Trigger zones. Clinical manifestations and treatment of facial pain with damage to the trigeminal nerve system

3240 0

Features of clinical manifestations

The clinical picture is characteristic of paroxysmal neuralgia. During the period of exacerbation of the disease, the patient usually has such a peculiar appearance that one can often suspect trigeminal neuralgia just by looking at him. On the face there is a pronounced mask of suffering, fear and even horror before the resumption of attacks of pain.

As a rule, such patients answer questions in monosyllables, barely opening their mouths, since the slightest movement of the facial muscles can provoke a painful paroxysm. Sometimes patients do not speak and communicate with others only in writing. During an attack, they do not rush about, do not moan, but freeze, stunned by the terrifying pain. Thus, neuralgia trigeminal nerve"silent"

Often the patient’s face is distorted due to twitching of the facial muscles (painful tic). In this case, patients try to strongly squeeze the painful area with their hand or roughly rub it (antagonist gesture), while a light, insignificant touch to the trigger area usually causes a painful paroxysm. During the period of exacerbation of trigeminal neuralgia, patients do not wash their faces, hardly eat, do not brush their teeth, and men do not shave.

The exit points of the trigeminal nerve are not always painful upon objective examination. Trigger zones are localized mainly in the medial parts of the face: with neuralgia

1st branch - y internal corner eyes, root of the nose, in the eyebrow area, 2nd branch - at the wing of the nose, nasolabial fold, above the upper lip, on the mucous membrane of the upper jaw. Hyperesthesia of predominantly pain sensitivity is detected in the area of ​​the affected branch; in patients treated with alcoholism, hypoesthesia and even anesthesia in the central parts of the affected area are detected. Hypoesthesia can also be observed with long-term neuralgia, etc.

In stage 1 of the disease, there are no changes in sensitivity outside of exacerbation. In stage 2, they often appear and often persist beyond exacerbation in the form of hyperesthesia. The third stage of trigeminal neuralgia is characterized by constant, relatively mild pain.

Usually they are sympathalgic in nature; against their background, paroxysms of acute pain occur, and there is a violation of sensitivity in the form of hyper- and hypoesthesia. With neuralgia of the 1st and 2nd branches, the corneal or conjunctival reflex may disappear; with neuralgia of the 3rd branch, trismus is sometimes observed in the acute period.

As a rule, as the disease progresses, pain spreads to neighboring branches of the trigeminal nerve. If the disease usually begins with damage to one branch of the trigeminal nerve (the 2nd, less often the 3rd, and only in exceptional cases the 1st), then in stages 2 and 3 of the disease the 2nd and 3rd branches are involved, less often the 2nd and 1st, sometimes all three.

Cardiac manifestations of trigeminal neuralgia during exacerbation of the disease appear quite clearly: short-term paroxysms of pain similar to electric shocks and trigger zones are observed. During the period of remission, as the pain subsides, the trigger zones disappear (Karlov V.A.).

With a longer duration of the disease (usually more than 2 years), trophic disorders are observed (especially in patients who have been repeatedly treated with destructive methods) in the areas of the affected branches, which are manifested by dryness, flaking of the facial skin, early graying and hair loss on the anterior scalp, facial atrophy muscles.

Most patients with trigeminal neuralgia suffer from various neurotic disorders - from neurotic reactions to asthenoneurotic syndrome. More often depressive syndrome develops, less often - anxiety-phobic and hypochondriacal (V.E. Grechko).

Differential diagnosis

Trigeminal neuralgia is distinguished from neuralgia of the glossopharyngeal and superior laryngeal nerves by a different area of ​​localization of the trigger zones. It can be difficult to recognize the most severe manifestation of trigeminal neuralgia in the form of neuralgic status (status neuralgicus), in which there is a prolonged attack of paroxysmal pain.

Upon detailed questioning of the patient, it is possible to establish that the indicated pain paroxysm represents the status of pain attacks that follow almost continuously one after another, similar to electric shocks, and trigger zones are necessarily identified. Patients avoid movement and conversation.

