Disorders of the Trigeminal System

ABSTRACT

The management of patients with trigeminal system dysfunction requires an understanding of the system's complex anatomy, which extends from peripheral nerve endings, through the skull base, cavernous sinus (V1, V2 only), and trigeminal ganglion, to the intraaxial nuclei, tracts, and cerebral cortex. The differential diagnosis is broad. Seemingly minor facial sensory loss may indicate an underlying malignancy (as in numb-chin syndrome). Painful syndromes of the trigeminal nerve are numerous and require careful categorization. Understanding trigeminal system anatomy and the appropriate use of imaging and electrodiagnostics should aid in the diagnosis and treatment of these disorders.

KEYWORDS

Trigeminal nerve - cranial nerve - fifth nerve - neuralgia - neuropathy

REFERENCES

• 1 Nemzek W R. The trigeminal nerve.  Top Magn Reson Imaging. 1996;  8 132-154
• 2 Ropper A H, Brown R H. Adams and Victor's Principles of Neurology. 8th ed. New York; McGraw-Hill 2005: 1178-1180
• 3 Moore K L, Dalley A F. Clinically Oriented Anatomy. 4th ed. Philadelphia; Lippincott Williams & Wilkins 1999 857-862 916-926 1015-1017 1093-1096
• 4 Prasad S, Galetta S. The trigeminal nerve. In: Goetz CG Textbook of Clinical Neurology. 3rd ed. Philadelphia; Saunders 2007 Available at: http://www.mdconsult.com.laneproxy.stanford.edu/das/book/body/99919254-3/0/1488/90.html?tocnode=53800740&fromURL=90.html#4-u1.0-B978-1-4160-3618-0.10010-4_508 Accessed July 2, 2008
• 5 Fix J D. High-Yield Neuroanatomy. 2nd ed. Philadelphia; Lippincott Williams & Wilkins 2000: 53-77
• 6 Becker M, Kohler R, Vargas M I, Viallon M, Delavelle J. Pathology of the trigeminal nerve.  Neuroimaging Clin N Am. 2008;  18 283-307
• 7 Barakos J A, D'Amour P G, Dillon W P, Newton T H. Trigeminal sensory neuropathy caused by cervical disk herniation.  AJNR Am J Neuroradiol. 1990;  11 609
• 8 Tornabene S, Vilke G M. Gradenigo's syndrome. J Emerg Med 2008; February 23 (Epub ahead of print). Available at: http://www.ncbi.nlm.nih.gov.laneproxy.stanford.edu/sites/entrez008 Accessed July 2, 2008
• 9 Headache Classification Subcommittee of the International Headache Society . The international classification of headache disorders: 2nd ed.  Cephalalgia. 2004;  24(suppl 1) 9-160
• 10 Krafft R M. Trigeminal neuralgia.  Am Fam Physician. 2008;  77 1291-1296
• 11 Bennetto L, Patel N K, Fuller G. Trigeminal neuralgia and its management.  BMJ. 2007;  334 201-205
• 12 Katusic S, Beard C M, Bergstralh E, Kurland L T. Incidence and clinical features of trigeminal neuralgia, Rochester, Minnesota, 1945–1984.  Ann Neurol. 1990;  27 89-95
• 13 Savica R, Laganá A, Siracusano R, Calabrò R S, Ferlazzo E, Musolino R. Idiopathic familial trigeminal neuralgia.  Neurol Sci. 2007;  28 196-198
• 14 Siccoli M M, Bassetti C L, Sándor P S. Facial pain: clinical differential diagnosis.  Lancet Neurol. 2006;  5 257-267
• 15 Kenner M, Menon U, Elliott D G. Multiple sclerosis as a painful disease.  Int Rev Neurobiol. 2007;  79 303-321
• 16 Schwartz N E, Rosenberg S, So Y T. Action at a distance: a lumbar spine tumor presenting as trigeminal neuralgia.  Clin Neurol Neurosurg. 2006;  108 806-808
• 17 Caranci G, Mercurio A, Altieri M, Di Piero V. Trigeminal neuralgia as the sole manifestation of an Arnold-Chiari type I malformation: case report.  Headache. 2008;  48 625-627
• 18 Jorns T P, Zakrzewska J M. Evidence-based approach to the medical management of trigeminal neuralgia.  Br J Neurosurg. 2007;  21 253-261
• 19 Guo S, Chao S T, Reuther A M, Barnett G H, Suh J H. Review of the treatment of trigeminal neuralgia with gamma knife radiosurgery.  Stereotact Funct Neurosurg. 2008;  86 135-146
• 20 Agostoni E, Frigerio R, Santoro P. Atypical facial pain: clinical considerations and differential diagnosis.  Neurol Sci. 2005;  26 S71-S74
• 21 Frediani F. Pharmacological therapy of atypical facial pain: actuality and perspective.  Neurol Sci. 2005;  26 S92-S94
• 22 Forssell H, Tenovuo O, Silvoniemi P, Jääskeläinen S K. Differences and similarities between atypical facial pain and trigeminal neuropathic pain.  Neurology. 2007;  69 1451-1459
• 23 Broggi G, Ferroli P, Franzini A, Galosi L. The role of surgery in the treatment of typical and atypical facial pain.  Neurol Sci. 2005;  26 S95-S100
• 24 Benoliel R, Eliav E. Neuropathic orofacial pain.  Oral Maxillofac Surg Clin North Am. 2008;  20 237-254
