How is trigeminal neuropathy differentiated from idiopathic trigeminal neuralgia (TN)?

Updated: Jul 11, 2019
  • Author: Manish K Singh, MD; Chief Editor: Robert A Egan, MD  more...
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Trigeminal neuropathy and atypical trigeminal neuralgia

Trigeminal neuropathy is also a consideration in the evaluation of trigeminal neuralgia. This condition presents as a constant, unilateral, often mild facial pain with prominent sensory loss. It is nontriggerable and unremitting, and it may be either symptomatic or idiopathic. By contrast, as previously discussed, idiopathic trigeminal neuralgia presents as episodic, unilateral, lancinating, triggerable, often shocklike facial pain with pain-free intervals.

To further complicate diagnostic matters, the clinician may encounter atypical trigeminal neuralgia, a syndrome that overlaps trigeminal neuralgia and trigeminal neuropathy. This syndrome consists of constant pain that episodically intensifies. According to Burcheil, these patients experience both lancinating triggered pain and a baseline, constant, dull, and throbbing discomfort. [2] The atypical form may occur in up to 5% of people after facial surgery or significant trauma and in 1-5% after the removal of impacted teeth. In the experience of many neurosurgeons, atypical trigeminal neuralgic pain results from lesions or injuries of the trigeminal nerve root distal to the route entry zone but with even greater compression than found in the idiopathic form of trigeminal neuralgia.

In contrast to trigeminal neuropathy, whether typical or atypical, atypical facial pain is distinguished by the extension of discomfort beyond the distribution of the fifth cranial nerve and by the frequent lack of lancinating pain and triggers.

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