The trigerminal nerve is involved in various pathological effect

Clinical observations and experimental examinations have proved that not only central formations but also peripheral structures participate in the formation of the clinical symptomatic complex of the trigeminal nerve, which means that not only the nerve but the whole nerve has been infected. Trigeminal nerve system should refer to all anatomic-functional formations that participate in the activity of the sensory and kinetic root of the trigeminal nerve, under normal and several pathological conditions.

Therefore, rough conducts in dental-maxillary field, for example during tooth extraction, may cause pathological push from the zone of peripheral neural structures (voluntary and involuntary) in stem- subcortical formations with further mutation of their regular function and the creation of pathological effects which lead to development of pain syndrome.

Trigeminal neuralgia (face pain)

Development of trigeminal neuralgia (face pain), caused by damage of the neural tubes, can also be provoked by vascular disorders in the area of peripheral part of the trigeminal nerve system. Due to ageing and, in particular, due to developing arteriosclerosis and hypertension, there are sclerotic mutations in vascula and hereafter there is deformation of capillary vessels, which with capillary venules are overfilled with blood and wall of extensive veins and venules are distorted into saccate diverticulum. All these lead to increase of venous link capacity of the microcirculation network up to 2-4 times.

Modern diagnosis methods detect the center of damages not only to the cores of cerebral thalamus but also in the structures of brain stem, in subcortical matter white and the cerebral cortex. Causes of damage in the peripheral part of the nerve system are different: metabolic mutations, injuries, poisonings (intoxication), infectious processes, mechanic contusions (Kukushkin ML, 2005).

Modern approaches of pain syndrome etiology

Therefore, modern approach for pain syndrome etiology in the trigeminal nerve system may be expressed as follows: the role of general vascular and infectious (contagious) diseases is not very important and probably local inflammatory processes that lead to pressure of the nerve play the leading role, while several mechanic factors may affect neurofibers at extracranial and intracranial level.

The “portal” theory

The “portal” theory (Melzack R., Wall P., 1965 - 1981) predicates that neuronal mechanism that is located in posterior spinal cord horns and the spinal trigeminal nucleus functions as gates, which can increase or decrease flow of neural pushes that come from peripheral fibers to the Central Nervous System. Damages of peripheral nerves or structures of pain receptors of the central link may cause disorder to the Central Nervous System in relation to control mechanism of neurons irritability, as well as they may destroy their part in spinal cord and cerebral structures. Destruction of neurons is caused due to excessive depletion (ejection) within synaptic cleft of salt glutamate and neurokinins, which have cellulotoxic effect. Developed intrasynaptic degradation in posterior spinal cord horns, thalamus cores and corporal-sensory cortex of big hemispheres contributes to the stable depolarization of neurons and the increase of their irritability. At the same time there is shortage of opiate, glycine and (illegible word) suppression, which consequently leads to suppression of neurons and creation of long auto-supported activity. The aforementioned reformat leads to pain expression which is not affected by any irritants. For the previously mentioned reasons and in order to cure such pathology, it is necessary to have means that reassure repression of pathological activity in peripheral pain receptors and super-irritative neurons of the Central Nervous System (Kukushkin ML, 2005).

How can pain be confronted?

Confrontation of pain remains one of the biggest problems in medicine so far. All existing and re-released analgesics have several side effects and a lot of deficits. One direction in creation of rational treatment of pain syndromes is the use of non- pharmaceutical methods of anesthesia (analgesia).

Acupuncture (reflexotherapy) in auricle conch in several cases of functional disorders, including the case of interruption of pain syndrome and several cases of emotional stress, as well as the ability to implement it as diagnostic system, supplementing to the already known clinical diagnostic methods, becomes more and more popular.

We recommend an anesthesia (analgesia) method but with an anatomically justifiable way of selecting main crucial points on the auricle in order to execute reflexotherapy and by the use of an original electronic device.

The invention of a new electro-acupuncture device for pain treatment

Analgesia method related to auricle includes selection of anatomical - topographical points of acupuncture which are the most effective for dealing with long-lasting pain. Several charts and diagrams were stipulated with regard to auricle related zones and a special electro-acupuncture device was manufactured, related to stimulation of auricles.

What does the device consist of?

The device is a generator synchronized to two channels. In the one channel, we have generation of sinusoidal power with specific frequency, which is discharged in three electrodes and in the other channel we have formation of differential power-pulses with other frequency. Output current of channels shall be regulated according to the circuit resistance.

