Prevalence Of Trigeminal Neuralgia Among Patients Treated For Orofacial Neuralgia - An Institutional Based Retrospective Study

Keywords

Prevalence; Orofacial Neuralgia; Trigeminal Nerve; Trigeminal Neuralgia.

Introduction

Neuropathic pain is the pain caused by somatosensory nervous system injury or disease. It may be classified based on its temporal aspect as episodic or continuous.Previous studies on effectiveness of chlorhexidine and biomedical waste management have been done , which let us gain experience to work on the present study [1, 2]. It is characterized by a short duration electric shock pain lasting from seconds to minutes. Previously we have done studies on pterygomaxillary disjunction and oral squamous cell carcinoma, which were helpful to work on the current study [3, 4]. In general there is a zone of trigger point which may be intra or extra oral and when provoked by mild non- traumatic stimulus is able to produce moderate to severe paroxysmal pain. Pain management is an emergency procedure followed by the dentist [5, 6]. In the latter, pain originates in the neural structures, is constant, continuous and burning, with different and fluctuating levels of intensity, sometimes without total remission. Dental anxiety is seen in a maximum number of patients [7, 8] .Trigeminal neuralgia is an extremely painful yet rare orofacial pain condition, and clear understanding of its mechanism and management remains an enigma. Maxillofacial trauma might occur in different patterns [9, 10].

Originally known as “tic douloureux” due to its characteristic facial tics, this disorder may be described as a paroxysmal unilateral facial pain along the distribution of one or more branches of the trigeminal nerve. Viral infections like varicella zoster can also lead to trigeminal neuralgia [11, 12]. The maxillary and mandibular branches of the trigeminal nerve are most commonly affected, followed by the ophthalmic branch. Patients with severe pain can be diverted with the help of virtual reality method for ease of the treatment [13-15]. Trigeminal neuralgia has a variety of etiologies, mass effect from metastases, viral infection, trauma, autoimmune processes are considered to lead to impaired trigeminal nerve function, often attributed to demyelination. Previously we have worked on 3D changes in pharyngeal airway, which helped us gain experience to work on the current study [16]. Pain associated with trigeminal neuralgia is described as severe, sharp, electric and stabbing, is unilateral and usually remains within the anatomic distribution of the affected nerve branch, regardless of remissions and exacerbations [17].

Trigeminal neuralgia pain is often triggered by chewing and swallowing, and may even be triggered by light touch to the face [18]. The pain is often relieved by sleep and may have periods of remission lasting from weeks to years [19]. While symptoms of trigeminal neuralgia are limited to pain, the quality of life for patients is profoundly worsened, which puts them at a high risk of depression and other psychological disorders [20]. Patients with trigeminal neuralgia tend to be asymptomatic when asleep, suggesting a bidirectionality between neuropathic pain and sleep. As sleep quality improves, pain sensitivity will decrease [21, 22]. The severity of pain associated with trigeminal neuralgia and its devastating psychological effects make a prompt diagnosis and treatment essential. Without a proper understanding of its clinical features and medical course, it may go undiagnosed for years [23, 24]. The aim of the study was to check the prevalence of trigeminal neuralgia among patients treated for orofacial neuralgia.

Materials And Methods

This study was done under a university setting.And it is a single centered retrospective study. The similar ethnicity of the study is that it is done with pro available data of the population. The disadvantage of this study could be the geographic locations, limitations and trends.

Two reviewers are involved in this study. The samples were taken from the patients who underwent treatment from June 2019 to March 2020. We reviewed patient records and analysed the data of 86000 patients between June 2019 and March 2020. The total number of patients reported with orofacial disorder were shortlisted to 36, based on inclusion criteria of patients treated for orofacial neuralgic disorder. The study was commenced after approval from the scientific review board, and the ethical clearance was obtained from the ethical committee of the university with the following ethical approval number - SDC/SIHEC/2020/DIASDATA/ 0619-0320.

The patient list was identified and the case sheets were verified with the help of treatment notes.

The data is obtained from the category “orofacial neuralgia treatment”. The data was collected, verified, tabulated and analysed. The data was imported to SPSS and the statistical Chi square test was done by using SPSS software by IBM. The type of analysis done in this study is descriptive and association.