In some cases, differentiation from neuralgia of the pterygopalatine ganglion and migraine neuralgia may be a known difficulty.

Treatment

If the disease lasts for a long time, the anticonvulsant drug carbamazepine (finlepsin, stazepin, tegretol, amizepine, mesatol) is prescribed first in individually selected doses. If the patient has not previously received this drug, then carbamazepine is prescribed orally, starting with 1 tablet (0.2 g) 1-2 times a day daily, the dose is gradually increased by 1/2 tablet or tablet, but not more than 2 tablets (0. 4 g) 3-4 times a day.

If side effects occur (loss of appetite, nausea, vomiting, headaches, drowsiness, ataxia, accommodation disturbance), the dose is reduced. Patients who have previously received the drug can immediately be prescribed carbamazepine 2-3 tablets (0.4-0.6 g) 2-3 times a day.

To enhance the effect of the anticonvulsant, antihistamines are prescribed - intramuscularly 2 ml of a 2.5% solution of diprazine (pipolfen) or 1 ml of a 1% solution of diphenhydramine at night.

Elderly people who have symptoms of chronic cerebral circulatory failure (even in the stage of compensation) must be prescribed antispasmodics and vasodilators (aminophylline, diaphylline, syntophylline, etc.).

It is more advisable to immediately inject 10-20 ml of a 40% glucose solution into a vein. At the same time, sedatives and vitamins are prescribed, the most effective of which are B vitamins: B,2 - 500-1000 mcg intramuscularly daily, for a course of 10 injections, then vitamin Bf, 2 ml of a 5% solution intramuscularly daily, for a course of 15-20 injections.

If an exacerbation occurs during treatment with carbamazepine, it should be replaced with a drug from another company or even another anti-consultant that gives a therapeutic effect for trigeminal neuralgia. Among those proposed in Lately drugs, the effectiveness of ethosuximide (suxilep, ronton, asamide) is noted.

In severe forms of neuralgia, it is recommended to prescribe sodium hydroxybutyrate (except for patients with glaucoma). You can use a ready-made 20% aqueous solution in 10 ml ampoules. The drug is administered intravenously (1-2 ml per minute), 1-2 times a day.

Mild attacks of pain can be relieved using transcutaneous electrical stimulation of the affected branches of the trigeminal nerve. The following devices have been mass-produced by the domestic industry: an electrical stimulator for pain “Electronics EPB-50-01” and a transcutaneous electrical neurostimulator for pain “Electronics TENS-2”.

The psychotherapeutic effect on the patient should not be underestimated. Often, a convincing conversation with a doctor or hospitalization of the patient can stop the recurrence of painful paroxysms.

In the acute period of the disease, physiotherapy is prescribed: irradiation with a Sollux lamp, ultraviolet irradiation, UHF therapy, electrophoresis of novocaine, diphenhydramine, platiphylline on the affected area of ​​the face. Diadynamic currents have an analgesic effect.

For severe pain, diadynamoelectrophoresis with a mixture of codeine, dicaine, sovcaine 0.1 g, 6 drops of adrenaline solution 1:1000, 100 g of distilled water is recommended. Sinusoidal modulated currents are also prescribed: current strength is 2-10 mA, procedure duration is 5-10 minutes daily, and can also be combined with medicinal substances.

In case of exacerbation of neuralgia, ultrasound or phonophoresis of analgin is used on the area of ​​the affected branches of the trigeminal nerve in a pulsed mode using a labile technique (small head of the Ultrasound-T5 apparatus); intensity 0.005-0.2 W/cm2, 2-3 minutes per field, 10-15 procedures per course of treatment (Popova E.M., 1972).

A course of treatment with nicotinic acid in combination with antihistamines and vitamin therapy can be recommended. Nicotinic acid is prescribed intravenously in the form of a 1% solution (starting with 1 ml daily for 10 days, increasing the dose to 10 ml, and then also gradually reducing it).

During the period when the exacerbation subsides, patients may be recommended a very light facial massage, first only the skin and muscles, and after 4-5 days - along the branches of the trigeminal nerve (15-20 procedures).

