Trigeminal nerve examination

According to the pathogenesis of trigeminal neuralgia, it can be divided into two types: secondary trigeminal neuralgia and primary trigeminal neuralgia. Secondary trigeminal neuralgia is often caused by tumors. The contents of trigeminal nerve examination mainly include exercise and feeling. And reflection in three aspects. Trigeminal neuralgia can be divided into primary and secondary. The secondary trigeminal neuralgia is the most common cause of tumors, and there are more clinically positive signs. Therefore, in addition to general investigation, the nervous system should be thoroughly examined. Basic Information Specialist classification: neurological examination classification: neuroelectrophysiology Applicable gender: whether men and women apply fasting: not fasting Tips: Maintain a normal diet and schedule. Don't be too nervous, actively cooperate with the doctor. Normal value 1, motor function check: bilateral sacral and jaw symmetry, no muscle atrophy. 2, facial sensation check: the left and right sides of the face feel consistent inspection, pain and touch barrier. Clinical significance Abnormal results: The items examined were different from the standard or showed a positive reaction indicating a lesion in the central nervous system of the trigeminal nerve. 1, motor function check: trigeminal motor nucleus is dominated by bilateral cortex, obvious side of the masticatory tendon suggestive of karyotype or subnuclear lesions, and often the side of the masticatory muscles of the muscle atrophy. Bilateral cortical medullary tendon lesions caused this lateral stenosis, with severe bilateral masticatory tendon accompanied by hypertrophy of the mandibular reflex. 2, facial sensation examination: facial pain, temperature and touch should be peripheral damage when the obstacle occurs simultaneously, and can occur in any of the three branches of the trigeminal nerve, only the pain, temperature sensation, and the sense of touch, It is a central lesion, its distribution is limited to the eye branch, or the eye branch combined with the maxillary branch, or three branches at the same time. People who need to be examined: patients with facial pain and lateral nerve spasms. Precautions Forbidden before examination: Maintain a normal diet and schedule. Requirements for inspection: Don't be too nervous when doctors check, and actively cooperate with the doctor's work. Inspection process Trigeminal neuralgia can be divided into primary and secondary. The secondary trigeminal neuralgia is the most common cause of tumors, and there are more clinically positive signs. Therefore, in addition to general investigation, the nervous system should be thoroughly examined. In patients with primary trigeminal neuralgia, there are few positive signs in the nervous system, and the trigeminal nerve is examined in detail. The examination included three aspects of trigeminal motion, sensation and reflection. If the patient needs to do puncture or surgical treatment, a more comprehensive physical examination, such as skin infection at the puncture or surgical incision site, the patient's systemic nutritional status, heart, lung, liver, kidney and other functions. Examination items for patients with trigeminal neuralgia: 1, facial sensation examination method: can use needles, cotton wool and hot water (40-45 ° C) or cold water (5-10 ° C) placed in the test tube, according to the three branches of the trigeminal nerve in the face distribution area, do left and right The comparison of lateral sensory examinations, and attention to whether there are obstacles in pain and touch, and the extent of their distribution, in order to identify the sensory disturbances belong to the trigeminal peripheral (peripheral or radiculous) or central (trigeminal sensory nuclear) damage. Since the fibers of the surrounding and central parts of the trigeminal nerve are distributed differently, it should be understood that the sensory disturbance is limited to a certain area or limited to a certain feeling. In the case of peripheral damage, pain, temperature and touch should occur simultaneously and can occur in any of the three branches of the trigeminal nerve. In the case of central damage, there are often only pain and temperature sensation, and the sense of touch exists. The distribution is limited to the ocular branch, or the ocular branch is combined with the maxillary branch, or the three branches are involved at the same time. Rare people have maxillary or mandibular single-handle disorders, which are often accompanied by other symptoms of lateral medullary or upper cervical spine damage. In the case of trigeminal nerve damage, in addition to sensory disturbances, there are tender points. The tender point is mostly located at the bone hole of the skull, such as the supraorbital or supraorbital incision of the first branch, the infraorbital hole of the second branch, and the pupil of the third branch. At the time of examination, attention should also be paid to the presence or absence of special sensitive parts of the facial skin. In the light touch of a part of the patient's trigeminal nerve distribution area (such as the upper lip, incisors, mouth, nose, eyebrows, etc.), the author of the trigeminal nerve is called the trigger. point". Facial sensory examination: mainly to check the facial skin feeling of patients with trigeminal neuralgia, is the distribution of sensory branches of the trigeminal nerve, the trigeminal nerve feels large roots, the cell body is concentrated in the trigeminal semilunar, and three large and thick from the half-moon ganglion Dry, including the maxillary branch, the eye branch, and the mandibular branch. 2, exercise examination method: Before the examination should first pay attention to whether the observer's crotch and jaw are symmetrical, with or without muscle atrophy, and then let the patient repeatedly bite the molars, the examiner touches both sides of the masseter and sputum with both hands Muscles, such as muscle atrophy, or a weakened muscle contraction on one side, have diagnostic value. If in doubt, ask the patient to bite the tongue depressor with the molars on both sides. The indenter can judge the contraction force when pulling. In addition, when the patient has a large mouth, observe whether the mandible is offset to the affected side. If there is an offset, it proves that the trigeminal nerve is damaged, causing the internal and external tendons, and the inner and outer muscles of the flank are pushed to push the lower jaw. Caused by the front and the affected side. However, patients with mandibular joint disease should be treated with bilateral asymmetry. Let the patient shift its jaw to both sides, and the examiner should take resistance to observe the contractile force of the wing muscle. The patient will have his mandible forward (wing muscle) and posterior (thoracic muscle, second abdominal muscle), pay attention to whether there is skew. Exercise examination: check the movement of the masseter, diaphragm, pterygoid and pterygoid muscles of patients with trigeminal neuralgia. Because the masticatory muscles stop at the mandible, under the control of the trigeminal motion branch, the temporomandibular joint is involved. Chewing exercise, speech, and to a certain extent involved in the expression of expression, if it is masticatory muscle lesions, can occur facial deformation, facial hypertrophy and other facial symptoms. Not suitable for the crowd Inappropriate crowd: None. Adverse reactions and risks Nothing.

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