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neuralgia(noo-ral'ja, nu- ) [ neuro- + -algia]
cardiac neuralgiaAngina pectoris.
facial neuralgiaTrigeminal neuralgia.
geniculate neuralgiaRamsay hunt syndrome.
Hunt neuralgiaRamsay Hunt syndrome.
Morton neuralgiaSee: Morton neuralgia
otic neuralgiaGeniculate neuralgia.
Symptoms include episodes of facial pain, often accompanied by painful spasms of facial muscles. Between attacks the patient may be pain-free. When observed during an attack, the patient will often try to splint or in other ways protect the affected area. In long-standing cases, the hair on the affected side sometimes becomes coarse and bleached. Physical examination shows no motor or sensory function impairment.
The cause is thought to be the pressure of blood vessels on the trigeminal nerve root at its point of entrance into the brainstem. Magnetic resonance imaging is used to identify other potentially hazardous causes of facial pain.
Carbamazepine, phenytoin, or other anticonvulsant drugs in gradually increasing doses are often effective. Other therapeutic options include narcotic analgesics or muscle relaxers such as lioresal. Nerve block provides temporary relief. Surgical therapies are various and may include rhizotomy, microsurgical nerve root decompression, or nerve root injections. Radiation therapy is sometimes employed.
The characteristics of each attack are observed and recorded. Analgesic drugs are administered as prescribed and observed for desired and adverse effects. Before surgery is contemplated, an effort should be made to reduce factors that make symptoms worse, e.g., by having the patient use a cotton pad to cleanse the face and a blunt-toothed comb to comb the hair.
After surgery, sensory deficits are assessed to prevent trauma to the face and affected areas. The patient who has had an ophthalmic branch resection should avoid rubbing his or her the eye, avoid using aerosol sprays, wear glasses or goggles outdoors, blink often, and examine the eye for foreign substances with a hand mirror frequently. The patient who has had a mandibular or maxillary branch resection should eat carefully to avoid oral injuries from hot food or drinks or chewing, e.g., by eating food on the unaffected side to prevent inner cheek injury. Frequent dental examinations detect abnormalities that the patient cannot feel. The patient and significant others require emotional support throughout treatment. Expression of feelings should be encouraged, and independence promoted, helping the patient to avoid trigger stimulation while carrying out self-care and physical activities.