; subluxation of the jaw-temporal joint; neoplasms in the area of the trigeminal node and along the branches of the nerve; temporal tendonitis; trigeminism - reflected pain in diseases of the internal organs; pathological processes relating to the teeth and jaw.

Neuritis and trigeminal neuralgia are components of the same process. When they talk about "pure" neuralgia, they mean acute paroxysmal pain of neurogenic origin, which cannot be stopped by available painkillers. Painful paroxysms are usually short, from a few seconds to two minutes, with a clear beginning and end. In the period between them, called refractory, the patient feels as usual, neurological symptoms are absent. Typical attacks of pain occur suddenly and are often repeated (30-40 times a day), sometimes preventing the patient from recovering. An attack of pain often provokes irritation of the affected area (trigger factor) - chewing, coughing, palpation, changing ambient temperature, for example, a patient enters a warm room from a winter street. Such pains are called "trigger". In addition, an attack of trigeminal neuralgia in some occurs as a result of severe excitement, stress, the use of stimulating foods and drinks: spicy foods, alcohol, coffee, and other stimulants of the nervous system.

The most typical trigger (algogenic) zones are the area above the brow, at the inner corner of the eye, on the back and under the nose, the outer point of the nose wing, the corner of the mouth, the inner surface of the cheek, gums. Slightly touching one of these areas can cause an attack of pain. What is characteristic, a sharp and severe irritation of the trigger zone can lead to the cessation of the pain attack. The acute period may be accompanied by hypersalivation, excessive sweating, nasal discharge, lacrimation. It is comforting that at night during sleep, trigeminal neuralgia usually does not bother, but many cannot sleep on the sore side.

Specific behavioral features are observed in individuals with trigeminal neuralgia - at the time of the attack, the patient freezes in silence, often putting his hand and rubbing the affected area of the face. At the same time, he does not cry, does not complain, does not cry, although the pain is very sharp and painful. Contact is available. Answers questions in monosyllables.

Neuralgia - pain along the nerve can be a manifestation of the inflammatory process in the nervous tissue, the presence of changes in the structure of the nerve trunk. Then they talk about neuritis. Nerve inflammation is clinically manifested not only by pain, but also by symptoms of impaired function - a decrease in muscle volume, a decrease in muscle strength, hyposthesia or anesthesia, and a decrease or loss of reflexes. The nature of pain in the neuritic stage also changes, it becomes aching and often constant. This indicates the neglect of the process and the upcoming difficulties of treatment.

Treatment of the trigeminal neuritis

The treatment of trigeminal neuritis is complex. Mandatory sanitation of the oral cavity and the elimination of inflammation in the nasal cavities, if detected, are corrected if any, any somatic pathology. Direct treatment boils down to eliminating bouts of pain and preventing relapses, if possible, restoring the sensitivity and structure of nerve fibers. [6]

In case of damage to the trigeminal node and the main branches of the trigeminal nerve, anticonvulsants provide an analgesic effect. The drug of choice is carbamazepine. The effect of its use occurs in 70% of patients suffering from trigeminal neuralgia. The pain usually disappears on the second or third day from the start of the medication. Carbamazepine begins to be taken with low doses. On the first day, a double dose is prescribed in a single dose from 100 to 200 mg. Every day, the patient takes 100 mg more of the drug. The daily dose is increased until the pain disappears due to a more frequent intake of the drug. The patient takes as much as possible three or four times a day, 200 mg each. After achieving pain relief, the dose of the drug is gradually reduced to 100 mg per day, stopping at the minimum effective. The average course of treatment is three to four weeks.

Valproic acid helps some patients. Treatment begins with a daily dose of 3 to 15 mg, divided into two doses. The possibility of increasing the dose at the rate of 5-10 mg per kilogram of patient weight per week, but not more than 3 g per day, is assumed.

Second-line drugs are central muscle relaxants baclofen and tizanidine, antidepressants, for example, amitriptyline.

