The Journal of the International College of Surgeons January-December 1948 [antikvár]

Originál Articies Neuralgias of the Face: Diagnosis and Treatment* ALFRÉD W. ADSON, M.D., F.A.C.S. SECTION ON NEUROLOGIC SURGERY, MAYO CLINIC ROCHESTER, MINNESOTA THERE are two major neuralgias char-acterized by paroxysmal painful sensa-tions of the face. The painful sensations may extend to the tongue, gums, throat and ears, depending on the branches of the nerve involved. The fifth eranial nerve (the tri-geminal nerve) and the ninth eranial nerve (the glossopharyngeal nerve) are the nerves afflicted. Trigeminal neuralgia occurs about 75 times as frequently as does glossopharyngeal neuralgia; occasionally they appear simultaneously. Sphenopalatine neuralgia as deseribed by Sluder18 may be a distinct entity, though Vail20 preferred to refer to the syndrome as a neuritis of the vidian nerve. The pain is continuous, not paroxysmal and is localized in the maxillary region with extension along the upper four cervical nerves. The present treatment does not offer the dramatic relief that the treatment for trigeminal and glossopharyngeal neuralgias offers to those patients with the one or the other major neuralgia. Migraine with extension of pain along the ophthalmic braneh of the trigeminal nerve is an extremely painful syndrome, accom-panied by lacrimation and photophobia. The attacks of pain are not paroxysmal and are not precipitated by touching the involved skin area. Postherpetic ophthalmic neuralgia is a continuous painful sensation, distributed to the area supplied by the ophthalmic branch of the trigeminal nerve. At the onset of the disease, papules and pustules develop on the forehead, eyelids, sclera and even cornea. However, the severest pain develops after the skin lesions have healed. The area involved is extremely hypersensitive to touch. * Reád before the Twelfth National Assembly, United States Chapter, International College of Surgeons, Chicago, 8ept. 29-Oet. 4, 1947. The pains accompanying infections of the antrum and other sinuses are constant and continuous and are associated with symptoms of sepsis. Localized dental caries gives rise to severe pain which is constant in character and is accompanied by local tenderness, signs of infection and roentgenographic evidence of the disease. These facts should be kept in mind when a patient complains of paroxysmal pain localized in a tooth without evidence of inflammation, since extraction of a tooth will not relieve trigeminal neuralgia. Dental neuritis, an aching, burning pain in the gums following complete extraction of a tooth, occurs occasionally. It is distin-guished from trigeminal neuralgia in that the pain is not paroxysmal, but continuous and usually involves both sides of the mouth. The gums remain tender, a fact which frequently prevents these patients from wearing their dentures. Localized dental neuritis alsó follows the nerve block which is employed to desensitize a part for a dental surgical procedure. Usually the pain and paresthesia disappear within two or three weeks. However, if anesthesia is a predominant symptom, it may continue indefinitely. trigeminal neuralgia Symptoms.—Trigeminal neuralgia is char-acterized by darting, stabbing, flashlike pains extending along one or more branches of the trigeminal nerve. The paroxysms of pain usually are initiated by irritation of the region involved, such as that caused by washing the face, cleaning teeth, chewing, swallowing or talking, or by exposure to currents of air. Frequently, a particular area, commonly known as the trigger zone, is more sensitive than are other areas. Patients with trigeminal neuralgia are seen to protect the