Evaluation of Surgical Procedures for Trigeminal Neuralgia

In: Anesthesia

2 Nov 2009

Evaluation of Surgical Procedures for Trigeminal Neuralgia

*Trigeminal neuralgia is characterized by episodic, paroxysmal, triggered pain in a distribution of 1 or more divisions of the trigeminal nerve. The pain is usually unilateral at any one time, although 5-10% of patients may at some time in their lives have contralateral paroxysmal triggered pain. The paroxysms of pain are usually severe and debilitating. It can be difficult to treat, and patients have committed suicide when the pain could not be controlled. Fortunately, effective medical and surgical therapies for the disorder exist. The wide ranges of treatments currently used for trigeminal neuralgia are ample evidence that there is no simple answer to how it should be managed. Opinions can differ greatly regarding the best treatment for this condition. Even when the patient is referred, quality medical care requires that the physician be acquainted with current evidence-based practice. Such practice may be radically different from the traditional view. We will confine this review to a critical analysis of the literature regarding the efficacy and adverse effects of surgical procedures used for trigeminal neuralgia. The surgical pro­cedures will also be compared with the medical treatment of trigeminal neuralgia (*Generic Tegretol is used for controlling certain types of seizures and relieving pain in patients with nerve pain in the face, jaw, tongue, or throat).

A literature review was done for evidence-based studies on the management of trigeminal neuralgia. Studies were identified by computer search with MEDLINE, Pubmed, Embase, Cinahl, and the Cochrane Library from 1966 to 2002. A broad free text search with restriction to publications in English was undertaken using all variants of terms “trigeminal neuralgia,” “facial pain,” and “surgical.” A hand search of relevant books or journals not indexed by the above indexes was also done, as well as a search through the references of relevant papers for useful citations. Only studies that included valid measures of *pain relief from the surgical procedures were included. Both clinical, basic sciences evidence and review papers were included as appropriate. Although prospective randomized control trials are considered the scientific standard in clinical research for establishing a cause-and-effect relationship, other study designs, including retrospective case-control studies, were also included. This was the result of the lack of randomized control trials in this area.

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Blog invites submissions of review articles, reports on clinical techniques, case reports, conference summaries, and articles of opinion pertinent to the control of pain and anxiety in dentistry.