[Trigeminal neuralgia and other facial pain--diagnosis and therapy]

The hallmark of trigeminal neuralgia is the abrupt onset of short pains in the face or in a part of the face, described as stabbing, lightning or electric shocks. Attacks are often triggered by cutaneous stimuli to the face or the oral cavity, which may be such minor activities as talking, chewing, brushing the teeth, or even wind blowing on the face. As a result, facial hygiene as well as a good diet may be neglected. Although 1% of the patients may eventually develop the disorder bilaterally, pain does not cross the midline during any single episode. The clinical course is characterized by exacerbations and remissions, but as the disorder progresses, remissions become shorter and exacerbations more severe. Carbamazepine is the most powerful drug for this condition, but side effects may occur. Neurosurgical treatment may then be considered; the different techniques and approaches are mentioned. Other pain conditions in the face will be reviewed. If the trigeminal neuralgia may be considered as a nerve irritation, like the glossopharyngeal neuralgia and the nasociliary neuralgia, nerve lesion may elicit neurogenic or neuropathic pain, characterized by chronic burning pain; post-zoster pain, iatrogenic and posttraumatic pain illustrate this condition. Cluster headache (Horton neuralgia), Sluder's neuralgia and auriculotemporal neuralgia may be related to a dysfunction of the autonomous nervous system. Finally, lesion in the mandibular joint may cause unilateral facial pain.