Introduction

Trigeminal neuralgia is often described as “one of the most severe pains a person can experience,” characterized by sudden, electric shock–like pain in the face. Attacks last only seconds to minutes but can recur repeatedly, causing a heavy burden on daily life and mental well-being. While conventional treatment typically involves medications or nerve blocks, in recent years, manual therapies such as osteopathy have drawn attention as potential complementary approaches.

1. Causes of Trigeminal Neuralgia

Trigeminal neuralgia may result from trauma, tumors, rheumatic diseases, demyelinating diseases (e.g., multiple sclerosis), or vascular compression of the nerve. Among these, compression by arteries in the cerebellopontine angle (such as the superior cerebellar artery) is a well-recognized cause. Such compression or inflammation can trigger demyelination and hyperexcitability of the nerve, leading to excruciating facial pain.

2. Anatomy of the Trigeminal Nerve

The trigeminal nerve (cranial nerve V) is the largest cranial nerve, responsible for facial sensation and motor control of the masticatory muscles. Its three main branches—the ophthalmic nerve (V1), maxillary nerve (V2), and mandibular nerve (V3)—converge at the trigeminal ganglion, located in Meckel’s cave at the middle cranial fossa. Each branch serves a distinct region of the face:

• V1 (Ophthalmic nerve): Sensation of the upper face and periocular region
• V2 (Maxillary nerve): Sensation of the midface
• V3 (Mandibular nerve): Sensation of the lower face and motor innervation to masticatory muscles

Blood supply derives from branches of both the internal and external carotid arteries, while venous drainage occurs via the dural venous sinuses and jugular veins. This anatomical background is closely tied to the onset and persistence of trigeminal pain.

3. Structural Issues of the Skull and Neck in Trigeminal Neuralgia: An Osteopathic View

From an osteopathic perspective, trigeminal neuralgia is not solely a problem of “vascular compression” but may also be aggravated by structural and functional dysfunctions (somatic dysfunction) of the skull, face, and cervical spine.

Key considerations include:

• Trigeminal root (near the pons): Reduced mobility of the cranial base (occiput, sphenoid, temporal bones) may increase neural tension.
• Trigeminal ganglion (Gasserian ganglion): Its close relationship with the sphenoid bone means sphenoidal strain could stress the ganglion.
• Exit points (superior orbital fissure, foramen rotundum, foramen ovale): Bony or fascial restrictions may irritate nerves at their passageways.
• Fascial and TMJ factors: Hypertonicity of the masseter, temporalis, or pterygoid muscles, as well as temporomandibular joint dysfunction, can contribute.
• Cervical involvement: Upper cervical segments (C0–C2) and tension in the sternocleidomastoid or scalene muscles may influence the cranial base.

Osteopathic approaches include cranial osteopathy to release restrictions of the sphenoid, temporal, and occipital bones; TMJ and masticatory muscle adjustments; cervical fascial release; and improving venous and lymphatic circulation around the cranial base. Together, these aim to restore a healthier environment for the trigeminal nerve and reduce pain.

In Conclusion

Trigeminal neuralgia can be approached not only with medication or surgery but also through improving cranial and cervical function. Osteopathy offers a unique perspective by addressing multiple contributing factors—nerve compression, blood and lymph circulation, fascial and joint balance. Since causes of trigeminal neuralgia vary widely (trauma, tumors, rheumatic conditions, demyelination, etc.), osteopathy is not a replacement for medical care but may be a valuable option when no major pathological cause is identified and dysfunction of the skull or cervical spine contributes to symptoms. For those suffering from facial pain, osteopathy may provide a complementary avenue worth exploring.

#Kyoto #KyotoOsteopathyCenter2F #Osteopathy #Chiropractic #Pain

#Numbness #TrigeminalNeuralgia #FacialNumbness

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