Empirically selected doses of muscle relaxants are selected so that muscle tone does not decrease until the appearance of motor disorders. Baclofen begins to be taken 2-5 mg three times a day, gradually, every three days, increasing the dose to a minimum effective. The daily dose should not exceed 60-75 mg. Cancel baclofen, also gradually reducing the dose.

Tizanidine begins to be taken with one capsule per day, as a rule, two capsules are enough to stop the pain syndrome. The dose is increased every three to seven days. In some cases, four capsules are required.

Amitriptyline is first taken 25-50 mg at bedtime, with a subsequent increase in the frequency of administration to three and the dose of the drug within five to six days, to 150 mg, and if the therapeutic effect does not occur within two weeks, the dose is increased to 300 mg / day. And most of it is taken before bedtime. After the cessation of pain, they gradually return to the initial maintenance dosage. Treatment can be long, but not more than eight months.

In severe cases, when treated in a hospital, anticonvulsants, muscle relaxants, antidepressants can be prescribed intravenously or drip.

In case of bacterial infections (detection of sinusitis, sinusitis, osteomyelitis, dental infections), intravenous infusions of hexamethylenetetramine, which has the necessary spectrum of antibacterial activity, are recommended.

Antihistamines are also prescribed, preferably also providing sedation (diphenhydramine, suprastin). They enhance the effect of painkillers and antidepressants. Biotonizing agents are prescribed - aloe extract, with severe muscle atrophy - adenosine triphosphoric acid, alcohol-novocaine blockade, and other symptomatic drugs.

With relapses of trigeminal neuralgia, a single drop-by-drop administration of phenytoin gives a good effect. The dose of the drug is calculated in the proportion of 15 mg per kilogram of patient weight. The procedure takes two hours.

Non-narcotic analgesics do not have the expected effect, except in cases of neurostomatological neuritis (damage to the dimpled nerves). Moreover, the desire to quickly relieve a pain attack with a large dose of the drug can lead to the development of such a side effect as abusus syndrome. This applies to taking pills. And the local use of the drug of the same group of dimethyl sulfoxide, better known as dimexide for trigeminal neuritis, was effective. The treatment method is very simple and doable at home. And in comparison with the above drugs, it is also absolutely safe, since side effects with local application are minimal.

Compresses with dimexide for trigeminal neuritis are made on the skin of the face at the exit points of the affected branches - they just apply a napkin dipped in a solution prepared from a mixture of dimexide with lidocaine or novocaine to this area for 20-30 minutes.

So, to make a compress solution, you need to buy a bottle of a standard 98% solution of dimethyl sulfoxide and a 2% solution of any anesthetic - lidocaine or novocaine in a pharmacy. Before starting treatment, it is necessary to make a test for sensitivity to each of the ingredients: moisten the swab with a solution and apply it to the skin. The appearance of a rash, redness and itching at the site of application will indicate the impossibility of using this method. In addition, dimexide is a pronounced conductor. Five minutes after the start of application, it is detected in the blood serum. Therefore, it is better to abstain from treating compresses with dimexidum for pregnant women, people with glaucoma and cataracts, severe violations of the liver, kidneys, heart, and vascular pathologies. In general, it is better to consult with your doctor before treatment. [7]

If there are no contraindications, we prepare a solution, that is, we mix dimexide with any of the anesthetics in the following ratios: 1: 9 (one part of dimexide to nine parts of anesthetic) or 1: 5 or 3:10. We choose the ratio of ingredients depending on the severity of the pain syndrome - the stronger the pain, the more concentrated the solution. We take a gauze napkin, dip it in the prepared solution and wring it not dry, but so that it does not flow. We apply to the exit point of the affected branch to the surface of the face: the first is the infraorbital notch, located directly above the eyebrow about a centimeter from its beginning; the second is the infraorbital canal; the third is the chin hole of the lower jaw, located under the fourth and fifth lower teeth from the center. Cover with a piece of cling film and a small terry towel. We lie with a compress for about half an hour. The procedure must be done two to three times a day (depending on the intensity of the pain). The course of treatment is from 10 to 15 days.

