The Trigeminal Trophic Syndrome: An Unusual Cause of Face Pain, Dysaesthesias, Anaesthesia and Skin/Soft Tissue Lesions

Cephalalgia ◽  
2008 ◽  
Vol 28 (9) ◽  
pp. 980-985 ◽  
Author(s):  
I Garza
Keyword(s):  
Trigeminal Nerve ◽  
Age Of Onset ◽  
Case Series ◽  
Infraorbital Nerve ◽  
Face Pain ◽  
Case Series Report ◽  
The Face ◽  
Trigeminal Trophic Syndrome ◽  
Record Review ◽  
Retrospective Medical Record Review

The trigeminal trophic syndrome is an unusual consequence of trigeminal nerve injury that results in facial anaesthesia, dysaesthesia and skin ulceration. Limited knowledge is available. The aim of this study was to increase the knowledge of this syndrome by performing a retrospective medical record review and case series report. Fourteen cases were identified. The female : male ratio was 6:1. Mean age of onset was 45 years (range 6-82). The cause was iatrogenic in most. Latent period to onset ranged from days to almost one decade. The majority ( n = 12) had bothersome dysaesthesias. Most ( n = 9) self-manipulated the face; a third ( n = 5) did not. Most ulcers affected the second trigeminal division, mainly in the infraorbital nerve distribution. Neuropathic and/or neuralgic facial pain occurred in 50% ( n = 7). Pain intensity was severe in most (n = 6). Gabapentin gave relief in two. To conclude, trigeminal trophic syndrome follows injury to the trigeminal nerve or its nuclei. For unclear reasons, most ulcerations follow infraorbital nerve distribution. Self-manipulation may contribute to ulcer development rather than being required. Gabapentin may help pain.

scholarly journals Selective Denervation of the Facial Dermato-Muscular Complex in the Rat: Experimental Model and Anatomical Basis

2021 ◽  
Vol 15 ◽  
Author(s):  
Vlad Tereshenko ◽  
Dominik C. Dotzauer ◽  
Udo Maierhofer ◽  
Christopher Festin ◽  
Matthias Luft ◽  
...  
Keyword(s):  
Trigeminal Nerve ◽  
Cortical Plasticity ◽  
Neuromuscular Junctions ◽  
Cranial Nerves ◽  
Experimental Models ◽  
Infraorbital Nerve ◽  
Immunofluorescent Staining ◽  
Surgical Model ◽  
Anatomical Basis ◽  
The Face

The facial dermato-muscular system consists of highly specialized muscles tightly adhering to the overlaying skin and thus form a complex morphological conglomerate. This is the anatomical and functional basis for versatile facial expressions, which are essential for human social interaction. The neural innervation of the facial skin and muscles occurs via branches of the trigeminal and facial nerves. These are also the most commonly pathologically affected cranial nerves, often requiring surgical treatment. Hence, experimental models for researching these nerves and their pathologies are highly relevant to study pathophysiology and nerve regeneration. Experimental models for the distinctive investigation of the complex afferent and efferent interplay within facial structures are scarce. In this study, we established a robust surgical model for distinctive exploration of facial structures after complete elimination of afferent or efferent innervation in the rat. Animals were allocated into two groups according to the surgical procedure. In the first group, the facial nerve and in the second all distal cutaneous branches of the trigeminal nerve were transected unilaterally. All animals survived and no higher burden was caused by the procedures. Whisker pad movements were documented with video recordings 4 weeks after surgery and showed successful denervation. Whole-mount immunofluorescent staining of facial muscles was performed to visualize the innervation pattern of the neuromuscular junctions. Comprehensive quantitative analysis revealed large differences in afferent axon counts in the cutaneous branches of the trigeminal nerve. Axon number was the highest in the infraorbital nerve (28,625 ± 2,519), followed by the supraorbital nerve (2,131 ± 413), the mental nerve (3,062 ± 341), and the cutaneous branch of the mylohyoid nerve (343 ± 78). Overall, this surgical model is robust and reliable for distinctive surgical deafferentation or deefferentation of the face. It may be used for investigating cortical plasticity, the neurobiological mechanisms behind various clinically relevant conditions like facial paralysis or trigeminal neuralgia as well as local anesthesia in the face and oral cavity.

scholarly journals Transcutaneous trigeminal nerve stimulation modulates the hand blink reflex

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Beniamina Mercante ◽  
Nicola Loi ◽  
Francesca Ginatempo ◽  
Monica Biggio ◽  
Andrea Manca ◽  
...  
Keyword(s):  
Median Nerve ◽  
Trigeminal Nerve ◽  
Nerve Stimulation ◽  
Blink Reflex ◽  
Infraorbital Nerve ◽  
Hand Position ◽  
Median Nerve Stimulation ◽  
Trigeminal Nerve Stimulation ◽  
Before And After ◽  
The Face

AbstractThe hand-blink reflex (HBR) is a subcortical response, elicited by the electrical stimulation of the median nerve, whose magnitude is specifically modulated according to the spatial properties of the defensive peripersonal space (DPPS) of the face. For these reasons, the HBR is commonly used as a model to assess the DPPS of the face. Little is known on the effects induced by the activation of cutaneous afferents from the face on the DPPS of the face. Therefore, we tested the effect of non-painful transcutaneous trigeminal nerve stimulation (TNS) on the amplitude of the HBR. Fifteen healthy participants underwent HBR recording before and after 20 min of sham- and real-TNS delivered bilaterally to the infraorbital nerve in two separate sessions. The HBR was recorded bilaterally from the orbicularis oculi muscles, following non-painful median nerve stimulation at the wrist. The HBR amplitude was assessed in the “hand‐far” and “hand‐near” conditions, relative to the hand position in respect to the face. The amplitudes of the hand-far and hand-near HBR were measured bilaterally before and after sham- and real-TNS. Real-TNS significantly reduced the magnitude of the HBR, while sham-TNS had no significant effect. The inhibitory effect of TNS was of similar extent on both the hand-far and hand-near components of the HBR, which suggests an action exerted mainly at brainstem level.

