Pathology · patient case question
Trigeminal neuralgia most commonly affects which divisions?
Patient case: Shingles, neuralgia and a toothache that is not one
demo: 62-year-old male
chief: Severe pain in the upper right teeth for three days, with no obvious dental cause.
history: Recent bereavement and poor sleep. Chickenpox as a child.
meds: None.
findings: All maxillary right teeth respond normally to pulp testing and are non-tender to percussion. Two days later a unilateral vesicular rash appears on the right cheek and hard palate, stopping abruptly at the midline. Separately, another patient describes brief, electric-shock facial pain triggered by shaving.
Show answer and explanation
Correct answer: A. V2 and V3
- A. Correct. The maxillary and mandibular divisions are affected in the great majority of cases, which is why these patients so often present to a dentist first and may undergo unnecessary treatment. V1 alone is involved in only about 4 percent. The pain is brief, lancinating and triggered by light touch, chewing, shaving or cold air.
- B. V1 involvement is uncommon, so this pairing is not the typical pattern.
- C. The same objection applies; V1 is the least affected division.
- D. Isolated V1 neuralgia is rare and should prompt investigation for a secondary cause.
Note: Bilateral trigeminal neuralgia, or onset in a young patient, raises the possibility of multiple sclerosis and warrants imaging.