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Tic douloureux

Trigeminal neuralgia, also known as tic douloureux, is a chronic pain condition that causes burning or shock-like pain in the face. Nicolaus Andre, a French physician, coined the term “tic douloureux” in 1756 in reference to the facial spasms that can occur during severe pain attacks.

The pain that occurs in short, unpredictable episodes rarely lasts more than a few seconds or a minute or two in a trigeminal neuralgia attack. The pain can feel like an electric shock or can be described as a sharp shooting pain.

Generally, trigeminal neuralgia affects just one side of the face. The pain is felt on the lower part of the face. Trigeminal neuralgia can progress to cause longer, more frequent attacks of searing pain.

The pain can sometimes affect both sides of the face, though not always at the same time.

The intensity of pain can be physically and psychologically incapacitating. People with tic douloureux may have regular attacks for days, weeks or months at a time. In severe cases attacks may happen hundreds of times a day.

Even though it can be debilitating, this disorder does not pose a life-threatening threat. A spontaneous remission is possible, although most people experience episodes over a long period of time.

The anatomy of the trigeminal nerve

This nerve supplies the face with sensory information and provides motor and sensory input to the masticatory muscles. It is a fifth cranial nerve (CN V).

Three trigeminal nerves split off from the trigeminal nerve (trigeminal = threefold):

  1. Ophthalmic (V1): Supplies the eye, upper eyelid, and the forehead
  2. Maxillary (V2): Supplies lower eyelid, cheek, nostril, upper lip, and upper gum
  3. Mandibular (V3): Supplies the lower lip, lower gum, jaw and the muscles of mastication

The mandibular division of the trigeminal nerve provides somatic motor innervation for the chewing muscles. The trigeminal nerve is a mixed nerve and it supplies the general somatic sensory function for touch, temperature, and pain in the face.

This figure shows the fifth cranial nerve, the trigeminal nerve.

Tic douloureux causes

Trigeminal neuralgia, also known as tic douloureux, occurs when the trigeminal nerve’s function is disrupted. Most cases result from compression of the trigeminal nerve root near its entry point into the pons.The problem is usually caused by a contact between a blood vessel – in this case, an artery or a vein – and the trigeminal nerve at the base of your brain. This pressure puts pressure on the nerve, causing it to malfunction.

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Health

Does sparkling water have any negative health effects?

Discover the truth behind the fizz.

You might turn to sparkling water – the fizzy, sugar-free alternative to soda and sports drinks. Sports drinks, iced teas, and juices are loaded with sugar or artificial sweeteners.

Whether it’s low-calorie seltzers, antioxidant-infused seltzers or even those that taste like soda, these bubbly drinks can be hard to resist. But are they really healthy?

How does sparkling water work?

Carbon dioxide is added to regular water to make sparkling water. Adding sodium carbonate to water helps water absorb CO2, hence the name “soda water.”

You can drink seltzer if you like the taste and fizz of soda but don’t want the calories. It’s helped many people cut sugar from their diets. But remember, there are such things as “too much of a good thing.”

When does seltzer become harmful?

The process of adding carbon dioxide to water creates carbonic acid, which lowers the pH level and makes the drink more acidic. It is likely to erode your teeth’s enamel over time if you drink a lot of sparkling water.

A sparkling water can also contain citric acid, which can further increase its acidity and lower its pH level. Some sparkling waters also contain carbonic acid for flavor.

The combination of carbonation and sugar in seltzer water can cause dental decay. You’ll want to avoid seltzer that contains sugars to prevent dental decay, says Dr. Guerrier.

Tip: If you love lemon or lime flavor but want to protect your teeth, try adding a slice of lemon or lime to plain seltzer water. It’s a less acidic way to add a little taste to plain water.

It is important to remember that not all clear, fizzy drinks are created equal. Some drinks that look like seltzer and claim “zero calories” actually contain artificial sweeteners, so check the labels to find the healthiest alternative.

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BLOG&NEWS

There is a wide variety of possible causes of neuralgia, and it can affect different parts of the body.

Trigeminal Neuralgia: Angioneuropathy involves pain from the trigeminal nerve, which travels from the brain to the face. It’s believed that a blood vessel presses against the trigeminal nerve at the point where it meets the brainstem.Trigeminal neuralgia causes pain in the face, usually on one side, and is most common in the elderly.

Postherpetic Neuralgia: This type of neuralgia occurs as a complication of shingles and may occur anywhere on the body. Shingles is caused by a virus that causes a blistering rash.There is an increased risk of neuropathy occurring in the area where the shingles outbreak occurred, and it may be mild, moderate, or severe, persistent, or intermittent, and may last for months or years.

Glossopharyngeal Neuralgia: Glossopharyngeal neuralgia produces neck and throat pain. It is not quite as common as cranial neuralgia.

Causes of Neuralgia

Any type of neuralgia is caused by damage to a nerve. Your body’s nerves are covered by a protective sheath called the myelin sheath. When this is damaged or worn away, you experience the stabbing, severe, shock-like pain that is characteristic of neuralgia.

There are numerous factors, including old age, that can cause myelin damage. Unfortunately, the cause of neuralgia is often never determined.

