Cranial Nerve Disorder: Trigeminal

Neuralgia and Bell’s Palsy

TRIGEMINAL
NEURALGIA
 • Trigeminal neuralgia (TN), also
Trigeminal known as tic douloureux, is a
type of chronic pain disorder

Neuralgia
that involves sudden attacks of
severe facial pain.
• Irritation of the 5th cranial nerve
• Severe sharp pain described as
electrical shocks to one side of
the face
• Triggers: Touching/moving
tongue, lips, face; chewing;
shaving; brushing teeth; blowing
nose; hot/cold drinks
 The trigeminal nerves are a pair of cranial nerves that connect the brain and brain stem to different parts of the face. The
trigeminal nerves have three branches that send and receive sensations from the upper, middle, and lower portions of the face.

Ophthalmic (upper) branch Maxillary (middle) branch

Supplies sensation to most of the scalp, Supplies sensation to the cheek, upper
forehead, and front of the head. jaw, top lip, teeth and gums, and side of
the nose.

Mandibular (lower) branch

Supplies nerves to the lower jaw, teeth

and gums, and bottom lip.
1.Classic
• Most common; unknown etiology,
artery/vein compressing cranial nerve V
root -> pain

TYPES

1.Secondary
• Nonvascular lesion compressing
nerve -> pain
 ETIOLOGY RISK FACTORS
1. Compression
• Trigeminal nerve root compression by
aberrant vascular loop (mostly superior • Biological sex (female/male)
cerebellar artery) • Age (peak incidence 50-60)
• Demyelinating disorders (e.g.
2. Demyelination multiple sclerosis)
• Trigeminal neuralgia is 20 times more
• Postherpetic trigeminal
common in patient with multiple
sclerosis neuropathy
• Acoustic neuroma
• Saccular aneurysm
3. Other brain causes • Vestibular schwannoma
• Amyloid and brainstem infarcts
 SIGNS AND
Diagnostics
SYMPTOMS
• Electric shock pain in lips and gums DIAGNOSTIC IMAGING
• Severe pain along cheekbone • CT scan/MRI: May identify lesion/vascular
• Dental like pain (triggered by hot food or compression
caffeine)
 TREATMENTS
Pharmacological Management Surgical Management

• Anticonvulsant drugs • Jannetta procedure; also known as

e.g. Carbamazepine, an anticonvulsant drug, microvascular decompression, is a
is the most common medication that doctors surgical procedure performed to relieve JANNETTA PROCEDURE
use to treat TN pressure on cranial nerves caused by
• Painkillers blood vessels or other structures.
• Balloon compression; Compression of
trigeminal fibers allows for immediate
pain relief in 80-90%

BALLOON COMPRESSION
 NURSING MANAGEMENT

• Instruct the patient to avoid • Provide emotional support

exposing affected cheek to sudden • Provide adequate nutrition in small
cold frequent meals at room temperature
• Avoid foods that are too cold or too • Use cotton pads gently, wash face
hot and for oral hygiene
• Chew food in affected side • Inspection of the eyes for foreign
• Administer Tegretal which relieves bodies, which the client may not
and prevent pain able to feel, and should be done
• Instruct patient in methods to several times a day
prevent environmental stimulation
of pain
• Warm normal saline irrigation of
the affected eye 2 to 3 times a day
is helpful in preventing corneal
infection
• Dental check up every 6 months is
encouraged, since dental caries do
not produce pain
• Explain to the client and his family
the disease and the treatment
 NURSING DIAGNOSIS

2. Imbalanced nutrition less than body

1. Chronic pain related to disease
requirements related to pain associated
process
with chewing

3. Fear related to anticipated painful 4. deficient knowledge of

episodes trigeminal neuralgia
BELL’S PALSY
BELL’S • Bell’s Palsy (facial paralysis) is
caused by unilateral inflammation
of the seventh cranial nerve,
PALSY which results in weakness or
paralysis of facial muscles on the
affected side.
• Damage/Inflammation to the 7th
cranial nerve in the face.
• Seen as sudden weakness to the
muscles on one side of the face ,
which typically resolves on its
own.
 ETIOLOGY
RISK FACTORS
1. Vascular ischemia
2. Viral disease (herpes simplex,
herpes zoster)

• Age (peak incidence over 50)

3. Autoimmune disease, a • Diabetes mellitus
combination of all of these factors • 3rd trimester pregnancy
4. Nerve trauma • Early postpartum
 • MNEMONIC
SIGNS AND Blink reflex abnormal
Ear sensitivity
SYMPTOMS Lacrimation
Loss of taste
• Unilateral facial weakness evolves rapidly
Sudden onset
over 48 hours - Eyebrow sags, eye won’t Palsy: CN VII nerve muscles
close, mouth corner droops; (drooling,
difficulty eating/drinking), decreased tear DIAGNOSIS
production --> ocular dryness, hyperacusis LAB RESULTS
(decreased sound tolerance), ageusia • Serologic testing if viral infection suspected
(decreased taste sensation) -> Electromyography is a test that checks the health
• Prodromal symptoms (pre-onset) - Ear pain, of muscles and the nerves the control the muscles
dysacusis (sound distortion) -> Nerve conduction velocity is a test to see how
fast electrical signals move through a nerve
 TREATMENTS
Pharmacological Management Other Interventions

• Corticosteroids - may reduce • Artificial tears, eye patching -

swelling around facial nerve reduce corneal damage
• Antivirals (such as acylovir) • Physical therapy (e.g. facial
• Mild analgesics to relieve pain exercise, neuromuscular
restraining)
• May resolve spontaneously within
Surgical Managemnt three weeks

• Tarsorrhaphy
 NURSING MANAGEMENT

• Test motor components of facial

nerve VII by assessing pt‘s smile,
ability to whistle, purse lips,
wrinkle forehead, and close eyes.
Observe for facial asymmetry.
• Observe pt’s ability to handle • Administer or teach pt to
secretions, foods, fluids; observe administer artificial tears and
for drooling ophthalmic ointment as prescribed.
• Assess pt’s ability to blink and • Advice to wear an eye patch while
speak clearly sleeping
• Assess effect of altered appearance
on body image
 NURSING DIAGNOSIS

1. Impaired verbal 2. Imbalanced nutrition less than body

communication related to requirements related to pain associated
muscle weakness with chewing

3. Risk for injury related to inability 4. deficient knowledge of bell’s

to blink palsy
 Conclusion

Trigeminal Neuralgia Bell’s Palsy

• Irritation of CN V • Inflammation of CN VII
• Severe sharp pain described as • Sudden weakness to muscles
electrical shocks 1 side of the on 1 side of the face
face • Idiopathic
• Caused by multiple sclerosis, • Apply warm, moist heat on CN
tumor, or vascular compression VII
• Avoid hot/cold foods, caffeine
Thank you for your attention