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TRIGEMINAL NEURALGIA, BELL’S PALSY AND FACIAL NERVE PALSY

INTRODUCTION OF TRIGEMINAL NERVE• 5th cranial nerve is the largest cranial nerve.• It is mixed nerve (sensory and motor)• Sensory to – skin of face

- mucosa of cranial visceraTRIGEMINAL NEURALGIA, BELL’S PALSY AND FACIAL NERVE PALSY

Presented By:Dr. Anjali Jain

Associate Prof. MGPC

- mucosa of cranial viscera- Except base of tongue and

pharynx• Motor to - Muscles of Mastication

- Tensor ville palatini , Tensortympany

- Anterior belly of digastric- Mylohyoid

Nuclei of trigeminal nerve • Various nuclei associated with the fifth

nerve are situated within the pons . They are :

• 1.motor nucleus- motor fibres arise from the trigeminal motor nucleus

• 2.sensory nucleus- light touch and pressure relays in this nucleus.

• 3.spinal nucleus –pain and temperature from most of the face area which relays here.

• 4.mesencephalic nucleus –it receives proprioceptive impulses from muscle of mastication , temporomandibular joint and teeth.

• Dissociated sensory loss, i.e ; a low pontine or medullary lesion will result in loss of pain and temperature sensation with preservation of light touch .

• Low pontine, medullary and cervical lesions produce a characteristic ‘onion skin’ distribution of pinprick and temperature loss.

• An ascending lesion spares the muzzle area until last.

• Some fibres ascend and other descend .• Ascending fibres end in superior sensory

nucleus .• Descending fibres end in the spinal nucleus

of fifth nerve.

DIVISIONS OF THE NERVE • V1:ophthalmic division • V2:maxillary division • V3:mandibular division

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• The ophthalmic division passes through the superior orbital fissure, divides into branches within the orbit and emerges from the supraorbital foramen to innervates the forehead.

• SUPPLIES: eye ball , conjunctiva ,lacrimal gland ,part of mucous membrane of nose and paranasal sinuses , skin of the forehead ,eyelids, nose.

• BRANCHES:I. Nasocilliary nerve

TRIGEMINAL NEURALGIA (tic douloureux)

• It is a neuropathic disorder of trigeminal nerve that causes episodes of intense pain in eyes, lips, scalp, forehead and jaws.• It has been labelled as suicide disease .I. Nasocilliary nerve

II. Frontal nerveIII. Lacrimal nerve

• The maxillary division passes through the foramen rotundum into the pterygopalatine fossa, then through the infraorbital foramen to become the infraorbital nerve.

• The mandibular division exits from the foramen ovale.

• It has been labelled as suicide disease .• Sudden, usually unilateral, severe brief stabbing recurrent pain

in the distribution of one or more branches of fifth cranial nerve.• It usually presents with sharp , electric shock like pain in the

face or mouth . Pain is intense , lasting for brief period of seconds to 1 min after which there is refractory period during which pain cannot be reinitiated for a period of time .

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• Surgical procedures can be separated into non -destructive and destructive.

a) Non–destructive :- It includes-

i. Microvascular decompression :This involves a small incision behind the ear and some bone removal from the area , an incision through the meninges is made to expose the nerve.Any vascular compression of nerve are carefully moved and a

sponge- like pad is placed between the compression and nerve stopping unwanted pulsation and allowing myelin sheath healing .

b. Destructive :All destructive procedure will cause facial numbness ,post relief as well as

pain relief -percutaneous techniques which all involves a needle or catheter .�Ballon compression :

Inflation of a ballon at this point causing damage and stopping pain signals .�Glycerol injection:

It usually produces good pain relief with less sensory damage.

�Radiofrequency thermocoagulation: application of a heated needle to damage the nerve at this point.� Supportive treatment :

psychological and social support has found to play a key role in the management of chronic illness and chronic pain condition ,such as trigeminal neuralgia.

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It usually produces good pain relief with less sensory damage.

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FACIAL PALSY INTRODUCTION

•Facial nerve is the 7th cranial nerve .•Facial muscles develop from the mesoderm of

second branchial arch.second branchial arch.•Facial muscles are remnants of panniculus

carnosus, the subcutaneous muscle of animals.•Has two roots .A large motor and a smaller

mixed sensory and parasympathetic .

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INVESTIGATIONS

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THANK YOU

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