A variety of infections can cause postherpetic neuralgia, including chicken pox, shingles, Lyme disease, and HIV. Syphilis can also trigger the condition.

Multiple Sclerosis: There are many symptoms associated with multiple sclerosis (MS), including facial nerve pain. MS is caused by degradation of myelin.

Pressure on Nerves: Several different pressure sources can wear away the myelin on nerves, including bones, ligaments, blood vessels, and tumors. The pressure of swollen blood vessels is a common cause of trigeminal neuralgia.

Diabetes (Diabetic Neuropathy):There is a high probability that people with diabetes will experience some form of neuralgia because excess glucose in the bloodstream can damage the myelin.

Less Common Causes: In cases where neuralgia cannot be attributed to infections, multiple sclerosis, diabetes, or pressure on the nerves, it may be due to one of many less common factors. These include:

  • chronic kidney disease
  • porphyria (a rare blood disease)
  • medications like cisplatin, paclitaxel, or vincristine (prescribed to cancer patients)
  • trauma, such as that caused by surgery
  • chemical irritation
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BLOG&NEWS

A systematic review of the literature and an illustrated case report on Scalp Cirsoid Aneurysm

Scalp cirsoid aneurysms are arteriovenous fistulas in the scalp without vascular access to the brain.

Draining veins dilatation can cause headache, tinnitus, and hemorrhage, as well as cosmetic concerns, masses, and local pain.

The etiopathogenesis of this condition is poorly understood. Treatment consists of surgery (fistula repair by simple surgical ligation until gross total resection), embolization (either endovascular or percutaneous), or a combination of both.

The last 10 years’ publications were reviewed in an updated systematic review.

A young boy with a posttraumatic cirsoid aneurysm with compelling documentation of head vascular examinations and multiple treatment options is described as well.The use of coils and cyanoacrylate for percutaneous embolization or endovascular embolization, respectively)This is accompanied by a reduction of pulsatile mass.

The final esthetic result was extremely pleasing due to a cosmetic surgery team that performed gross total resection.

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Health

The snore should not be ignored.

Sleeping with a snorer may leave you awake counting sheep

(or fiddling for earplugs). But they aren’t consciously snoring, and it could be a sign of something else.

Most people who snore have obstructive sleep apnea, a medical condition that occurs when the airway at the back of the throat becomes physically blocked.Geisinger otolaryngologist Kevin Stavrides, MD, says breathing can stop for a minute, leading to gasping, snorting, and waking the sleeper.

Carrying a few extra pounds is the most common cause, but heavy smoking, drinking and using sedatives can also contribute to sleep apnea. One of the best ways to avoid sleep apnea is to sleep on your side instead of your back.

In many cases, lifestyle changes can solve the problem, says Dr. Stavrides. If snoring persists, your doctor will likely order a sleep study.

Your doctor may prescribe a continuous positive airway pressure machine (CPAP) or a bi-level positive airway pressure machine (BiPAP) if you have sleep apnea.You wear this mask to bed to keep your airways open while you sleep.

If you have mild sleep apnea triggered by anatomical factors, you may also benefit from a mouthpiece that holds your tongue and jaw in place.

Others may benefit from an implantable hypoglossal nerve stimulator. “The device stimulates your neck before bed to allow your airways to open up,”

A sleep surgeon will determine if surgery is right for you if you need to remove tissue and expand your airway.

Sleep apnea is usually asymptomatic until someone (gently) points it out. After all, most people with it are the ones snoring away.

It will be a win-win for you and them, as you will both sleep better once it’s corrected.

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BLOG&NEWS

How to deal with Scalp Lacerations with this “HAT” trick!

How many of you have heard of the Hair Apposition Technique, or perhaps even used it on a patient? I figured it existed since 2002, but have only learned about it recently!

Hair Apposition Technique, or HAT trick, is a creative method of approximating the scalp lacing by using the patient’s own hair as sutures.

Let me explain the steps:

  1. Irrigate your wound as usual, inspect for foreign bodies
  2. Pull together 3-7 strands of hair on one side of the wound.
  3. Do the same on the other side of the wound.
  4. Twist these two hair bundles in 360-degree revolutions. Do not tie a knot
  5. Secure the intertwined hair bundles by applying a few drops of Dermabond.
  6. Repeat as needed to close the length of the laceration.

If your patients have short hair, don’t worry, you can still use the HAT trick; all you need is two pairs of clamps.

Traditional staples/sutures have 3 advantages over them : 1) Zero pain (especially useful in kids; just tell them you’re braiding their hair!) 2) No need to anesthetize the wound (forget waiting for your nurses to first apply LET, then waiting more for it to kick in) 3) No need to return to ED for removal! The hair will unravel on its own after a week.

A quick tip for preventing loose hairs from entering your field of repair! When you try to staple Goldberg’s latest scalp lac and his hair keeps falling in, try using petroleum-based ointment instead. Apply ultrasound jelly (or grease) around the area to smooth down the strands, and spread them out to the sides as follows:

Using this method, you will not only be able to visualize the lac more clearly, but you will also be able to avoid trapping hair within the lac, which could cause wound dehiscence, a foreign body reaction, or local cellulitis.

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