As part of a comprehensive treatment for both essential and symptomatic neuralgia, vitamin therapy is indicated. Assigned from the first days of treatment, mainly B vitamins, known for their neuroprotective effect, also - ascorbic acid and vitamin D. 

Vitamins of group B (B1, B2, B3, B6, B12) are catalysts for the reactions of intermediate metabolism in nerve fibers, have analgesic activity, especially vitamin B12 (cyanocobalamin), its deficiency leads to demyelination of nerve fibers. The course of this intramuscular injection of this vitamin significantly, according to the observations of clinicians, eliminates pain and improves the general condition of the patient.

In clinical studies, the role of B vitamins in the normalization of the nervous system at all levels, reducing the manifestations of inflammation and reducing the level of pain is proved. They participate in metabolic processes, help strengthen the myelin sheaths of nerve fibers, axial cylinders, connective tissues, preserve their integrity and, accordingly, can help restore impaired innervation and normalize the transmission of nerve impulses. Preference is given to complex preparations in tablets, however, injectable forms can be prescribed, and also electrophoresis with vitamins can be prescribed.

Physiotherapeutic treatment is indicated both in the acute period of neuritis and in order to prevent relapse of the disease. During seizures, thermal procedures are prescribed. The use of ultraviolet radiation of the affected half of the face, phototherapy with infrared rays (Sollux lamp) is shown. A moderate heat exposure with an electric heating pad may be helpful. [8]

Diadynamic therapy is widely used. Treatment with DC pulses has a pronounced analgesic and anti-inflammatory effect. In the acute period, daily procedures are prescribed, two or three ten-day courses are recommended at weekly intervals. Using diadynamic currents, drugs are delivered - a local anesthetic procaine or tetracaine, an epinephrine adrenomimetic, which contributes to rapid pain relief.

The effects of ultrasound and a laser beam on the exit points of the trigeminal nerve branches, sinusoidal modulated currents, drug electrophoresis (for trigger pains - according to the endonasal technique with procaine and vitamin B1) are also used. In case of trigeminal neuritis, d'arsonval is performed by the method of pinpointing on the affected half of the face in the areas where its branches reach the surface, the area under the earlobe, the cervical-collar region, and also the palmar surface of the phalanx of the thumb of the corresponding hand. [9]

Exercise therapy for trigeminal neuritis is performed in the form of facial gymnastics and helps to restore the mobility of the affected part of the jaw, improve trophism and normalize reflexes. For the same purpose, massage is prescribed for trigeminal neuritis.

In complex treatment, a special place is given to reflexology. Acupuncture helps some patients recover completely without medication.

Mud therapy, ozocerite and paraffin baths, radon, sea, sulfide baths are also prescribed as additional therapeutic methods and for the purpose of relapse prevention.

Alternative treatment

Official medicine denies the possibility of curing trigeminal inflammation using alternative medicine. Of course, if you need to re-fill the tooth canal, then such treatment is unlikely to be successful. And in other cases, when radical interventions are not required, according to the testimony of the patients themselves, alternative remedies help faster and better. In addition, they do not have serious side effects. The disease does not apply to those where the delay in death is similar, so you can almost immediately begin to help yourself with the help of healers, which does not exclude a visit to the doctor and examination. After all, facial pain can be caused by various reasons.

Let's start with the simplest recipes for eliminating pain. According to those who have tried, they help relieve pain right away, and not on the second or third day like carbamazepine.

