Pharmacological and Surgical Treatment for Trigeminal Neuralgia a Review of the Literature

Pharmacological and Surgical Treatment for Trigeminal Neuralgia a Review of the Literature

Main Article Content

Edison Bernaola
Carlos Cava
José Robello
Atilio Santos
Jaime Rodríguez


Trigeminal neuralgia is the most common orofacial pain, with incidence levels that increase every year. Characterized by paroxysmal attacks of pain, brief, lancinating, stabbing, is considered one of the most painful conditions affecting patients. Drug therapy has been the gold standard for the management and control of this neuropathy, on the contrary, recent studies find wide drug resistance with history of neuralgia for many years, causing recurrence of the picture. That is why there is a need to establish a proper surgical planning, among which stands vascular decompression and percutaneous micro harmful methods such as retrogasserianas rhizotomies, chemical methods, such as injection of alcohol or glycerol in the oval hole, mental foramen, as an alternative to medical-pharmacological treatment, however, not all procedures reviewed in the literature indicate a continued success rate and further, the various adverse effects involving the implementation of each treatment should be considered.


Ariyawardana, A.; Pallegama, R.; Sitheeque, M. & Ranasinqhe, A. Use of single- and multi-drug regimens in the management of classic (idiopathic) trigeminal neuralgia: an 11-year experience at a single Sri Lankan institution. J. Investig. Clin. Dent., 3(2):98-102, 2012.

Bovaira, M.; Peñarrocha, M.; Peñarrocha, M. & Calvo, A. Conventional radiofrequency treatment in five patients with trigeminal neuralgia. Med. Oral Patol. Oral Cir. Bucal, 18(1):e76-80, 2013.

Broggi, G.; Ferroli, P. & Franzini, A. Treatment strategy for trigeminal neuralgia: a thirty years experience. Neurol. Sci., 29 Suppl., 1:79-82, 2008.

Campos, W. K. & Linhares, M. N. A prospective study of 39 patients with trigeminal neuralgia treated with percutaneous balloon compression. Arq. Neuropsiquiatr., 69(2A):221-6, 2011.

Chakravarthi, P. S.; Ghanta, R. & Kattimani, V. Microvascular decompression treatment for trigeminal neuralgia. J. Craniofac. Surg., 22(3):894-8, 2011.

Chole, R.; Patil, R.; Degwekar, S. S. & Bhowate, R. R. Drug treatment of trigeminal neuralgia: a systematic review of the literature. J. Oral Maxillofac. Surg., 65(1):40-5, 2007.

de Siqueira, S. R.; da Nóbrega, J. C.; Teixeira, M. J. & de Siqueira, J. T. Masticatory problems after balloon compression for trigeminal neuralgia: a longitudinal study. J. Oral Rehabil., 34(2):88-96, 2007.

de Siqueira, S. R.; da Nóbrega, J. C.; de Siqueira, J. T. & Teixeira, M. J. Frequency of postoperative complications after balloon compression for idiopathic trigeminal neuralgia: prospective study. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 102(5):e39-45, 2006.

Harries, A. M. & Mitchell, R. D. Percutaneous glycerol rhizotomy for trigeminal neuralgia: safety and efficacy of repeat procedures. Br. J. Neurosurg., 25(2):268-72, 2011.

Hossain, M. A.; Molla, M. R.; Akhter, M.; Sikder, M. A. & Haider, M. N. Comparative Study on Cryosurgery with Carbamazepine and Alcohol injection in Trigeminal Neuralgia. Bangladesh J. Med. Sci., 11(3):197-200, 2012.

Jellish, W. S.; Benedict, W.; Owen, K.; Anderson, D.; Fluder, E. & Shea, J. F. Perioperative and longterm operative outcomes after surgery for trigeminal neuralgia: microvascular decompression vs percutaneous balloon ablation. Head Face Med., 4:11, 2008.

Jiao, W.; Zhong, J.; Sun, H.; Zhu, J.; Zhou, Q. M.; Yang, X. S. & Li, S. T. Microvascular decompression for the patient with painful tic convulsif after Bell palsy. J. Craniofac. Surg., 24(3):e286-9, 2013.

