Trigeminal pinch

Sharp jaw pain can be the result of such a pathology as pinching of the trigeminal nerve. This problem belongs to the category of severe neurology, since its appearance is due to a number of factors, the symptoms are determined by severe pain and disability, and the therapy is often long and complicated.

Epidemiology

Most often, pinching of the trigeminal nerve is diagnosed on the right side (from medical practice, a right-sided painful process is recorded in 70% of cases). At the same time, 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 get sick more often than men.

The defeat of the trigeminal nerve has a certain cyclical nature: relapses occur mainly in the off-season, in autumn or spring.

The most common symptom of pinching is pain - severe, severe, which is difficult for patients to tolerate. In most patients, the lower facial segment is affected, however, involvement of the upper, frontal and middle areas of the face is possible.

Causes of the pinched trigeminal nerve

The causes of pinching of the trigeminal nerve are many, although the main factors are impaired blood flow and direct compression of the nerve. Most often, doctors indicate such underlying causes:

• adhesions, tumor processes, with spread to the nerve branches;
• arterial aneurysms;
• impaired 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 jaw;
• stomatitis;
• vascular atherosclerotic changes associated with malnutrition of the trigeminal nerve;
• facial, maxillary injuries; [2]
• cold exposure.

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

Risk factors

• Autoimmune diseases of the nervous system, multiple sclerosis.
• Endocrine Disorders
• Diseases of the cardiovascular system.
• Viral infections, herpevirus.
• Psychogenic disorders (neurosis, psychosis, psychosomatic pathology, abnormal psychoemotional reactions).
• Vitamin or micronutrient deficiency in the body.
• Weakened immunity, acute respiratory infections, acute respiratory viral infections, colds.

Pathogenesis

The main function of the trigeminal nerve is considered to ensure the sensitivity of the face. Trigeminal nerves are paired and lie on the left and right. Each nerve takes away from itself three branches:

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

When pinching the trigeminal nerve, 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 structure of the nerve.

The causes of pinching of the trigeminal nerve in the cervical region are irritation of the vegetative structures of the spinal cord, or damage to the superior cervical sympathetic ganglion with an infection or inflammatory reaction. In this case, commissures and fibrotic changes are formed, the autonomic nucleus of the trigeminal nerve is compressed. [4]

Symptoms of the pinched trigeminal nerve

Contraction of the trigeminal nerve always occurs suddenly, sharply.

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

• the person washed himself;
• brushed his teeth;
• shaved;
• treated teeth;
• applied makeup;
• laughed, smiled, talked;
• injured an area of the face or mouth.

In some cases, pinching symptoms appear “out of the blue”, for no apparent reason:

• there is an acute pain resembling an electric shock or lumbago, with damage to one side of the face; [5]
• facial expression is distorted, facial expressions change dramatically, there is a “skew” due to loss of sensitivity;
• facial muscles tremble, twitch in the area of damage to the trigeminal nerve;
• from the side of damage, the angle of the oral cavity, eyelid;
• body temperature rises;
• sharp weakness appears;
• possible myalgia, chills;
• due to excessive emotional stress irritability, aggression;
• headache appears;
• tear and salivation are observed on the side of the lesion.

The most typical symptom of pinching of the trigeminal nerve is cyclic soreness in the affected facial zone. The pain syndrome worries almost constantly or several times a day, always starting sharply, suddenly. Each attack lasts from several 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 the pinching of the trigeminal nerve. The stages of the pathology are divided depending on its features.

Acute pinching is diagnosed if the disease lasts up to 14 days, subacute - up to one month. The chronic form is said to be if the disease lasts for 5 weeks or more.

Complications and consequences

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

• hearing impairment, vision;
• paresis of facial muscles, facial expressions, uncontrolled tremor of muscles;
• with compression of the nerve endings in the cerebellar vessels - hemorrhage or cerebellar hematoma;
• ataxic (coordination) disorders;
• depression, psycho-emotional instability, apathy. [7]

Diagnostics of the pinched trigeminal nerve

Diagnosis of pinching of the trigeminal nerve is carried out on the basis of a careful neurological examination. It is according to its results that the doctor manages to determine the features of the pain syndrome:

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

In addition to examination, the doctor conducts palpation. As auxiliary methods, magnetic resonance imaging and computed tomography are used, thanks to which you can find out the cause of pinching. If necessary, electroneurography is prescribed, which allows to determine the quality of the passage of electrical impulse vibrations through nerve fibers. [8]

Differential diagnosis

Differential diagnosis always requires joint consultations of specialists such as otolaryngologist, dentist, neuropathologist. Often, a similar pain syndrome accompanies inflammatory processes in the paranasal sinuses or dental diseases.

Facial pains of different intensities are observed:

• with neuritis or neuralgia of sensitive nerve fibers;
• with ganglioneuritis;
• with dental diseases;
• with eye diseases;
• at otolaryngological pathologies.

When conducting differential diagnosis, it must be borne in mind that pain can be of a vascular nature, as well as arthrogenic, articular, psychogenic origin. Not uncommon - the so-called "reflected" pain, radiating from other pathological foci.

Treatment of the pinched trigeminal nerve

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

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

To facilitate the patient’s well-being, Finlepsin is often prescribed as an anticonvulsant that 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 medication is 1.6 g. Reception is carried out on average 3 times a day, depending on the severity of pinching and the total dosage of the drug.

Ancillary drugs may include:

• Nonsteroidal 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 are mandatory, which contain B-group vitamins. Such complex remedies include Milgamma, Neurobion, etc. Additionally, medications of immunostimulating action are used: echinacea extract, ginseng tincture, etc.

Physiotherapeutic treatment includes procedures to relieve pain and improve blood flow in the affected area. This allows you to accelerate the regeneration of damaged nerves. When pinching the trigeminal nerve, the following procedures are considered popular:

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

Physiotherapy courses can be repeated, with a preventive purpose. [9]

Surgical treatment for pinching the 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 the pain syndrome.

When pinching the trigeminal nerve, the following interventions may be appropriate:

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

Prevention

Preventive measures to prevent pinching of the trigeminal nerve include:

• timely treatment of infectious and inflammatory processes in the middle ear, nasal cavity and sinuses, oral cavity and organs of vision;
• adherence to oral hygiene;
• prevention of hypothermia, avoidance of drafts;
• immunity support, high-quality nutrition, periodic course intake of vitamin and mineral preparations;
• healthy lifestyle, physical activity, hardening;
• high-quality healthy sleep, good rest;
• prevention of physical and psycho-emotional overload;
• prevention of head and face injuries.

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

Forecast

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

Self-medication falls under a categorical ban: independent improper or chaotic use of drugs almost always leads to aggravation of the disease and its progression. Contraction of the trigeminal nerve is a complex recurring pathology that requires constant monitoring by a doctor, and treatment with only alternative means without qualified medical care is inappropriate in this case.