1. Take the old teapot, put in it five cloves of garlic, cut into large (2-3) parts. Pour boiling water and breathe through the nose of the nostrils from the affected side until the pain subsides. Literally several such procedures help in the initial stage. The pain goes away and never comes back. Procedures are carried out if necessary to eliminate the pain syndrome.
2. Take a freshly boiled steep chicken egg, peel, cut in half, apply to the points of the most intense pain. When the halves of the egg on the face have cooled - the pain syndrome will go away for a long time.
3. Apply a freshly picked leaf of home geranium along the pain (it has an anti-inflammatory effect). [10]
4. You can smear areas of the face along the pain with black radish juice or apply grated horseradish wrapped in a piece of gauze. These substances have a local irritating effect, that is, they stimulate blood flow to the surface of the skin, and activation of blood flow in the right direction, as practice shows, leads to a normalization of the condition.
5. It is also good to lubricate the skin in areas of pain with fir oil, if necessary. Three days of such treatment for a long time relieve pain.
6. Contrast procedure: wipe the pain zones with a piece of ice, and then massage them until they are warmed up. In one procedure, you need to do wiping → massage three times.

Herbal treatment occupies a large place in alternative medicine. Mint decoction will help cope with the pain: a tablespoon of mint is poured with a glass of boiling water and simmer in a water bath for 10 minutes. Insist until it cools down to a temperature of about 40 ℃, filter, divide in half and drink in the morning and evening. The second portion needs to be slightly warmed up.

Yarrow infusion is prepared in the same proportion, it is drunk during the day in three to five receptions.

And the infusion of chamomile (a teaspoon of dry chopped herbs in a glass of water) is recommended to rinse your mouth with neuro-dental problems.

Homeopathy

Homeopathic treatment is often effective in cases in which official medicine fails. It should be carried out by a professional homeopath, then its success is guaranteed. The homeopathic medicine kit has an extensive arsenal for treating neuritis.

With the defeat of the second and third branches of the trigeminal nerve, alveolar mandibular processes, buccal nerve, the use of Aconite can be effective. Severe pain, causing the patient anxiety and fear, paresis, convulsive twitching of the muscles of the affected area, loss of sensitivity, are characteristic. Aconite copes well with pain of inflammatory origin. In cases of hyperemia of the affected part of the face, it is taken alternately with Belladonna, with traumatic genesis - with Arnica, and neuro-dental problems are well stopped by the combination with Brionia. The same drugs are suitable in some cases for monotherapy of trigeminal neuritis.

With right-sided defeat of the first branch, Helidonium is used. With complications of the organs of vision, and from any side, Quininum sulfuricum can be effective.

Coffey, Hypericum, Ignation and other drugs are also used. Only a doctor can accurately prescribe treatment, having studied the medical history and propensities of the patient. In this case, you can count on success, and quite fast.

Surgery

In the absence of the effect of conservative therapy, intolerance to drugs or their pronounced side effects, the question of surgical intervention is raised.

Modern neurosurgery has many methods of gentle surgical treatment. Currently resorting to:

• microsurgical release of a nerve site at the exit of the brain stem;
• puncture destructive operations;
• partial sensory transection of a nerve or its peripheral blockade by excision of its part and replacing it with muscle or fascial tissue.

Neuroectomy is performed by gentle methods using ultra-low temperatures (cryodestruction), using ultra-high temperatures (diathermocoagulation), and high-frequency radiation.

A promising area is laser treatment of trigeminal neuritis. The dissection or removal of part of the nerve root with a laser beam ensures the absence of direct contact and blood, rapid healing and recovery.

Prevention

The main preventive measure is the timely rehabilitation of the oral cavity, for which it is necessary to visit the dentist regularly (every six months) so as not to bring about the development of pulpitis and nerve removal.

It is also recommended not to start other chronic diseases, eat well, try to avoid accidental facial injuries and hypothermia, lead a healthy lifestyle and strengthen immunity.

With the appearance of pain in the face, it is necessary to be examined and find out their cause, and not take analgesics and hope that it goes away.

Forecast

With timely diagnosis and treatment, the prognosis is favorable. It is usually possible to cure neuritis by conservative methods. However each case is individual