A pinched trigeminal nerve

Sharp jaw pain can be a consequence of such a pathology as pinched trigeminal nerve. This problem is classified as a severe neurology, since its occurrence is caused by a number of factors, the symptoms are determined by severe pain and loss of ability to work, and the therapy is often long and complicated.

Epidemiology

Most often, pinched trigeminal nerve is diagnosed on the right side (from medical practice, the right-sided painful process is recorded in 70% of cases). Simultaneously, bilateral damage occurs only in isolated cases. [ 1 ]

Most often, pinching is observed in patients belonging to the age category from 40 to 55 years. Women are slightly more often affected than men.

Trigeminal nerve damage has a certain cyclicity: relapses occur mainly in the off-season, in autumn or spring.

The most common symptom of pinching is pain – severe, sharp, and difficult for patients to bear. In most patients, the lower facial segment is affected, but the upper, frontal, and middle areas of the face may be involved.

Causes trigeminal nerve entrapment

There are many reasons for pinching the trigeminal nerve, although the main factors are impaired blood flow and direct compression of the nerve. Most often, doctors point to the following underlying causes:

• adhesions, tumor processes, spreading to nerve branches;
• arterial aneurysms;
• poor dental filling technique, nerve damage during tooth extraction;
• inflammatory processes in the form of periodontitis or pulpitis;
• infectious and inflammatory processes in the nasopharynx or jaws;
• stomatitis;
• vascular atherosclerotic changes associated with disruption of the nutrition of the trigeminal nerve;
• facial, jaw injuries; [ 2 ]
• cold effects.

In addition, there are several risk factors, or diseases, in which the clinical picture of pinched trigeminal nerve most often develops. [ 3 ]

Risk factors

• Autoimmune diseases of the nervous system, multiple sclerosis.
• Endocrine disorders.
• Diseases of the cardiovascular system.
• Viral infections, herpes virus.
• Psychogenic disorders (neuroses, psychoses, psychosomatic pathologies, abnormal psychoemotional reactions).
• Vitamin or microelement deficiency in the body.
• Weakened immunity, acute respiratory infections, acute respiratory viral infections, colds.

Pathogenesis

The main function of the trigeminal nerve is to provide sensory ability to the face. The trigeminal nerves are paired and run to the left and right. Each nerve gives off three branches:

• the branch responsible for the sensitive ability of the visual organs, the skin on the forehead and the upper eyelid;
• a branch that determines the sensitivity of the buccal, nostril, upper lip, gingival zone and lower eyelid;
• the branch responsible for the sensitivity of the lower jaw and lip, as well as for interaction with the chewing muscles.

When the trigeminal nerve is pinched, an inflammatory process develops, which is characterized as neuralgia or neuritis. With neuralgia, peripheral nerves are affected, their sensitive fibers are irritated. Neuritis is accompanied by painful destruction of the nerve structure.

The causes of pinched trigeminal nerve in the cervical region are irritation of the autonomic structures of the spinal cord, or damage to the superior cervical sympathetic ganglion by infection or inflammatory reaction. In this case, adhesions and fibrous changes are formed, the autonomic nucleus of the trigeminal nerve is compressed. [ 4 ]

Symptoms trigeminal nerve entrapment

Pinching of the trigeminal nerve always occurs suddenly and abruptly.

The standard first signs are a piercing pain on one side of the face and, as a result, panic and lack of understanding of what happened. This condition often occurs against the background of the following actions:

• the man was washing himself;
• brushed my teeth;
• shaved;
• treated teeth;
• applied makeup;
• laughed, smiled, talked;
• injured the face or mouth area.

In some cases, symptoms of pinching appear “out of the blue”, without any apparent cause:

• a sharp pain occurs, reminiscent of an electric shock or shooting pain, with damage to one side of the face; [ 5 ]
• facial expressions are distorted, facial expressions change abruptly, and a “distortion” occurs due to loss of sensitivity;
• the facial muscles tremble and twitch in the area of damage to the trigeminal nerve;
• on the side of the injury, the corner of the oral cavity and eyelid are lowered;
• body temperature rises;
• a sharp weakness appears;
• possible myalgia, chills;
• due to excessive emotional stress, irritability and aggression arise;
• headache appears;
• On the side of the injury, tears and salivation are observed.

The most typical symptom of a pinched trigeminal nerve is considered to be cyclical pain in the affected facial area. The pain syndrome bothers almost constantly or several times a day, always beginning acutely, suddenly. Each attack lasts from a few seconds to a couple of minutes, reaching a peak point and gradually subsiding. [ 6 ]

Stages

The most pronounced clinical picture is observed during the first two days from the moment of pinching of the trigeminal nerve. The stages of the pathology are divided depending on its features.

Acute strangulation is diagnosed if the disease lasts up to 14 days, subacute – up to one month. Chronic form is said to occur if the disease lasts for 5 weeks or more.

Complications and consequences

Treatment for pinched trigeminal nerve should be carried out without delay and as soon as possible. Lack of medical care can lead to complications and development of facial contractures (spasm, involuntary tightness, etc.). Other unpleasant consequences are also possible:

• deterioration of hearing, vision;
• paresis of facial muscles, facial expression disorders, uncontrolled muscle tremors;
• when the nerve ending is compressed by cerebellar vessels - hemorrhage or hematoma of the cerebellum;
• ataxic (coordination) disorders;
• depression, psycho-emotional instability, apathy. [ 7 ]

Diagnostics trigeminal nerve entrapment

Diagnosis of pinched trigeminal nerve is carried out on the basis of a careful neurological examination. It is based on its results that the doctor can determine the characteristics of the pain syndrome:

• his type;
• the exact area of the painful focus;
• causal factors.

