A Child with Trigeminal Neuralgia

Abstract

Trigeminal neuralgia (TN) has been seldom described in children and adolescents. The clinical course of a 14-year-old girl who rapidly developed TN following mandibular trauma is reported. Her symptoms evolved in a few days from classical TN without concomitant persistent facial pain to classical TN with concomitant persistent facial pain. According to the ICHD-3 beta, the patient ultimately suffered from the subform 13.1.2.3 painful posttraumatic trigeminal neuropathy, where unilateral facial or oral pain follows trauma to the trigeminal nerve, with other symptoms and/or clinical signs of trigeminal nerve dysfunction. Neurological examination showed hypoesthesia in the distribution of the third division of the trigeminal nerve, which, as stated by the ICHD-3 beta, always indicates axonal damage. Nevertheless, thorough imaging disclosed no cerebral or mandibular abnormalities. The symptomatology improved gradually with carbamazepine then oxcarbazepine therapy. Treatment improved symptoms in reverse order of appearance. TN has a similar presentation in the adult and pediatric populations, characterized by intermittent lancinating pain confined to the distribution of the trigeminal nerve, usually on one side of the face. It remains a clinical diagnosis made on the basis of pain character, time course, distribution, triggers, and response to medication. Medical management constitutes the first avenue of treatment for children with trigeminal neuralgia, carbamazepine, being the first-line medication. The literature on surgical treatment of pediatric onset TN remains scarce. Preliminary results suggest that microvascular decompression may be performed with good pain relief and minimal side effects in the pediatric population.