- incidence: 4.5 per 100,000 individuals
- characterised by excruciating paroxysms of pain in the lips, gums, cheek or chin (maxillary and mandibular branches, rarely ophthalmic branch)
- pain seldom last more than a few seconds or a minute or two
- may occur spontaneously or with speaking, chewing or smiling
- essential feature: objective signs of sensory loss cannot be demonstrated on examination
- symptoms result from ectopic generation of action potentials in pain sensitive afferent fibres of 5th cranial nerve roots just before it enters the lateral surface of the pons
- treatment: carbamazepine 100mg od increased gradually to maintenance dose of 200mg qid, alternative is oxcarbazepine 300-1200mg bd
- if medical treatment fails, consider microvascular decompression
4 comments:
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