Pathogenesis of Trigeminal Neuralgia

Since Nicolaus Andre,* of Versailles, described in 1756 paroxysmal facial pain under the term douloureux, the literature on this subject has become enormous; yet even today the fundamental cause and pathophysiologic mechanism underlying trigeminal neuralgia remain obscure. Various theories attempting to explain the nature of trigeminal neuralgia will be reviewed first, before we discuss our own concept of the disease. The mechanism responsible for tic douloureux has been localized in the trigeminal pathway anywhere from the facial skin to the endings of thalamocortical fibers; various causative factors have been incriminated, such as mechanical pressure, infectious-inflammatory lesions, and organic or functional vascular changes. Harris2(1926) considered an infectious neuritis of the trigeminal nerve endings in the region of the maxilla or mandible as the main cause. He assumed this process to be mostly dental in origin, but occasionally secondary to sinusitis. Rowbotham6(1954) found perineural fibrosis of the