In addition to examination, the doctor performs palpation. Magnetic resonance imaging and computed tomography are used as auxiliary methods, which can help determine the cause of the pinching. If necessary, electroneurography is prescribed, which allows determining the quality of the passage of electrical impulse oscillations along nerve fibers. [ 8 ]

Differential diagnosis

Differential diagnostics always requires joint consultations with specialists such as an otolaryngologist, dentist, and neurologist. Often, similar pain syndrome accompanies inflammatory processes in the paranasal sinuses or dental diseases.

Facial pain of varying intensity is observed:

• in case of neuritis or neuralgia of sensory nerve fibers;
• with ganglioneuritis;
• for dental diseases;
• for eye diseases;
• in otolaryngological pathologies.

When conducting differential diagnostics, it is necessary to take into account that pain can also be of vascular origin, as well as arthrogenic, joint, and psychogenic origin. So-called "reflected" pains radiating from other pathological foci are not uncommon.

Treatment trigeminal nerve entrapment

When the trigeminal nerve is pinched, a comprehensive, well-thought-out therapy is prescribed, consisting of the following stages:

• relief of symptoms;
• elimination of factors that led to the development of pinching;
• stabilization of the nervous system function (prevention of stress, improvement of central nervous system processes);
• physiotherapy (massage procedures, acupuncture, electrophoresis).

To ease the patient's well-being, the drug Finlepsin is often prescribed - an anticonvulsant that perfectly relieves pain in neuralgia. Treatment begins with a small amount of the drug, literally 0.2 g per day, with a gradual increase in dosage to 1.2 g per day. The maximum daily amount of the drug is 1.6 g. It is taken on average 3 times a day, depending on the severity of the pinching and the total dosage of the drug.

The following may be auxiliary drugs:

• Non-steroidal anti-inflammatory drugs such as Ketorol, Nimesulide, Ibuprofen relieve the inflammatory reaction and relieve pain.
• Antispasmodic drugs and analgesics (Spazmalgon, Spazgan).
• Sedatives and antidepressants.

In addition to the main drug therapy, vitamin preparations containing B vitamins are prescribed. Such complex preparations include Milgamma, Neurobion, etc. Additionally, immunostimulatory drugs are used: echinacea extract, ginseng tincture, etc.

Physiotherapy treatment includes procedures to relieve pain and improve blood flow in the affected area. This helps speed up the regeneration of damaged nerves. When the trigeminal nerve is pinched, the following procedures are considered popular:

• UFO of the affected side of the face.
• Ultra-high frequency therapy.
• Laser therapy.
• Electrophoresis with Novocaine, Diphenhydramine, Platyphylline, B-group vitamins.

Physiotherapy courses can be repeated for preventive purposes. [ 9 ]

Surgical treatment for pinched trigeminal nerve

The basic focus of surgical treatment is to eliminate compression of the nerve trunk. In some cases, doctors have to inactivate the nerve to eliminate pain.

When the trigeminal nerve is pinched, the following types of intervention may be appropriate:

• The radiosurgical method involves the impact of a directed γ-ray on the pathological focus. This is a simple intervention that does not require hospitalization of the patient, anesthesia or special preparatory measures.
• The microvascular decompression method is the neutralization of the vessel that exerts pressure on the trigeminal nerve. This procedure is appropriate in case of incorrect placement of the arterial network in the cranial cavity.
• The balloon-compression method is the introduction of a special catheterization device equipped with a kind of balloon. As the catheter reaches the nerve plexus, the balloon increases in size and destroys the nerve. The procedure is performed against the background of MRI: the doctor visualizes and controls his own actions.
• The method of radiofrequency trigeminal rhizotomy consists of inactivating the nerve trunk using electromagnetic pulse oscillation of high frequency. Unfortunately, the procedure brings only temporary effect.
• Injection of glycerin into the trigeminal nerve leads to its inactivation. The pain ceases to bother, relapses occur only in isolated cases.

Prevention

Preventive measures to prevent pinched trigeminal nerve include:

• timely treatment of infectious and inflammatory processes in the middle ear, nasal cavity and sinuses, oral cavity and organs of vision;
• maintaining oral hygiene;
• preventing hypothermia, avoiding drafts;
• immune support, high-quality, nutritious nutrition, periodic courses of vitamin and mineral supplements;
• healthy lifestyle, physical activity, hardening;
• quality healthy sleep, complete rest;
• avoidance of physical and psycho-emotional overload;
• prevention of head and facial injuries.

In addition, it is important to monitor the health of the spine. It is recommended to attend manual therapy courses 1-2 times a year to support the function of the spine.

Forecast

If you seek medical help in a timely manner, and the treatment is correct and competent, then the prognosis of the disease can be called generally favorable. Although you should not count on a quick cure: therapy is usually complex and lengthy. Compliance with all medical prescriptions and preventive measures helps to achieve a stable period of remission.

Self-medication is strictly prohibited: independent, incorrect or chaotic use of medications almost always leads to a worsening of the disease and its progression. Pinched trigeminal nerve is a complex recurring pathology that requires constant monitoring by a doctor, and treatment with folk remedies alone without qualified medical care is inappropriate in this case.