Patients with trigeminal neuralgia are prescribed a course of treatment with aloe extract - 1 ml intramuscularly daily, for a course of 15 injections.

Patients with bilateral neuralgia should be treated for a month in a hospital setting. In the future, patients should be under the supervision of a neurologist. Preventative treatment For patients with mild and moderate severity of the disease, it is carried out once a year, for patients with severe disease - twice a year. In all cases, before prescribing a course of treatment, an examination by a dentist is necessary.

For some patients with trigeminal neuralgia, commonly used medications are ineffective. In these cases, neuroexeresis is prescribed, which is performed by surgeons and neurosurgeons. The method of treating the nerve stump with liquid nitrogen is especially effective (Grechko V.E., Kornienko A.M., Nesterenko G.M., 1986).

One of the methods of treating trigeminal neuralgia is tissue therapy by grafting a preserved nerve. The trigeminal nerve, Gasserian ganglion are used, but more often the sciatic nerve, which is more easily removed (Munteanu I.F.). In our clinic, alcoholization of the Gasserian ganglion is very successfully used (Nazarov V.M., 1999). We have accumulated experience in treating 400 patients.

B.D. Troshin, B.N. Zhulev

areas of skin located on the lips, nasolabial folds, wings of the nose, eyebrows, a light touch of which causes an attack of pain, and strong pressure alleviates the developed pain attack in patients with trigeminal neuralgia.

• - see Zakharyin - Geda...

  Medical encyclopedia

• - areas of the facial skin in which pain and temperature sensitivity is impaired according to the segmental type when the middle cerebral tract of the trigeminal nerve or the trigeminal nerve of the same name is damaged...

  Medical encyclopedia

• - painful points on the body, pressure on which can cause a hysterical attack in patients with hysteria...

  Medical encyclopedia

• - areas of bone tissue restructuring that occurs as a result of increased load on normal bone or normal load on bone when it is damaged...

  Medical encyclopedia

• - areas of the body that include a set of receptors, the irritation of which causes a certain reflex - see Reflex...

  Medical encyclopedia

• - weakly stained secondary chromosomal constrictions according to Feilgen, the same width as the chromosome body; participate in the formation of nucleoli...

  Medical encyclopedia

• - see Hysterogenic...

  Medical encyclopedia

"Trigger zones" in books

Grandfather Matvey

From the book The Lord Will Rule author Alexander Avdyugin

Grandfather Matvey Grandfather Matvey old. He himself says: “They don’t live that long these days.” He probably says it right, because there are no people his age left in the area, especially those who went through the war: with trenches, attacks, wounds and other fears, which we can now judge only from books

5. Levi Matvey

From the book Woland and Margarita author Pozdnyaeva Tatyana

5. Levi Matthew At the foot of the Mount of Olives, in Bethphage, Yeshua Ha-Nozri met his only disciple Levi Matthew. Yeshua talks about this during interrogation, and although the Yershalaim topography does not indicate the proximity of this small village to the Olivet

Matvey

From the book The Secret of the Name author Zima Dmitry

Matvey Meaning and origin of the name: from the Hebrew name Matthew - a gift from God, bestowed by the Lord. Energy and Karma of the name: today the name Matvey is quite rare, although it is possible that it may soon become fashionable. At least today they are

MATVEY

From the book 100 happiest Russian names author Ivanov Nikolay Nikolaevich

MATVEY Origin of the name: “given by God” (Jewish). Name day (new style): July 13; August 22; October 11, 18; November 29. Positive character traits: calmness, responsibility, harmony, absence of contradictions, complexes. Matvey is reliable,

Matthew of Paris

From the book Russian-Livonian War of 1240-1242 author Shkrabo D

Matvey of Paris Matvey of Paris, French author of the 1st half. 13th century, wrote that the Danish king sent princes Knut and Abel with an army and settlers to populate the Novgorod possessions devastated by the Tatars. He mixed two events: the German-Danish campaign of 1240

