Introduction
The trigeminal nerve is a fifth of the cranium (skull involving the brain) out of twelve nerves. The trigeminal nerve has three branches. It supplies nerves to the face. It needs to be blocked due to some pain-relieving factors. The trigeminal is the largest of all cranial nerves. This topic explains the trigeminal nerve, its branches, why it needs to be blocked, the procedure to block the trigeminal nerve, and its complications.
What Is the Trigeminal Nerve?
The human nervous system has twelve pairs of cranial nerves (nerves in the brain). The trigeminal nerve is the fifth cranial nerve of the brain. It is also paired like other cranial nerves. One nerve moves on the right and the other on the left side of the face. A single trigeminal nerve has three branches; ophthalmic, maxillary, and mandibular branches covering half of the face. The other trigeminal nerve covers the other half of the face with its three branches. The trigeminal nerve can sense touch, pain, and temperature on the face and send nerve messages to the brain. It supplies nerves to the face including eyeballs, eyelids, lips, upper jaw, and lower jaw. It is a mixed nerve because it has two types of neurons: motor (messages from the brain to the site) and sensory (messages from the site to the brain). But primarily it is sensory.
What Are the Branches of the Trigeminal Nerve?
The trigeminal nerve is needed because it is one of the primary nerves of the face. It helps us to bite, chew and swallow food. It helps in feeling the things on touch or in pain. There are three branches of the trigeminal nerve. The main trunk of the trigeminal nerve splits into three at the trigeminal ganglion (junction of nerves). The branches are:
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The Ophthalmic Branch - Ophthalmic branch of the trigeminal nerve is the smallest of the three divisions. It sends nerves to the upper parts of the face and forehead and head, upper eyelids, nose side, eyeball, nose sinus, and lacrimal gland.
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The Maxillary Branch - The maxillary branch is a pure motor branch that carries nerves to the facial areas from the brain. This nerve supplies to the middle of the face and involves the upper jaw, cheeks, lower eyelids, nose, gums of the upper teeth, and upper lip.
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The Mandibular Branch - The mandibular branch is the largest of all the divisions. It carries nerve supply to the lower part of the face involving the chin, lower jaw, gums of lower teeth, and lower lip. It is the only branch that is motor and sensory. It helps us to bite, chew and swallow.
What Is the Trigeminal Nerve Block?
The trigeminal nerve block blocks the nerve messages from areas of the trigeminal nerve supply to the brain. It is done by injecting the medication of anesthesia. This medicine relieves facial pains and numbs the areas of the eyeball, eyelid, upper jaw, lower jaw, and upper and lower lips. A radiologist or an anesthesiologist even in an outpatient service can perform a trigeminal nerve block. Outpatient sources can be a clinic, a health center, or a radiology unit where it can be performed.
What Are the Indications of a Trigeminal Nerve Block?
Trigeminal nerve block numbs the areas, and thus, the feeling of pain gets stopped. Indications of trigeminal nerve block are:
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Trigeminal neuralgia (chronic pain affecting the trigeminal nerve).
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Herpes zoster infections (reactivation of chickenpox in adults).
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Facial pain due to unknown reasons.
How Is Trigeminal Nerve Block Performed?
The doctor initially starts the process by relaxing the patient. A thin needle is used to insert anesthesia on the side of the face and the anesthetic is injected. Next, with the help of X-ray guidance, the doctor will insert a second needle for steroids. It is not a lengthy procedure and takes just thirty minutes. The patient is relieved from pain soon. Usually, doctors use local anesthesia with Lidocaine or Bupivacaine but some use sedatives along with it like Midazolam or Fentanyl.
What to Expect After a Nerve Block?
The effect of an anesthetic relieves the pain of the patients. As soon as anesthesia starts acting, the patient's pain is relieved. However, when the drug wears off, the pain begins again. So, doctors use steroids for longer-term relief of pain.
Numbness is felt over the face within a few minutes after injecting anesthesia into the nerve. The purpose of the injection is to relieve the pain, sometimes the pain can gain permanent relief because of a temporary nerve block. The patient can generally work after the treatment the next day. And if no sedative is used, the patient can go home alone. But regular follow-ups are required with a doctor.
What Are Complications Related to Trigeminal Nerve Block?
Complications to trigeminal nerve block are:
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Difficulty in biting or chewing food.
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Bruising.
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Swelling.
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Soreness.
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Infection.
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Bleeding.
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Nerve damage.
How Can Trigeminal Nerve Blocks Treat Trigeminal Neuralgia Patients?
Trigeminal neuralgia is a severe pain condition involving the face and jaw. The patient can not touch his cheeks, or the pain can make him unable to brush his teeth. Trigeminal neuralgia cases require both medication and surgery. But initially, a trigeminal nerve block is given to relieve the patient's pain and to relax the patient. As long as the anesthetic effect is present, the pain in the affected areas may get relieved.
Is It Safe to Have a Trigeminal Nerve Block?
The trigeminal nerve block is safe to perform on the requirement of facial pain relief. It helps in relieving the pain of the patient immediately upon use. But if it is used repeatedly, then its effectiveness decreases.
Conclusion
The trigeminal nerve block is performed mainly to control the patient's pain spreading over the face. It is indicated in cases of trigeminal neuralgia, herpes zoster infection, and migraines. The trigeminal nerve block starts work immediately on use as patients get relaxed and feel painless over the face. A radiologist or an anesthesiologist performs it in outpatient sources.
