Trigeminal neuralgia: induced remission without surgery, and observations on its aetiology

A case is described in which trigeminal neuralgia was controlled primarily by a programme of mandibular relaxation. The symptoms and the success of the management were consistent with the hypothesis that trigeminal neuralgia is caused by chronic compression of the trigeminal nerve and surrounding tissues in the vicinity of the temporomandibular joint. The triggering of attacks appears to be a result of stimulation of individual pain receptors associated with neurons in which transmission thresholds have been reduced by cumulative nerve damage. Extracranial and systemic trigger factors, of cervical and abdominal origin, are described. The conservative management involved mandibular relaxation, avoidance of flatulence and constipation, occasional use of an acrylic occlusal splint, and when necessary, use of Dilantin in prescribed amounts.