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Review
. 2013 Jan 1;3(4):e2.
doi: 10.5037/jomr.2012.3402.

Aetiology and pathogenesis of trigeminal neuralgia: a comprehensive review

Gintautas Sabalys  1 , Gintaras Juodzbalys  1 , Hom-Lay Wang  2
Affiliations
Review

Aetiology and pathogenesis of trigeminal neuralgia: a comprehensive review

Gintautas Sabalys et al. J Oral Maxillofac Res. .

Abstract

Objectives: The aim of present paper was to discuss issues related to trigeminal neuralgia with strong emphasis on the aetiology and pathogenesis of this problem.

Material and methods: An electronic search of 5 databases (1965 - Oct 2012) and a hand search of peer-reviewed journals for relevant articles were performed. In addition, experience acquired from treating 3263 patients in the Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, were also summarized.

Results: Generally, aetiological factors can be classified into 3 most popular theories that were based on: 1) Related to other disease, 2) Direct injury to the trigeminal nerve, and 3) Propagates the polyetiologic origin of the disease. In addition, two pathogenesis mechanisms of trigeminal neuralgia were proposed. First: the peripheral pathogenetic mechanism that is often induced by progressive dystrophy around the peripheral branches of the trigeminal nerve. Second, central pathogenetic mechanism which often triggered by peripheral pathogen that causes long-lasting afferent impulsation and the formation of a stable pathologic paroxysmal type irritation focus on the central nerve system (CNS).

Conclusions: Patients with susceptive trigeminal neuralgia should be examined carefully by specialists who have expertise in assessing and diagnosing of possible pathological processes and be able to eliminate the contributing factors so the trigeminal neuralgia can be properly managed.

Keywords: trigeminal ganglion; trigeminal nerve; trigeminal neuralgia; trigeminal nuclei..

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Figures

Figure 1
Figure 1
An orthopantomograph of a patient with infraorbital neuralgia: a narrowed left infraorbital canal (arrow).
Figure 2
Figure 2
An orthopantomograph of a patient with a third-branch trigeminal neuralgia: a narrowed left mandibular canal in the region of a second molar.
Figure 3
Figure 3
Fluorescent photomicrograph of an affected peripheral branch of the compromised nerve: A = Acute stage of TN. Mast cell degranulation. Magnification x300. B = Remission period of TN. Granules of mast cells. Magnification x300.
Figure 4
Figure 4
Illustrated an affected peripheral branch of the compromised trigeminal nerve. This sample was taken during an acute period of trigeminal neuralgia from a patient with at least three-year-long history of the TN (Bielschowsky-Gross silver impregnation; magnification x240): A = Part of thick nerve fibers with nodular thickenings; B = Vacuolisation and disintegration of nerve fibers.
Figure 5
Figure 5
Pathologic regeneration shown in a specimen of an affected peripheral branch of the compromised nerve taken during a remission period of TN (Bielschowsky-Gross silver impregnation; magnification x150).
Figure 6
Figure 6
Increased amount of connective tissue and decreased number of nerve fibers in an affected peripheral branch of the compromised nerve. The samle was taken from a patient with a more than ten-year-long history of TN (Silver impregnation; magnification x75).
Figure 7
Figure 7
Pathogenetic scheme of TN.
See this image and copyright information in PMC

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