fdfghudfghjhgfxcvbncfghjkgfccvbnpart 3.pptx

fdfghudfghjhgfxcvbncfghjkgfccvbnpart 3.pptx

• 1.
  Trigeminal Neuralgia Dr.Meghna Kothari 1st MDS
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  Endodontic considerations  Calciumhydroxide  SPAD  Eugenol contining sealers  endoflas  AH26  Capseal 1  Resilion
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  Tic doulourex  Frenchterminology  Tic –a spasmodic contraction of muscles mostly often of face.  Doulourex- pianful.
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  Paroxysmal  Greek word Sudden recurrence or outbrust , intensification symptom such as spasm Lancinating • Piercing type
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  Etiology  PERIPHERAL: ◦ Dentaletiology ◦ Infections- Herpes zoster ◦ Multiple sclerosis ◦ Injuries to nerve ◦ Nerve compression  CENTRAL: ◦ Post-traumatic neuralgia ◦ Intracranial tumors ◦ Intracranial vascular abnormalities (aneurisms) ◦ Segmental demyelination
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  Dental etiology  Accordingto Westrum and Black (1976)  Differentiation from loss of teeth and degeneration of nerve is not restricted to peripheral parts of ganglia.  It proceeds proximally to involve maxillary and mandibular.
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  Infections  Herpes zosterinfection- reactivation of varicella zoster-ophthalmic branch  Granulomatous infections –Leprosy  Non granulomatous  Peripaical pathologies
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  Multiple slcerosis  Adisease in which immune system is hampered and there is loss of protective covering of nerve  demyelinating disease  Olfson(1966) suggested presence of sclerotic plaque located at the root entry zone of trigeminal nerve.
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  Injury to nerve Direct trauma to nerve  During nerve blocks administration
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  Nerve Compression  Lee(1937)suggested that trigeminal neuralgia may be caused by at foramen or petrous part of bone  Most common by superior cerebellar artery –maxillary and mandibular  Inferior cerebellar artery – ophthalmic
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  Post traumatic neuralgia Painful condition that affects the nerve fibres  damage to the peripheral nerve caused by reactivation of varicella zoster virus  Confined to area supplied by nerve  Approximately 20% of people affected by herpes report pain within 3 months .
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  Intra-cranial tumors  Epidermoidtumors  Meningiomas of cerebello-pontine angle  Arteriovenous malformations  Trigeminal neuromas  May impinge on the nerve.
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  Vascular abnormlities  Jannettaet al. showed that vascular compression is a common finding in patients with TN  Distortion of the root entry zone of the trigeminal nerve at the pons by an arterial loop, usually of the superior cerebellar artery, or by venous compression by arteriovenous malformations  Aneurism of the internal carotid artery may cause TN
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  ICHD-III classification  13.1.1Trigeminalneuralgia ◦ 13.1.1.1Classical trigeminal neuralgia  13.1.1.1.1Classical trigeminal neuralgia, purely paroxysmal.  13.1.1.1.2Classical trigeminal neuralgia with concomitant continuous pain. o 13.1.1.2 Secondary trigeminal neuralgia o 13.1.1.2.1Trigeminal neuralgia attributed to multiple sclerosis o 13.1.1.2.2Trigeminal neuralgia attributed to space occupying lesion o 13.1.1.2.3Trigeminal neuralgia attributed to other cause o 13.1.1.3 Idiopathic trigeminal neuralgia o 13.1.1.3.1Idiopathic trigeminal neuralgia, purely paroxysmal. o 13.1.1.3.2Idiopathic trigeminal neuralgia with concomitant continuous pain.
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  Mechanism of action
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   A 78-year-oldwhite woman went to her general dental practitioner with intermittent pain in the left posterior mandible. Intraorally, the patient had a fixed partial denture with her lower left first premolar and first molar as abutments. Pain could not be elicited by percussion of the teeth or palpation of the tissues of the left mandible. All teeth in this region responded normally to thermal pulp tests, and all periodontal probing depths were less than 3 ram. No sinus tracks or swellings were observed. A periapical radiograph was made that revealed an area of increased radiopacity on the mesial side of the molar, which was consistent with an enostosis (Fig. 1)Root canal therapy was initated for the molar. Approximately 7 months later, the patient was seen ona n emergency basis for discomfort in the mandibular left posterior area. At this time she reported that the treated tooth had been extracted by another dentist because of episodes of sharp pain (Fig. 2). The patient was referred to the Head and Neck Pain Clinic at the University of Iowa College of Dentistry. Further questioning revealed the pain episodes consisted of "an ache with periods of intense shooting pain" that radiated to the mandibular angle. The pain could be elicited by touching her lower lip and during eating. A periapical radiograph of the area revealed no abnormalities. The presenting complaint was diagnosed as trigeminal neuralgia, and carbarnazepine was recommended as the treatment of choice. Initially, 100 mg of carbamazepine, taken twice daily, was prescribed. This was subsequently increased to 100 mg three times daily and was effective in controlling the symptoms without side effects. S. Law, DDS, Lilly.P.J, b Iowa City, Iowa Trigeminal neuralgia mimicking odontogenic pain:A case report
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  Case 1: radiographicfindings include sclerotic bone distal (closed arrow) and enostosis mesial (open arrow) to first molar. This tooth was mistakenly diagnosed with irreversible pulpitis because of pain in the region that was later found to be trigeminal neuralgia. As a result, root canal treatment was initiated. Fig. 2. Case 1:7 months after root canal treatment. Because symptoms persisted, the bridge was sectioned and the first molar extracted. Note the continued presence of sclerotic bone distal to the extraction site.
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  Role of Computedtomography  Imaging studies are indicted to differentiate idiopathic and secondary trigeminal neuralgia.  CT is limited in evaluating brainstem and should be considered the initial screening procedure.  Provides lesser resolution than MRI
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  Role of MRI MRI ids preferred over CT due to better resolution of posterior fossa  MRI scan helps to determine if mutiple sclerosis or pontine gliomas  Protocol including T1 or T2 volumetric acquisition technique with thin slices in all three planes are useful.  Magnetic Resonance Angiogram-One may inject dye in blood vessel to view arteries and veins
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  Differential diagnosis  Migrane Sinusitis  Odontogenic pain  Orofacial pain  Tempromandibular joint disorders  Post herpetic neuralgia  Multiple sclerosis  Glossopharyngeal neuralgia
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  Thank you