Results And Discussion

Orofacial neuralgia is an unpleasant sensation caused by a noxious stimulus that is mediated only along a specific nerve pathway into the central nervous system, where it is interpreted as pain. This pain can be etiologically classified into three groups as somatic pain, neuropathic pain psychological pain. There are many types of orofacial neuralgia, namely trigeminal neuralgia, glossopharyngeal neuralgia, sphenopalatine ganglion neuralgia, postherpeticneuralgia,etc. Among all those mentioned earlier, Trigeminal neuralgia accounts for overall orofacial neuralgic disorder. Trigeminal neuralgia is a painful, chronic condition involving the trigeminal nerve. The pain caused due to trigeminal neuralgia can be brought on by mild stimulation of the face, such as brushing.

Trigeminal neuralgia occurs in the age groups ranging from 40 to 80 years and it is most common among 35 to 84yrs in males and 37 to 85yrs in females. The present study shows that the most prevalent age group for Trigeminal l neuralgia was 41 to 50 yrs(red) and 51 to 60 yrs (white) with the percentage of 27.8%, followed by 61 to 70 yrs (black) with 22.2%, as depicted in Figure 1. A study by Derafshi R, et.al, 2019 [25], also found that Trigeminal neuralgia has been more common among 50 to 70 yrs (32%). Underlying disease predisposing Trigeminal neuralgia could be due to multiple sclerosis related neuralgia, traumatic neuroma,Cerebero-pontine tumor and vascular lesion compressing trigeminal ganglion.

Out of the patients treated for Trigeminal neuralgia, 61.1% of the patients were males(green) and 38.9% of them were females(blue) as shown in Figure 2. According to the results, males show higher prevalence with 61.1% and females with 38.9%. Hence males are more prevalent to Trigeminal neuralgia than females.When the association analysis was done between age and prevalence of trigeminal neuralgia, it was found patients from the age group of 41 to 50 yrs(red) showed the highest prevalence for trigeminal neuralgia in our institutional patient’s data. A study conducted by ArpitaRai, et.al, 2017 [26], had similar results where the most prevalent age group showing trigeminal neuralgia is 50 to 60 yrs (33%) is in consensus with the present study.

Association of gender and the prevalence of trigeminal neuralgia,was assessed in the present study .Though it was found not statistically significant, as shown in Table 2 and Figure 5,Males(green) showed higher prevalence with 62.5% than females(blue) with 37.5%. A study given by Siqueira SR, et. al, 2009 [27], shows that females are more prevalent to trigeminal neuralgia(65%). A study by Katheriya, et. al, 2019 [28], shows that females are more prevalent (58.3%) to trigeminal neuralgia than males (41.7%). Previous studies are not in consensus. Out of 36 patients, the prevalence of trigeminal neuralgia is 66.7% (pink) and 33.3% (yellow) of the patients did not have trigeminal neuralgia as shown in Figure 3. In this study, prevalence of trigeminal neuralgia is high (66.7%) among patients treated for orofacial neuralgia.

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Zakrzewska JM, Linskey ME, 2009 , in their study have described that trigeminal neuralgia has the highest occurrence rate (43%) in patients treated for orofacial neuralgia. The present study where most of the patients reported with Orofacial neuralgia were finally diagnosed with Trigeminal neuralgia is in consensus with the previously mentioned study [29].

Hence it is very evident from the present study that the prevalence of trigeminal neuralgia is highly in the patients treated for orofacial neuralgia in the present study center. The most common age group affected is 41 to 50 yrs (red). Studies on more population should be done to explore the clinical features and treatment modalities in patients with trigeminal neuralgia.

Conclusion

From this retrospective study it can be concluded that prevalence of trigeminal neuralgia in the patients treated for orofacial neuralgia is at a higher rate. It is more prevalent in males than in females. The most prevalent age group for trigeminal neuralgia is 40 to 50yrs. Further a large sampled randomised control trial is necessary to generalize the outcome of this study.

Acknowledgement

The authors sincerely acknowledge the Medical record department faculties in helping and sorting out datas pertinent to this study.