• 25 Shaikh S, Ta C N. Evaluation and management of herpes zoster ophthalmicus.  Am Fam Physician. 2002;  66 1723-1730
• 26 Liesegang T J. Herpes zoster ophthalmicus natural history, risk factors, clinical presentation, and morbidity.  Ophthalmology. 2008;  115 S3-S12
• 27 Dubinsky R M, Kabbani H, El-Chami Z, Boutwell C, Ali H. Practice parameter: treatment of postherpetic neuralgia: an evidence-based report of the Quality Standards Subcommittee of the American Academy of Neurology.  Neurology. 2004;  63 959-965
• 28 Dworkin R H, Nagasako E M, Johnson R W, Griffin D RJ. Acute pain in herpes zoster: the famciclovir database project.  Pain. 2001;  94 113-119
• 29 Johnson R W, Dworkin R W. Treatment of herpes zoster and postherpetic neuralgia.  BMJ. 2003;  326 748-750
• 30 Jackson J L, Gibbons R, Meyer G, Inouye L. The effect of treating herpes zoster with oral acyclovir in preventing postherpetic neuralgia. A meta-analysis.  Arch Intern Med. 1997;  157 909-912
• 31 Bowsher D. The effects of pre-emptive treatment of postherpetic neuralgia with amitriptyline: a randomized, double-blind, placebo-controlled trial.  J Pain Symptom Manage. 1997;  13 327-331
• 32 Oxman M N, Levin M J, Johnson G R et al.. A vaccine to prevent herpes zoster and postherpetic neuralgia in older adults.  N Engl J Med. 2005;  352 2271-2284
• 33 Harpaz R, Ortega-Sanchez I R, Seward J F. Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC). Prevention of herpes zoster: recommendations of the Advisory Committee on Immunization Practices (ACIP).  MMWR Recomm Rep. 2008;  57 1-30
• 34 Rosenbaum R. Neuromuscular complications of connective tissue diseases.  Muscle Nerve. 2001;  24 154-169
• 35 Olney R K. Neuropathies associated with connective tissue disease.  Semin Neurol. 1998;  18 63-72
• 36 Mori K, Iijima M, Koike H et al.. The wide spectrum of manifestations in Sjögren's syndrome-associated neuropathy.  Brain. 2005;  128 2518-2534
• 37 Mellgren S I, Göransson L G, Omdal R. Primary Sjögren's syndrome associated neuropathy.  Can J Neurol Sci. 2007;  34 280-287
• 38 Kalladka M, Proter N, Benoliel R, Czerninski R, Eliav E. Mental nerve neuropathy: patient characteristics and neurosensory changes.  Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;  106 364-370
• 39 Laurencet F M, Anchisi S, Tullen E, Dietrich P Y. Mental neuropathy: report of five cases and review of the literature.  Crit Rev Oncol Hematol. 2000;  34 71-79
• 40 Campbell Jr W W. The numb cheek syndrome: a sign of infraorbital neuropathy.  Neurology. 1986;  36 421-423
• 41 Brazis P W, Vogler J B, Shaw K E. The “numb cheek-limp lower lid” syndrome.  Neurology. 1991;  41 327-328
• 42 Tay A B, Zuniga J R. Clinical characteristics of trigeminal nerve injury referrals to a university centre.  Int J Oral Maxillofac Surg. 2007;  36 922-927
• 43 Guthikonda B, Theodosopoulos P V, van Loveren H, Tew J M, Pensak M L. Evolution in the assessment and management of trigeminal schwannoma.  Laryngoscope. 2008;  118 195-203
• 44 Fisher L M, Doherty J K, Lev M H, Slattery III W H. Distribution of nonvestibular cranial nerve schwannomas in neurofibromatosis 2.  Otol Neurotol. 2007;  28 1083-1090
• 45 Patel N K, Aquilina K, Clarke Y, Renowden S A, Coakham H B. How accurate is magnetic resonance angiography in predicting neurovascular compression in patients with trigeminal neuralgia? A prospective, single-blinded comparative study.  Br J Neurosurg. 2003;  17 60-64
• 46 Kuncz A, Vörös E, Barzó P et al.. Comparison of clinical symptoms and magnetic resonance angiographic (MRA) results in patients with trigeminal neuralgia and persistent idiopathic facial pain. Medium-term outcome after microvascular decompression of cases with positive MRA findings.  Cephalalgia. 2006;  26 266-276
• 47 Kress B, Schindler M, Rasche D et al.. MRI volumetry for the preoperative diagnosis of trigeminal neuralgia.  Eur Radiol. 2005;  15 1344-1348
• 48 Galeotti F, Truini A, Cruccu G. Neurophysiological assessment of craniofacial pain.  J Headache Pain. 2006;  7 61-69
• 49 Cruccu G, Biasiotta A, Galeotti F, Iannetti G D, Truini A, Gronseth G. Diagnostic accuracy of trigeminal reflex testing in trigeminal neuralgia.  Neurology. 2006;  66 139-141
• 50 Deeb G R, Dierks E, So Y T. Sensory nerve conduction study of the mental nerve.  Muscle Nerve. 2000;  23 1121-1124