How is trigeminal neuralgia diagnosed?

Written by Shu Zhi Qiang
Neurosurgery
Updated on September 02, 2024
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Trigeminal neuralgia is divided into primary and secondary types. Primary trigeminal neuralgia refers to cases where no specific cause is apparent. However, with the advancement of modern medicine, doctors have discovered that there is actually a cause for primary trigeminal neuralgia. It is due to the lack of protective myelin sheath over the initial segment of the trigeminal nerve, which gets irritated by the pulsation of nearby small arteries. In such cases, further investigations like brain MRI and cerebral angiography can usually identify the responsible blood vessel. On the other hand, secondary trigeminal neuralgia occurs along with corresponding tumors and inflammation during the progression of the neuralgia, and MRI can assist in diagnosis.

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Does trigeminal neuralgia cause facial swelling?

For patients with trigeminal neuralgia, when they frequently experience bouts of pain, most do not have significant facial swelling. The pain typically occurs distinctly in the areas distributed by the trigeminal nerve roots, often starting and stopping suddenly, and each episode may last from a few seconds to several minutes. Due to repeated pain, facial muscle atrophy may occur, but generally, there is no swelling of the face. For treating trigeminal neuralgia, surgery is commonly used. Microvascular decompression surgery is often recommended to help improve symptoms and can even achieve a clinical cure.

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Does trigeminal neuralgia cause facial swelling?

Patients with trigeminal neuralgia may also experience slight swelling on their face, but it is not very obvious. This is because the nerve also has a special function, which is to provide nourishment. When the facial area innervated by the trigeminal nerve shows abnormal signs, the facial nerves in this area will become affected, leading to malnutrition and eventually causing facial swelling. However, such swelling is usually not very severe. If there are other factors involved, the swelling could become more serious. For instance, it could be due to a gum infection triggering trigeminal neuralgia, or pressure caused by other tumors. Therefore, the best approach is to visit a hospital promptly for relevant examinations to clarify the cause, which is the best for the patient.

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trigeminal neuralgia area

The trigeminal nerve, being the fifth pair of cranial nerves, branches into three divisions after emerging from the skull. The first division is the ophthalmic division, which innervates the upper eyelid and superficial parts of the eye and forehead. The second division is the maxillary division, governing the cheek, upper lip, and gums. The third division is the mandibular division, which affects the lower lip and gums. Trigeminal neuralgia is pain that occurs in the areas innervated by the trigeminal nerve, typically affecting one side and primarily involving the second and third divisions, with the second being the most common and the third next, while the first division is rare. The pain of trigeminal neuralgia can be confined to the area of one division or can occur in two or all three divisions simultaneously.

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Trigeminal neuralgia should register for which department?

The department for registering trigeminal neuralgia depends on the distribution of departments in the local hospital. Most commonly, registration is done in the department of functional neurosurgery. However, different hospitals may have different levels of specialization and may employ varying treatment methods which require different departments. For instance, initially, one can register at the department of neurosurgery for oral medication adjustment, usually with carbamazepine. If there is no significant improvement later on, one may register with the department of pain management or anesthesiology for nerve block treatment. Due to the detailed specialization in some hospitals, it might also be necessary to consult other departments. If there is still no effective outcome, it is necessary to register at the department of neurosurgery for surgical treatment to fundamentally address the disease.

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Early manifestations of trigeminal neuralgia

For patients with trigeminal neuralgia, the initial symptoms mainly include sudden onset of intense pain that stops abruptly. The nature of the pain is generally sharp, resembling sharp stabbing or knife-like pain. In most cases, trigger points are easily formed on the face, commonly appearing around the bilateral nostrils and corners of the mouth as fixed trigger points. Touching these trigger points can easily trigger an attack of trigeminal neuralgia, which lasts for a relatively short duration, typically from a few seconds to several seconds. In most cases, attacks are more likely to be triggered when the patient is tired, fatigued, or under mental stress.