INTRODUCTION
It is a facial pain syndrome which is characterised by short term, unilateral facial pain following the sensory distribution of cranial nerve V, the Trigeminal nerve. Most commonly, the pain radiates to the mandibular or maxillary regions.
CLINICAL ANATOMY
The trigeminal nerve, the 5th cranial nerve, is the nerve responsible for sensation in the face, and control of motor functions such as biting and chewing. It has three branches:-
i) Opthalmic nerve (V1) - It is sensory nerve receive sensation from the forehead.
ii) Maxillay nerve (V2) - It is again sensory which takes sensation from the maxillary region.
iii) Mandibular (V3) - It is sensory and motor both, controlling the muscles of mastication: Temporalis and Masseter.
MECHANISM OF INJURY
The symptoms of pain is usually caused by compression of the Trigeminal nerve route in CNS. The common cause of compression can be tumor or their associated blood vessels. It can be due to the complication of Multiple Sclerosis and neurological conditions, due to demyelination of the root entry of Trigeminal nerve in the pons.
CLINICAL FEATURES
The pain can come in sharp spasms that feel like electric shocks. Pin generally occurs on one side of the face and may be brought on by sound or touch. Pain can be triggered by brushing teeth, shaving, putting on makeup, touching face, eating or drinking, speaking, etc. 60% of patients with TN present with lacinating pain shooting from the corner of the mouth to the angle of jaw.
DIAGNOSIS
There is no need for any particular diagnosis, as the patient with characteristic history and normal neurological examination may conclude the disease. MRI scanning is often indicated simply to exclude the other causes of the pain, such as Acoustic Neuroma.
DIFFERENTIAL DIAGNOSIS
✔ Atypical facial pain
✔ migraine
✔ Cluster headache
MANAGEMENT
Antiepileptic drugs are very useful in management of TN. Some patient require surgery if condition worsens over time and drug management becomes less effective. Microvascular decompression and radiofrequency thermorhizotomy are the surgical procedure.
PHYSIOTHERAPY MANAGEMENT
The main goal of physiotherapy are:-
✔ to relieve symptoms
✔ to restore functions
✔ to reduce the pain in face and other affected areas
Patient were treated with continues TENS for 20 minutes over the path of the affected nerves for 5 days a week for 4 weeks. One electrode was placed just before the ear, the other one at end of the respective nerve.
To reduce muscle spasm, a hot moist pack was applied on neck and trapezius muscle for 10 minutes, Isometric exercises for each side and pain free neck range of motion exercises (neck flexion, extension, side-flexion) for five repetitions each are given.
Relaxation exercises which includes deep breathing exercises should be performed for 10 minutes.
Distraction techniques are also incorporated, patient are asked to involve in those activities in which they like to perform instead of sitting and thinking of the pain situations.
To reduce hypersensitivity, patient were asked to cover the affected side of their face with the soft cloth or with the cotton pad for 15 minutes per day, which may help in promoting a reduction of the nervous system to constant afferent input.
Finally, the patient is asked to avoid use of cold water for drinking and washing their face, use of a scarf to avoid the exposure of the face to the cold environment and to avoid eating hard food and chewing food on the non-affected side.
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