 Hello everyone, welcome back to a new session on dentistry and more. Today's topic is trigeminal neuralgia or tick-dollars or further gills disease. So, as the name suggests it is a pain which is associated with a nerve that is trigeminal nerve which is the fifth cranial nerve. So, let's see what is the details of trigeminal neuralgia. So, trigeminal neuralgia is a long-term pain disorder which affects a trigeminal nerve. So, trigeminal nerve basically has three branches V1, V2 and V3. So, this is not exactly V, this is a fifth cranial nerve the Roman letter. So, the first branch is ophthalmic branch then the maxillary branch and mandibular branch. So, it affects the trigeminal nerve. So, the pain can be anywhere in this area elicited by the trigger zones. So, it is a neuropathic disorder of trigeminal nerve that causes episodes of intense pain in eyes, lips, scalp, forehead and jaws. So, these are the areas which is supplied by trigeminal nerve. This is also known as tick-dollars or further gills disease and it has another name that is suicidal disease because of this unbearable pain there are reports people commit suicide because the pain elicited just like that without any specific causes while you are brushing, while you are eating, while you are touching your face, while shaving even with a cool breeze can elicit the pain that pain will be very intense and very severe. So, there are reports people committed suicide because of trigeminal neural shear. So, by definition it is a sudden unilateral severe brief stabbing recurrent pain in the one or more branches of fifth cranial nerve. So, this is the fifth cranial nerve it has three branches of thalmic, maxillary and mandibular branches. So, the basic classification is typical trigeminal neuralgia a typical one primary which is idiopathic and secondary. So, classification are based on the nature and etiology it is basically due to the compression of nerve root. So, the nerve root of fifth cranial nerve is compressed because of many reason it could be meningal diseases, schwannoma, epidomoid cyst and it could also be due to primary demyelination disorder that is multiple sclerosis or carcinomatous deposits in this roots and also non demyelination lesions of bones or medulla. So, when its root is compressed the problem arises because the root distributes all the branches. So, it problem can be seen in one of the branch or one of more than one of the branch and it can trigger the pain from certain trigger zones. So, let us see what is the pathogenesis of trigeminal neuralgia. So, the superior cerebellar artery pressing on or grooving the root of nerve which causes pressure. So, it is a superior cerebellar artery which is in close connection with its root pressing on the root or it is grooving the root which causes or which creates pressure and focal demyelination and hyper excitability of nerve fiber happens. So, there will be focal at some points there will be demyelination, the myelin sheath will be removed or will be gone and there will be hyper excitability of nerve fiber happens. So, on light touch which results in brief episodes of intense pain. So, this is how this pathogenesis works that is superior cerebellar artery pressing or grooving the root of nerve which creates pressure and focal demyelination and hyper excitability of nerve fiber. So, what happens on very light touch which results in brief episodes of intense pain. Now, let us move on to the clinical features. So, clinical features which is basically very rare disease commonly seen middle age groups and it has female predilection that is 60 to 40 percentage. So, 60 percentage seen in women and the maxillary division is more commonly involved that is week 2 or the fifth cranial branch the second division and the ophthalmic division is rarely involved this one. So, when the pain elicits on what occasions on what procedure the pain elicits that creates this disease is very complicated and it is very disturbing to your day to day life that is the pain the intense brief lancinating pain you may have while shaving while showering while speaking while eating while exposure to wind. So, that means there is literally there is you have no escape from pain it can just like that arise from any of these any of these things that is shaving just like shaving just like showering the pain elicited that is the pain is very intense and it lasts for seconds to minutes. So, your day to day life is totally interrupted. So, it can the pain can be seen in cheek, jaw, teeth, gum, lips because this trichamen and now supplies all of these areas it has ophthalmic branch it has maxillary branch it has mandibular branch. So, it applies all these areas it has applied it supplies cheek, jaw, teeth, gum, lips and all areas it supplies. So, all of these areas will be affected or some of the areas will be affected. So, wherever the problem is that branch or the areas that branch supplies will be affected. So, pain is very very severe it is tabbing type or it is like electric shocks it is like burning or it is like crushing or exploding or lancinating pain. So, people described it is like stabbing electric shocks burning crushing exploding or lancinating type of pain. So, you can imagine the intensity of this pain and the reasons occasions it is elicited. So, it may last from few seconds to minutes and most commonly it is unilateral that it affects commonly on the right side of the patient. So, the patient has a frozen or mask like face this is the most important feature of trigeminal neuralgia that is frozen or mask like mask like face and why because on extreme pain moments the patient's face will be frozen. So, the patient is not able to move a bit not able to make any facial expression because the patient is undergoing very severe pain that is why it is got a frozen or mask like face and it is precipitated by trigger zones. So, there are various trigger zones like eyes, lateral path of nose, corner of mouth, lips, upper lip, lower lip. So, all these can act as trigger zone simply touching these trigger zone will create will elicit this pain. So, how do we diagnosis? So, most commonly the history taking the clinical examination and the diagnostic LA block. So, LA block should be applied to each branch and we diagnose or we rule out the involvement of each branch. We can go for CT scan and MRA. So, these are the diagnostic part then the treatment part we can go for either medical management or surgical management. So, medical management is mainly we are giving drugs like carbamazepine, phenytoin or clonazepam. Surgical management is like either we need to do a micro vascular decompression or percutaneous balloon decompression or gamma knife radio surgery or retro-gasarian rhizotomy. So, these are the various surgical procedures which can be used to remove the trigeminal ganglion, trigeminal nerve or the parts of trigeminal nerve so that the patient won't feel the pain. So, this is very complicated disease which is known as suicidal disease. So, the name itself gives a lot of clue about this disease. So, how severe and how complicated this disease is? So, trigeminal neuralgia. So, the name gives which nerve it is affected that is trigeminal fifth nerve fifth cranial nerve it has three branches that is trigeminal three branches one two three trigeminal branches which is also known as tick dollar oaks or father gill's disease. So, the take away points is it is a suicidal disease it has trigger triggering points it is frozen or mask like face and it is the severe brief stabbing pain. So, frozen or mask like face trigger points and the stabbing recurrent pain on just like shaving, showering, speaking the basic routine procedures or routine things what we do in our day to day life. So, that's all about trigeminal neuralgia. So, I will come up with a new topic in dentistry and more. Thank you.