Cat Matvey

From the book Knitted toys author Kaminskaya Elena Anatolyevna

Cat Matvey Such a knitted cat can not only become your baby’s favorite toy, but also a wonderful gift friend for the birth of a child. Cat Matvey You will need 50 g of yarn of the main color, 20 g of white yarn for the face and paws,

Matvey

From the book All the Monarchs of the World. Western Europe author Ryzhov Konstantin Vladislavovich

Matvey From the Habsburg dynasty. King of Hungary in 1608-1618. King of the Czech Republic and 1611 -1617 King of the Germans and Emperor of the Holy Roman Empire in 1612-1619. Son of Maximilian II and Maria Habsburg.J.: from 4 Dec. 1611 Anna, daughter of Archduke Ferdinand of Tyrol (b. 1585, d. 1618). 24

Komarov Matvey

From the book Great Soviet Encyclopedia (KO) by the author TSB

Matvey from Mekhov

TSB

Matvey from Yanov

From the book Great Soviet Encyclopedia (MA) by the author TSB

Matvey Korvin

From the book Great Soviet Encyclopedia (MA) by the author TSB

Matvey Parizhsky

From the book Great Soviet Encyclopedia (MA) by the author TSB

Shaum Matvey

From the book Great Soviet Encyclopedia (SHA) by the author TSB

Matvey Roizman

From the book “The Trumpets of Glory Are Not Sung...” Small Imagists of the 20s author Kudryavitsky Anatoly Isaevich

Matvey Roizman * * * Fly around in the cold square. And fight, autumn, about the cornice, And drop the menacing golden feathers down the alleys! Already with sad words the poplars greet you And the wedding purple is squandered On the bare fields. And I see: behind the foggy blue, Another hunchback and

Matvey

From book Orthodox names. Choosing a name. Heavenly patrons. Saints author Pecherskaya Anna Ivanovna

Matvey Name meaning: from ancient Hebrew. Mattityahu - “gift of Yahweh” (“given by the Lord”). Main features: honesty, modesty, morality. Character traits. In his family, Matvey is usually a long-awaited child; his parents entrust him big hopes. He

Typical prosopalgia- this is paroxysmal neuralgia of the trigeminal, glossopharyngeal and upper laryngeal (branch of the vagus) nerves. Characterized by short-term (seconds, tens of seconds) “shots” of excruciating pain, similar to a blow electric current, in the forehead, eyes (with neuralgia of the 1st branch of the trigeminal nerve), teeth of the upper jaw and the upper jaw itself, zygomatic region (with neuralgia of the 2nd branch), teeth lower jaw and the lower jaw itself (with neuralgia of the 3rd branch of the trigeminal nerve); in the area of ​​the root of the tongue, arch, tonsil, sometimes in the depths of the external auditory canal (with neuralgia of the glossopharyngeal nerve); in the area of ​​the pharynx, larynx (with neuralgia of the superior laryngeal nerve). In the latter case, attacks of pain may be accompanied by a cough, and with neuralgia of the glossopharyngeal nerve - fainting with a weak, slow pulse. The neuralgia of these nerves is “silent”: stunned by the terrifying pain, patients freeze during an attack, in rare cases they make certain movements, for example, putting their hand to their chin (antagonist gesture). A sign of neuralgia of these nerves is the trigger zones, touching which causes an attack of neuralgia.

Trigger zones in trigeminal neuralgia located mainly in the medial areas of the face - at the inner corner of the eye, root of the nose, upper lip, chin or on the oral mucosa. With neuralgia of the glossopharyngeal nerve, trigger zones appear in the area of ​​the tonsil, root of the tongue, and sometimes the tragus of the ear. For fear of causing an attack, patients avoid shaving, brushing their teeth, talking, eating, etc. During the period of exacerbation of the disease, the patient acquires such a characteristic appearance that one can suspect neuralgia just by looking at him: on his face is a mask of suffering, fear and even horror of the possible attack.

