However, in our case MRI showed no compression of the nerve along its course. When pain is felt in second and third divisions, the usual finding is the compression of the rostral and anterior portions of the nerve by superior cerebellar artery, if the pain is felt in ophthalmic division, the usual finding is compression of the nerve by the anterior inferior cerebellar artery. Most commonly, the nerve compressed by a major artery, usually the superior cerebellar artery. Mechanical compression of the TN can occur as the nerve leaves the pons and traverses the subarchonoid space toward Meckel's cave. ![]() The most common reported cause of TN is compression of the nerve root. For most patients, the cause is unknown as was in our case. Fothergill provided a vivid description of TN in 1773, hence also called as Fothergill's disease.Īlthough several hypotheses have been put forward, the cause of TN has not been fully explained in the literature. Nicholas Andre in 1756 used the term tic doulourex (painful sensation) to describe the disorder. It was later discussed by Johannes Bausch in 1672. TN has long been recognized in the medical literature infact, it was described as early as the first century AD in the writings of Aretaeus. TN is usually unilateral affecting the maxillary (35%), mandibular (30%), both (20%), ophthalmic and maxillary (10%) and ophthalmic (4%) branches and all branches of the trigeminal nerve (1%). There is a female predominance ranging from 1:2 to 2:3. TN is by far the most frequently diagnosed form of neuralgia with mean incidence of 4 per 100,000 populations and mean age of 50 years at the time of examination. The term neuralgia is used to describe unexplained peripheral nerve pain and the head and neck are the most common sites of such neuralgias. Patient has been relieved of pain since last 1 year. The infraorbital nerve was avulsed in the same way. ![]() Then, the infraorbital nerve was exposed through intraoral approach by giving upper vestibular incision from 13 to 16 region. Double layer closure was done with 3–0 vicryl and 3–0 ethilon. The nerve was identified and avulsed by twisting the nerve on the artery forcep. The patient was taken under GA with endotracheal intubation and the supraorbital nerve was exposed via upper eyebrow incision. Blood investigations were within normal limits. The treatment of peripheral neurectomy was planned as he was on already medication since last 6 years. To rule out the possible etiology of the neuralgia, MRI of cranium was advised and there was no intracranial involvement of the nerve was found. ![]() This confirmed the infraorbital and supraorbital neuralgia. Diagnostic block was given in the infraorbital and supraorbital regions on different occasions for which pain was relieved for several hours. After taking a detailed history, the trigger zones were noted which were nasolabial fold, ala of nose, cheek region, supraorbital rim on right side of the face. ![]() He reported to Department of Oral and Maxillofacial Surgery, Modern Dental College and Research Centre, Indore. The pain did not subside even he visited various clinics in various places where he was medicated with tablet carbamazepine 200 mg eight hourly. He visited a dental clinic for the same, for which he has undergone extraction of the upper right posterior teeth (16). A 35-year-old man with a history of severe (score of 10 in the verbal numerical scale), shock like and throbbing pain in the right V1–V2 region, lasting for 5–10 s that increased on talking, chewing, smiling, with strong breeze and cold water while washing his face since last 6–7 years.
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