A Variation of the Infraorbital Nerve

2010 ◽  
Vol 67 (3) ◽  
pp. onsE315-onsE315 ◽  
Author(s):  
R. Shane Tubbs ◽  
Marios Loukas ◽  
William R. May ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Trigeminal Nerve ◽  
Clinical Presentation ◽  
Practical Importance ◽  
Pterygopalatine Fossa ◽  
Infraorbital Nerve ◽  
Nerve Branch ◽  
Male Specimen ◽  
Maxillary Nerve ◽  
Pterygoid Plate ◽  
The Face

Abstract OBJECTIVE: We report the case of a seemingly rare variation of a branch of the trigeminal nerve. This unusual finding is of practical importance to the neurosurgeon because ablation of this nerve(s) in such a case would require modification of technique. The existence of a bifurcated infraorbital nerve is also relevant for application of local anesthesia to portions of the face innervated by the maxillary nerve. CLINICAL PRESENTATION: During cadaveric dissection of the face of a male specimen, 2 branches of the infraorbital nerve were identified emanating onto the face. The 2 branches entered separate osseous canals within the orbit to emerge via 2 infraorbital foramina. INTERVENTION: The unusual variation of the trigeminal nerve branch in the reported case necessitates a change in the way in which the nerve is blocked clinically. A common practice involves blocking the infraorbital nerve as it emerges from the infraorbital foramen. The needle is aimed superiorly, posteriorly, and slightly laterally; however, to provide adequate anesthesia to both branches of the infraorbital nerve, as reported here, a needle can be inserted between the zygomatic arch and the notch of the mandible in the pterygopalatine fossa. After the needle contacts the lateral pterygoid plate, it is withdrawn slightly and angled both superiorly and anteriorly to pass into the pterygopalatine fossa. CONCLUSION: Although apparently uncommon, such derangement of the infraorbital nerve should be kept in mind by surgeons during surgical procedures in the region for treatment of various disorders including trigeminal neuralgia.

Hyperoxic myopia: a case series of four divers

2020 ◽  
pp. 261-265
Author(s):  
Jonathan W. Brügger ◽  
Glenn A. Rauscher ◽  
John P. Florian ◽  
Keyword(s):  
Hyperbaric Oxygen ◽  
Prolonged Exposure ◽  
Case Series ◽  
Oxygen Toxicity ◽  
Hyperbaric Oxygen Treatment ◽  
Subjective Data ◽  
Residual Symptoms ◽  
Oxygen Treatment ◽  
Blurry Vision ◽  
Record Review

Hyperoxic myopia is a phenomenon reported in individuals who have prolonged exposure to an increased partial pressure of oxygen (PO2) and subsequently have a myopic (nearsighted) change in their vision. To date, there are numerous accounts of hyperoxic myopia in dry hyperbaric oxygen treatment patients; however, there have been only three confirmed cases reported in wet divers. This case series adds four confirmed cases of hyperoxic myopia in wet divers using 1.35 atmospheres (ATM) PO2 at the Navy Experimental Diving Unit (NEDU). The four divers involved were the first author’s patients at NEDU. Conditions for two divers were confirmed via record review, whereas the other two divers were diagnosed by the first author. All subjects were interviewed to correlate subjective data with objective findings. Each subject completed five consecutive six-hour hyperoxic (PO2 of 1.35 ATM) dives with 18-hour surface intervals. Each individual was within the U. S. Navy Dive Manual’s standards for general health. Visual acuity was measured prior to diving. Within three to four days after diving, the individuals reported blurry vision with an associated myopic refraction shift. Each diver had spontaneous resolution of his myopia over the next two to three weeks, with no significant residual symptoms. The divers in this case series were exposed to an increased PO2 (1.35 ATM for 30 hours over five days), a lesser exposure than that in other reports of hyperoxic myopia in wet divers diagnosed with hyperoxic myopia (1.3-1.6 ATM for 45-85 hours in 12-18 days). Furthermore, this pulse of exposure was more concentrated than typically seen with traditional hyperbaric oxygen therapy. Hyperoxic myopia continues to be a risk for those conducting intensive diving with a PO2 between 1.3-1.6 ATM. Additional investigation is warranted to better define risk factors and PO2 limits regarding ocular oxygen toxicity.

TRIGEMINAL PROJECTIONS IN THE RETICULAR FORMATION OF THE PONS IN THE CAT

1962 ◽  
Vol 40 (1) ◽  
pp. 7-12
Author(s):  
J. M. Langlois ◽  
Guy Lamarche
Keyword(s):  
Reticular Formation ◽  
Trigeminal Nerve ◽  
Unit Activity ◽  
Functional Organization ◽  
Pontine Reticular Formation ◽  
Recording Unit ◽  
Spatial Convergence ◽  
The Face ◽  
High Degree ◽  
Stimulation Of

The projections of the trigeminal nerve in the pontine reticular formation of the cat have been investigated by recording unit activity, after physiological stimulation of the face, in 30 "encéphales isolés" preparations. No somatotopical arrangement was found but a high degree of spatial convergence onto pontine reticular units exists and a certain degree of functional organization was observed.

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