Patients answer questions in monosyllables, almost without opening their mouths, since the slightest movement of the facial muscles can cause attack of pain. Sometimes the patient does not dare to speak at all and explains himself only with gestures and in writing. Frequent spasms of the facial muscles are clonic twitches, the so-called pain tic.

It has now been established that paroxysmal neuralgia has a tunnel origin: it is based on compression of the root of the trigeminal or glossopharyngeal nerve by pathologically tortuous arteries, less often by veins, tumors. As established at our department by O.N. Savitskaya, compression of the branch can also occur at the level of the peripheral nerve in the channels of the 2nd (infraorbital canal) or 3rd (mandibular canal) branches of the trigeminal nerve. This happens as a result of the congenital narrowness of the canal or due to local inflammatory processes. With neuralgia of the superior laryngeal nerve, it is assumed that it is compressed when passing through the thickened stylohyoid membrane.

As a result compression of the root or the nerve itself the afferent ascending sensory flow (peripheral factor of pathogenesis) is disrupted, which leads to the formation of a paroxysmal type algogenic system (central factor of pathogenesis) in the central formations of the affected nerve and in the associated structures. This causes the appearance of both painful attacks and areas of hyperexcitability on the skin of the face and mucous membranes of the oral cavity - trigger zones.

Treatment of paroxysmal neuralgia perhaps conservative and . Therapy primarily includes the use of some antiepileptic drugs, the best of which is carbamazepine (Tegretol, Finlepsin). These drugs, not being analgesics, have a pharmacospecific effect in trigeminal neuralgia, which is associated with their influence on the central mechanisms of the disease - the paroxysmal algogenic system. Doses are selected individually and vary from 600 to 1200 mg or more, after the exacerbation is relieved, they are gradually reduced to maintenance.

Baclofen is also helpful; its doses can reach 500 mg/day. Recently, sirdalud (up to 8-12 mg/day) has been tested. In acute cases, intravenous administration of 20 ml of 10% sodium hydroxybutyrate solution is effective. Acupuncture, transcutaneous electrical stimulation of the area of ​​the affected nerve branch, as well as thymoleptics - antidepressants are used. During electrical stimulation, the existing trigger zones are lubricated with an anesthetic. Surgery, which consists of decompressing a root or nerve at the site of compression, can be a radical means of eliminating the disease. At our department, V.B. Karakhan developed a microsurgical gentle method of operation through the use of intracranial endoscopy and endosurgery with subsequent protection of the root from possible re-compression with a special microprotector.

Trigger zones are areas of skin located on the lips, nasolabial folds, wings of the nose, eyebrows, lung touching which causes an attack of pain, and strong pressure eases the developed pain attack in patients with trigeminal neuralgia.

Large medical dictionary. 2000 .

See what “trigger zones” are in other dictionaries:

NEURALGIA- – pain of a shooting, stabbing, burning nature, occurring in paroxysms, spreading along the trunk of the nerve or its branches and localized in the zone of innervation of certain nerves or roots. Causes may include injury, intoxication,... encyclopedic Dictionary in psychology and pedagogy

I Neuralgia (neuralgia; Greek neuron nerve + algos pain) paroxysmal, intense pain spreading along the trunk of a nerve or its branches, sometimes accompanied by sensory disturbances in the area of ​​innervation of the affected nerve and... ... Medical encyclopedia

TRIGEMINAL NEURALGIA- honey Trigeminal neuralgia (TN) is a disease characterized by severe paroxysms of facial pain in the innervation zones of one or more branches of the trigeminal nerve, often provoked by touching the skin of the trigger zones; the disease is caused by... Directory of diseases

NEURALGIA OF THE GLOSPHARYNGEAL NERVE- honey Neuralgia of the glossopharyngeal nerve is a rare disease affecting the IX pair of cranial nerves (glossopharyngeal nerve), characterized by the appearance of paroxysmal pain on one side of the root of the tongue, pharynx and soft palate when taking hot, cold... ... Directory of diseases

This article is about a non-academic area of ​​research. Please edit the article so that this is clear both from its first sentences and from the subsequent text. Details in the article and on the talk page... Wikipedia