PRESENTED BY :DR ISHANI SHARMAPG FIRST YEARDEPT OF PAEDODONTICS AND PREVENTIVE DENTISTRY.

MODERATER : DR SHIREEN DR AMRITA

1. Malamed S. Handbook of local anesthesia. St. Louis, Mo.: Elsevier/Mosby; 2002.

2. Rajendran R, Sivapathasundharam B, Shafer W. Shafer's textbook of oral pathology. 4.

3. Ghom A. Textbook of oral medicine. St Louis (USA): Jaypee Bros.; 2010.

4. Chaurasia B. Bd chaurasia's human anatomy regional and applied dissection and clinical.; 2013.

Introduction . Embryology of trigeminal nerve. Nuclei of trigeminal nerve. Trigeminal ganglion. Branches. Ganglia associated with the trigeminal

nerve. Complications of nerve blocks. Applied anatomy. Conclusion.

Nerve- a bundle of fibers that uses chemical

and electrical signals to transmit the sensory and motor information from one body part to another.

Neuron – these are specialized cells that

constitute the functional units of the nervous system and has a special property of being able to conduct impulses rapidly from one part of body to another.

During the development of embryo , the pharyngeal arches appear in the fourth and fifth week.

It gives rise to the six pharyngeal arches, of which the fifth arch dissappears.

Each arch is characterized by its own :1. Muscular component.2. Nerve component.3. Arterial component.4. Skeletal component.

Trigeminal nerve is derived from the first pharyngeal arch.

It has got 4 nuclei :1. Main sensory nuclei2. Spinal nuclei3. Mesencephalic nuclei4. Motor nuclei

The central processes large sensory root attached to pons at middle cerebellar peduncle.

The peripheral processes three divisions namely the ophthalmic , maxillary and mandibular nerve.

The ganglion is supplied by twigs from:1. Internal carotid. 2. Middle meningeal.3. Accessory meningeal arteries.4. By the meningeal branch of the

ascending pharyngeal artery.

largest cranial nerve. composed of small motor and large

sensory root. motor root supplies -muscles of

mastication and other muscles in the region.

sensory root supply-the skin of the entire face ,the mucous membrane of the cranial viscera and oral cavity , except for the pharynx and base of tongue.

Injury to ophthalmic nerve: There is a loss of corneal blink reflex.

‘shingles or zona ‘. acute viral infection. Caused by Varicella Zoster virus. extremely painful. characterized by inflammation of dorsal

root ganglion. vesicular eruptions of skin and mucous

membrane.

Trauma Malignancy dorsal root ganglion. Radiation – local x-ray radiation can also

be pre disposing factor. Immunosuppressive therapy-lead to

reactivation of virus.

Age and sex – Adults , no sex prediliction.

Prodromal symptoms- prodromal period of 2 to 4 days , shooting pain , paresthesia , burning and tenderness appears along the course of the affected nerve.

Appearance – unilateral vesicles on an erythematous base appear in clusters.

Corneal scarring Blindness Lesion of scalp Related to viral spread , neural damage ,

vasculitis and inflammatory immune response.

Known as herpes zoster ophthalmicus.

Clinical diagnosis – lesions along the nerve.

Fluorescent antibody testing-smear is obtained by scraping the lesion and staining it with the fluorescent conjugated monoclonal antibody.

PCR – used to detect viral antigen. Biopsy –it will show multinucleated giant

cells.

Recurrent herpes simplex infection –vesiculoerosive lesion in crops and clustures but not limited to a specific dermatome.

Herpangina – acute infection , palatal vault is affected.

Antiviral drug- ACYCLOVIR 800mg five times a daily.

Symptomatic treatment – antipyretic medication with anti-pruritics diphenhydramine can be administered to decrease itching.

Capsaicin – topical capsaicin 0.025% four times a day for temporary relief.

1. Hematoma2. Penetration of orbit – greater palatine

approach.3. Penetration of nasal cavity.

1. Hematoma – a)syringe in pterygoid plexus of veins.

b) intraoral hematoma within several minutes.

2. Mandibular anesthesia – located lateral to the PSA nerves.

Hematoma and discoloration.

Hematoma – across lower eyelid and tissues between it and infraorbital foramen.

Injury to eye.

Ischemia and necrosis of soft tissues. Hematoma – possible but rare due to the

density and the firm adherence of soft tissues.

Necrosis of soft tissues. Tender- interdental papilla between

maxillary incisors.

Trigeminal neuralgia - 5th cranial nerve. affects 2ND and 3RD division-exhibit a

trigger zone , stimulation of which initiates paroxysm of

pain.

The pain - brief facial tic or spasm. unilateral and lasts for few seconds to a

minute.

Unknown Initially thought to be of dental origin.

Older adults , seldom occurring before the age of 35 years.

Females are more commonly affected (3:2) .

Right side of the face is affected more (1.7 to 1).

searing , stabbing or lancinating type of pain,

Initiate- patient touches a “trigger zone” on the face.

‘tic douloureux’ -spasmodic contractions of facial muscles.

Early pain – termed as ‘pre-trigeminal neuralgia’ by MITCHELL

sometimes described as dull , aching or burning or resembling a sharp toothache.

As attack occurs -patient may clutch his face as if in terror of the dreaded pain.

The ‘trigger zones’- the vermillion border of the lips , the alae of the nose , the cheeks and around eyes.

In some cases it is not necessary that skin actually be touched to initiate the painful seizure; exposure to the strong breeze or simply the act of eating or smiling has been known to precipitate it.

1. Migraine2. Sinusitis3. Dental pain4. Tumors of nasopharynx5. Post herpetic neuralgia

Abrupt onset of pain with trigger point. Pain is extreme in nature with less

duration of time. Pain is localized to known distribution of

trigeminal nerve. Spontaneous remission can occur. Diagnostic nerve block.

1. CARBAMAZEPINE has a special effect on the paroxysmal pain.

dose – 100mg twice daily

2. DILANTIN- diphenylhydantoin , an anti-convulsant , 300-400mg per day

3. BACLOFEN – antispastic drug.4. COMBINATION THERAPY –

carbamezipine combined with dilantin.5. CLORAZEPAM- anti-epileptic drug

belonging to benzodiazepine.6. ANTI-INFLAMMATORY- indomethacin

and short course steroids.7. TRICHLOROETHYLENE INHALATION.

temporary relief

area where a nerve exits. neurolysis occurs distal to the site of

injection. Nerve regeneration occurs in 6 to 24

months for most patients.

If the injection in the ganglion Is successful then the anesthesia will last for 6 months to 1 year.

Generally -1-95% alcohol is used or 2-procaine or monocaine 2% , 3-chloroform 5% , 4-absolute alcohol 70% , 5- ringer lactate solution 23% can also

be used.