Liu, C.; Zhou, Z. G.; Wang, P. L. & Han, W. Treatment of primary trigeminal neuralgia with radiofrequency thermogangliocoagulation: Report of 152 consecutive cases. Shanghai Kou Qiang Yi Xue, 14(1):94-6, 2005.

Liu, C.; Zhou, Z. G. & Yuan, C. Y. Treatment of primary trigeminal neuralgia with radiofrequency thermocoagulation: report of 648 consecutive cases. Shanghai Kou Qiang Yi Xue, 21(4):466-9, 2012.

McLeod, N. M.; Tekeli, K. M. & Cherivan, J. Trigeminal neuralgia: assessment and management by oral and maxillofacial surgeons in the United Kingdom. Br. J. Oral Maxillofac. Surg., 47(1):42-5, 2009.

Martin, W. J. & Forouzanfar, T. The efficacy of anticonvulsants on orofacial pain: a systematic review. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 111(5):627-33, 2011.

Montiel Mera, E. D. & Meneses Rodríguez, F. Tratamiento de la neuralgia trigeminal: empleo de las descompresiones vasculares. Rev. Neurol. Neurocir. Psiquiatr., 36(3):109-18, 2003.

Ngeow, W. C. & Nair, R. Injection of botulinum toxin type A (BOTOX) into trigger zone of trigeminal neuralgia as a means to control pain. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 109(3):e47-50, 2010.

Park, J. H.; Lee, S. H. & Kim, S. T. Pharmacologic management of trigeminal nerve injury pain after dental implant surgery. Int. J. Prosthodont., 23(4):342-6, 2010.

Peñarrocha, M.; Mora, E.; Bagán, J. V.; García, B. & Peñarrocha, M. Idiopathic trigeminal neuropathies: a presentation of 15 cases. J. Oral Mmaxillofac. Surg., 67(11):2364-8, 2009.

Reyes Velázquez, J. O.; Véjar Alba, I. & Rodríguez Andino, J. C. Tratamiento farmacológico de la neuralgia trigeminal con carbamacepina versus carbamacepina en combinación con meloxicam y vitaminas B1, B6 y B12. Med. Oral, 11(1):9-18, 2009.

Robaina, P. F. Neuralgia del Trigémino: Revisión del tratamiento médico y quirúrgico. Rev. Soc. Esp. Dolor, 15(4):248-56; 2008.

SECOM (Sociedad Española de Cirugía Oral y Maxilofacial); Granizo López, R. M. & López Davis, A. Cirugía Oral y Maxilofacial. 3ª ed. Madrid, Editorial Médica Panamericana, 2012. pp.280-2.

Tate, R.; Rubin, L. M. & Krajewski, K. C. Treatment of refractory trigeminal neuralgia with intravenous phenytoin. Am. J. Health Syst. Pharm., 68(21):2059-61, 2011.Toda, K. Operative treatment of trigeminal neuralgia: review of current techniques. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod., 106(6):788- 805, 2008.

Volcy, M.; Tepper, S. J.; Rapoport, A. M. & Sheftell, F. D. Botulinum toxin A for the treatment of greater occipital neuralgia and trigeminal neuralgia: a case report with pathophysiological considerations. Cephalalgia, 26(3):336-40, 2005.

Wang, Q. P. & Bai, M. Topiramate versus carbamazepine for the treatment of classical trigeminal neuralgia: a meta-analysis. C. N. S. Drugs, 25(10):847-57, 2011.

Weng, Z.; Zhou, X.; Liu, X.; Wei, J.; Xu, Q. & Yao, S. Perioperative pain in patients with trigeminal neuralgia undergoing radiofrequency thermocoagulation of the Gasserian ganglion. J. Craniofac. Surg., 24(4):1298-302, 2013.

Zhu, S.; Rong, Q.; Chen, S. & Li, X. Pterygopalatine fossa segment neurectomy of maxillary nerve through maxillary sinus route in treating trigeminal neuralgia. J. Craniomaxillofac. Surg., 41(7):652- 6, 2013.