Operation

The device operates as follows:

The generator (ELTRON MASTER) creates impulsions of specific frequency which, through electronic switch, are led to two adjustable digital signal generators that are controlled through digital frequency regulator according to the power amount that goes through each circuit of every generator and is measured by power quantity meters. Generated digital signals go to digital - analog modifiers and at their output we have formation of base impulsions. In the first channel, base impulsions come into the integrator at the output of which sine-wave direct current is produced due to change in base impulsions frequency. In the second channel, base impulsions go into base impulsions at the output of which we have the creation of differential electro-pulses with pre-definite shape.

In order to have analgesic effect, the device starts operating automatically during the first 24 hours: 3 times for 30 minutes every 8 hours, the second 24 hours: 2 times for 30 minutes every 12 hours and the following days: 1 time for 30 minutes, accordingly to decrease of pain syndrome. Total operation time of the device is 5 to 10 days (24 hours).

Therapeutic results

Such suggested treatment and the relevant device were used by us to 37 patients (between 30 and 73 years old) in order to stop pain syndromes in oral and neurological practice (neuralgia of trigeminal nerve, odontogenic neuralgias, dentalgias of neuroplex, as well as in maxillary-facial surgery and pre-operative and post- operative period (genyantrum surgery, surgery for placement of implants, fractures of upper and lower jaw). Observation of all patients was conducted for one year. No deteriorations or implications were detected (one application-order for studying the device and the method was submitted).

Auricular reflexotherapy

Reflexotherapy related to auricle is better than the corporal reflexotherapy, in particular regarding analgesia issues. At first, modern perceptions for analgesia mechanisms are based on anatomical, physiologic and phylogenetic special characteristics of the auricle and the total number of impulses that such area receives (Durinian RA, 1982).

Why is it highly effective?

High effectiveness in points of auricle during interruption of pain syndromes is explained due to existence of direct relations between the trigeminal system and basic structures of cerebral anti-pain receptors. Acupuncture (reflexotherapy) shall cause repression of focal forces in caudal core of the trigeminal simplex (Dolgkich BG 1983, 1985 Resetnial BK, 1986).

The relations of centripetal fibers of auricle with reticular systems, sub-thalamus system, thalamus-cortical and limbic system - and their interaction with centripetal impulses from inner organs and tegmen of the body in all organization levels of cerebral sensory systems - reassure such good results of acupuncture in auricle zones. Such interaction in the form of centripetal interruptions in several levels of the Central Nervous System shall define how sensibility of most of physical organs and corporal areas is reflectively represented on the auricle. Sensory projections of face and head correspond to the ear berry and the auricle antitragus.

Auricle projections that reflect the operations of stem structures of the Central Nervous System (reticulate substance, sub-thalamus) are mainly concentrated on auricle antitragus and thalamus-cortical projections are mainly located on the ear berry.

Cortical somaticovisceral zones located on the auricle may be used in cases of pathology of inner organs. Stimulation of thalamus zone may be used for general results of most cases related to the auricle with regard to reflexotherapy and especially at analgesia.

Auricle zones of most people (almost 90%) are reflectively and homolaterally related to with several parts of the body.

Example

Patient “B”, 58 years old, has been hospitalized in the Clinic GOU VPO Tverskaya GMA in the city of Tver with symptoms of intense pain in the left area of lower jaw. The patient observed pain access which lasted from 20 to more than 40 minutes. Factors that caused the aforementioned access were chilling and physical fatigue.

History:

Two years ago the patient visited our clinic due to dental caries in her 36th tooth. She received respective treatment (capping). However, some days later she ached in the area of lower jaw dentale. Pains were continuous and permanent and there were pain accesses that lasted from 20 to 40 minutes. Next she underwent pulpectomy of the 36th tooth and endodental treatment. One month later, she suffered again from pains and she was addressed for neurological examination in her residency. Diagnosis: III class trigeminal nerve neuralgia.

The implemented treatment with exclusion of FINLEPSIN and NOVOCAIN did not have positive results. The patient was addressed in oral clinic in the city of Tver and upon being examined the following were diagnosed: odontogenic III class trigeminal nerve neuralgia at the left side under exacerbation.

Treatment

The patient was recommended to be treated with use of electro- stimulating device, place in the area of left ear. The initial device outline had been connected to the main points according to the attached diagram. Selection of symptomatic points was done according to the principles of anatomic-topographic subject and corresponded to the points of stipulated schemes (Tabeeva D.M, 1982, Matseret E.L, 1986). The recommended device operated for 7 days according to the stipulated operation program. Pains disappeared within 20 minutes upon onset of stipulation and never appeared again. For one year no deterioration of pain access was detected. Final outcomes prove the effectiveness of the recommended treatment and device.

Extended clinical examination, personal approach and assessment of all complex causal and pathogenetic interactions provides the ability to successfully use auricle electro-stipulation as a method that is pathogenetically justifiable for termination of long lasting pain syndromes.