Pune:- Trigeminal neuralgia is a disorder of the fifth cranial nerve called the trigeminal nerve. With blood vessel pressing against the trigeminal nerve , the condition leads to unbearable pain on the face, cheek and one side of the face normally on the upper side of the chin and upwards and backwards till the ear level. The progressive disorder gets worse due to elongation of blood vessels and subsequent crowding near the nerves and folding in a limited available space. This causes hitting pulsation which destroys myelin, an insulating layer around the nerve. The character of this myelin changes at and around the region where the nerve enters into the brain. One or more blood vessels compressing in this zone can cause trigeminal neuralgia. This can happen either due to age, in some cases due to genetic structures and in rare cases due to tumour and Multiple sclerosis.
The worrying characteristics of this disease include excruciating pain like an electric shock or piercing knife or multiple needles or red chilli powder on the face being put etc.
One other similar disorder where one side of the face twitches repeatedly is called as Hemi Facial Spasm (HFS). In this, One side of the person's face appears to be repeatedly contracting. It usually starts in the muscles surrounding the eye. For an observer, it appears as if the person is repeatedly winking with that eye and making gestures and creating an embarrassing situation.
The diagnosis involves understanding the typical features about the pain , where and when it occurs. The face becomes extremely sensitive to touch , lower temperature or even light breeze created by household fans. Even the process of chewing or eating can become unbearable. The intense pain depletes the patient’s moral and can push a person into suicidal thoughts which is why it is called as ‘suicide disease’. The disease causes behavioural changes, the patients start to stay aloof because of pain or muscle contractions. The patient reaction to the pain of putting a hand on the side of the pain or winking of eyes makes the observers feel that there might be some physiological issue. This may push the patients into social aloofness and overall depletion in quality of life.
The key to the diagnosis of the disease is to understand clinical history, description of the pain and has to be backed with MRI including a specific CISS – nerve sequence. The only treatment for this condition is Micro Vascular Decompression ( MVD ) surgery. When the disease starts, surgery may not be advised. Initially, a small numbing dose of medication may give. It needs to be seen whether the disease is evolving. If the pain intensity increases then the MVD procedure is advised. The timeline between the onset of pain and increase in intensity is variable in different cases. Sometimes the facial pain can lead to wrong diagnosis resulting in dental procedures and triggering pain.
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