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Nevralgia do nervo trigémeo
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Advisor(s)
Abstract(s)
O trigémeo, quinto e maior entre os nervos cranianos, a partir do gânglio de Gasser é composto por três ramos que desempenham papel crucial na transmissão da sensibilidade nos 2/3 anteriores de cabeça e face. A nevralgia do trigémeo é uma síndrome neuropática crónica, intensamente dolorosa e paroxística. O paciente sofre com dores intensas e espontâneas na face, como queimaduras em forma de pontadas. Comportamentos diários como mastigar ou toques leves nos chamados “trigger points” podem desencadear esses
episódios.
Etiologicamente, caracteriza-se como dor idiopática, clássica e secundária, levando a desmielinização e desregulação do canal de sódio no voltagem-dependente na membrana do nervo. É crucial que os médicos dentistas possuam conhecimento amplo para diagnosticar corretamente e adotar tratamentos adequados. A sintomatologia da nevralgia do trigémeo frequentemente assemelha-se a outras patologias faciais ou orais, como a dor dentária associada a pulpites e outras patologias, nomeadamente as tumorais.
Os médicos dentistas em geral têm diversos meios à sua disposição, desde a história clínica até ao tratamento final, incluindo a ressonância magnética como complemento no diagnóstico clínico.
No tratamento, a farmacoterapia de primeira linha inclui antiepiléticos como a carbamazepina, analgésicos, relaxantes musculares e antidepressivos tricíclicos. Nos pacientes resistentes à terapêutica médica, podem optar pela terapia invasiva, nomeadamente a cirúrgica, como técnicas percutâneas do gânglio de Gasser, fenolização e radiofrequência do gânglio de Gasser e descompressão microvascular. A “gamma
knife” também é uma opção.
O objetivo desta dissertação é definir a nevralgia do trigémeo, abordando quadros clínicos, fatores predisponentes, incidência na população e os aspectos do diagnóstico e tratamento.
The trigeminal, fifth and largest among the cranial nerves, from Gasser's ganglion is composed of three branches that play a crucial role in transmitting sensitivity in the anterior 2/3 of the head and face. Trigeminal neuralgia is a chronic, intensely painful and paroxysmal neuropathic syndrome. The patient suffers from intense and spontaneous pain in the face, like burning in the form of stitches. Daily behaviors such as chewing or light touching so-called “trigger points” can trigger these episodes. Etiologically, it is characterized as idiopathic, classic and secondary pain, leading to demyelination and dysregulation of the voltage-gated sodium channel in the nerve membrane. It is crucial that dentists have extensive knowledge to correctly diagnose and adopt appropriate treatments. The symptoms of trigeminal neuralgia often resemble other facial or oral pathologies, such as dental pain associated with pulpitis and other pathologies, particularly tumors. Dentists in general have several means at their disposal, from clinical history to final treatment, including magnetic resonance imaging as a complement to clinical diagnosis. In treatment, first-line pharmacotherapy includes antiepileptics such as carbamazepine, analgesics, muscle relaxants and tricyclic antidepressants. In patients resistant to medical therapy, they can opt for invasive therapy, namely surgery, such as percutaneous techniques of the Gasser's ganglion, phenolization and radiofrequency of the Gasser's ganglion and microvascular decompression. The “gamma knife” is also an option. The objective of this dissertation is to define trigeminal neuralgia, addressing clinical conditions, predisposing factors, incidence in the population and aspects of diagnosis and treatment.
The trigeminal, fifth and largest among the cranial nerves, from Gasser's ganglion is composed of three branches that play a crucial role in transmitting sensitivity in the anterior 2/3 of the head and face. Trigeminal neuralgia is a chronic, intensely painful and paroxysmal neuropathic syndrome. The patient suffers from intense and spontaneous pain in the face, like burning in the form of stitches. Daily behaviors such as chewing or light touching so-called “trigger points” can trigger these episodes. Etiologically, it is characterized as idiopathic, classic and secondary pain, leading to demyelination and dysregulation of the voltage-gated sodium channel in the nerve membrane. It is crucial that dentists have extensive knowledge to correctly diagnose and adopt appropriate treatments. The symptoms of trigeminal neuralgia often resemble other facial or oral pathologies, such as dental pain associated with pulpitis and other pathologies, particularly tumors. Dentists in general have several means at their disposal, from clinical history to final treatment, including magnetic resonance imaging as a complement to clinical diagnosis. In treatment, first-line pharmacotherapy includes antiepileptics such as carbamazepine, analgesics, muscle relaxants and tricyclic antidepressants. In patients resistant to medical therapy, they can opt for invasive therapy, namely surgery, such as percutaneous techniques of the Gasser's ganglion, phenolization and radiofrequency of the Gasser's ganglion and microvascular decompression. The “gamma knife” is also an option. The objective of this dissertation is to define trigeminal neuralgia, addressing clinical conditions, predisposing factors, incidence in the population and aspects of diagnosis and treatment.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Nevralgia do trigémeo Fatores predisponentes Diagnóstico Tratamento