Dr.

KIRAN SAVANT
PG Student
Department of oral, maxillofacial and reconstructive surgery
Bapuji Dental College & Hospital,
Davangere.Karnataka
 INTRODUCTION

 Trigeminal neuralgia, also known as tic douloureux, is a

clinical syndrome distinguished
ETIOLOGY by brief, repetitive, extremely
intense paroxysms of unilateral lancinating facial pain.
Diagnosis
 Well-taken history

 Classic clinical pattern -Sweet diagnostic

criteria for TN
 MRI/ CT scan

 Response to T/t with carbamazepine

 Diagnostic injections of a LA into trigger zone

 Although the immediate effect of minor surgical
treatment (peripheral alcohol injections,
cryosurgery, peripheral neurectomy etc.) is
indisputable, the major disadvantage is that total
anaesthesia results and relief may be only
temporary as the nerve eventually regenerates
(Bayer and Stenger, 1979).

Streptomycin/lidocaine
 “Peripheral streptomycin/lidocaine injections for
trigeminal neuralgia
-our clinical experience”

 THREE patients of both sexes(2 male, 1 female) aged 56-70 years

diagnosed with idiopathic trigeminal neuralgia in whom
previous treatment had failed and who had intractable pain
before commencement of treatment were included.

 Patients with renal disease or vestibulocochlear disturbances

were excluded because of the known systemic side effects of
streptomycin.
 METHOD

 1st 1 to 2 ml of 2% lignocaine HCL

with 1:80,000 used to achieve
local anesthesia over affected
region.

 2nd after half hour of LA 1 Gram

of streptomycin mixed with 2 ml
sterile inj water was infiltrated.
 All patients received five/seven injections, the time
between each injection varying from three to seven days,
according to the intensity and frequency of pain attacks.

 Patients were allowed to continue to take tegretol

(carbamazepine) in their usual or reduced dose.

 The patients were advised to report to our unit when pain

recurred.
 Duration from last injection to recurrence was noted as
pain free period.
PATIENT AFFECTED PREVIOUS REGION TREATED PAIN FREE
NAME DIVISION TREATMENT WITH STREPTOMYCIN PERIOD
AGE /SEX AND NO OF DOSES
69/FEMALE RIGHT V2, V3 TEGRETOL, 5 INJ AT 1WEEK 9 MONTHS
CRYOTHERAPY OF INTERVAL AT RIGHT IO
IAN,IO
AGAIN AFTER 2 yrs
5 INJ AT 1WEEK
 RESULTS INTERVAL > 6 MONTH
AT RIGHT IO

67/MALE LEFT V2 TEGRETOL, 5 INJ AT 1 WEEK 4 MONTH

CRYOTHERAPY OF INTERVAL AT LEFT IO
IO, PERIPHERAL
NEURECTOMY OF IO
AND BLOCKING OF
IOF WITH BONE
WAX.

57/MALE RIGHT V2, V3 MULTIPLE 7 INJ AT 1 WEEK 4 MONTH

PERIPHERAL INTERVAL AT RIGHT
PROCEDURES – MENTAL REGION
CRYOTHERAPY OF
IO, IAN.
MVD
Discussion –
 It has been reported that streptomycin, when applied
topically, can achieve pain relief in different types
orofacial pain such as odontalgia or cluster-tic
syndrome. With regard to its favourable effects on
trigeminal neuralgia, reports are controversial.

 Sokolovic et al. (1986), in their preliminary study,

claimed good results following peripheral
streptomycin/lidocaine injections ,whereas Stajcic et
al. (1990), in a double-blind controlled trial, showed
that these injections were only initially effective.
 Neurolytic effects of streptomycin following systemic
use such as damage to the acoustic nerve, inhibition of
secretion of acetylcholine at nerve endings, and
stabilization of the nerve cell membrane have been
well documented.

 Histological study on Effects of streptomycin on the

rat infraorbital nerve demonstrated that streptomycin
can cause peripheral nerve damage when injected
perineurally.
 Histologic Cross-section
of rat infraorbital nerve 1
week following injection
streptomycin

 It is known that trigger stimuli giving rise to severe pain in trigeminal neuralgia
are mediated only by large myelinated fibres. It was found that streptomycin
produces axonal damage peripherally in the nerve bundle covering
approximately one-fifth of the entire circumference. This suggests that there is
little probability of affecting those axons that transmit trigger stimuli with a
single injection of streptomycin.

 This coincides with the pure clinical observation that streptomycin should be
given in 5-weekly peripheral injections (Sokolovic q et al., 1986; Stajcic et al.,
1990).
 Provide acceptable degree of pain relief.
 Well tolerated by patients.
 Can be beneficial in medically compromised patients
who are unfit for surgery.
 Less cost, easily available.
 No local or systemic effects of peripheral injection.
 Lowers the tegretol doses, helps in reduction of side
effects.
 Does not produce fibrosis like alcohol and repeated inj
can be given easily with this technique.
Collaborative research
Although the sample is destined
size is small to yield
& is ongoing
study,
new we got promising
targets for drug results AND this and,
treatment therapy
more
would add a new dimensions to peripheral
broadly, new knowledge
injection procedure . of pain
mechanisms.
ACKNOWLEDGEMENT
• DR. KIRTHI KUMAR RAI (Professor & HOD)
• DR. RAJESH KUMAR B. P. (Professor)
• DR. SUBHASH RAI (Professor)
• DR. SHIVAKUMAR H. R. (Professor)
• DR. UMASHANKAR (Professor)
• DR. HARIKRISHNA K. RAO (Professor)
• DR. AMARNATH P. UPASI (Reader)
• DR. NANDAKISHORE. (Asst. Prof)
• DR. GEETHA N.T (Asst. Prof)
• DR. NAGAMANI D. (Asst. Prof)