( Tic doulourex, trifacial neuralgia, fothergill’s disease)

• A major neuralgia involving teeth, face and jaws.
• Usually occurs among middle aged people (above 35 years of age) and right side of the face is affected more frequently that the left side.
• Seldom occurs below 35 years.
• Presence of trigger zones is characteristic in nature.

• The disease never crosses midline.
• Pain- sudden, unilateral, intermittent, paroxysmal, sharp, shooting, lancinating, shock like pain, elicted by slight touching of superficial “trigger points” and rarely crosses midline.
• This condition often cause severe, unilateral lancinating type of pain in the orofacial region that is usually radiationg in nature, and very often the pain attacks are precipitated by touching some trigger zones on the face.
• Most of the patients give the history of an excruciating pain that lasts for only a few seconds and then disappears promptly.
• The term ” tic douloureux” is applied only when the patient suffers from spasmodic contractions of facial muscles.
• ” Trigger zones” may get stimulated by touching, eating , smiling, during shaving or even by a strong breeze.

DIFFERENTIAL DIAGNOSIS:

1. Horton’s syndrome
2. Sinusitis
3. Costen syndrome
4. Trotter’s syndrome
5. Postherpetic neuralgia

TRIGEMINAL NEUROPATHY is a poorly understood condition which has a variety of presumed causes:

• Some dental surgical procedures
• Pressure of a denture on the dental nerve
• Surgical(other then dental) or mechanical trauma
• The therapeutic use of hydroxystilbamidine isethionate
• Tumors of head and neck
• Intracranial aneurysms
• Some cases are idiopathic

TREATMENT

• Peripheral neurectomy
• Injection of alcohol or boiling water into the gasserian ganglion
• Electro coagulation of the same ganglion
• Administration of carbamazepines
• Baclofen is the latest drug used