Trigeminal neuralgia secondary to infectious and inflammatory processes of the skull base

clinical, anatomical, and diagnostic correlations

Abstract

Trigeminal neuralgia is a neuropathic condition characterized by acute and recurrent facial pain, usually unilateral, with a significant impact on quality of life. While the classical form of the disease is related to neurovascular compression, trigeminal neuralgia secondary to infectious and inflammatory processes of the skull base is a rare but important etiology, often underdiagnosed. This study conducted an integrative literature review to analyze the clinical, anatomical, and diagnostic correlations of this condition. Six articles published between 2021 and 2024 were selected, involving 41 patients, with infections such as sphenoidal sinusitis, mastoiditis, necrotizing otitis media, and parapharyngeal abscesses associated with trigeminal neuralgia. The most common symptoms include intense unilateral pain accompanied by local infectious signs. Computed tomography revealed bone changes suggestive of infection, while magnetic resonance imaging showed signs of neuritis and perineural involvement. Treatment based on antibiotic therapy, drainage, and debridement resulted in significant pain improvement in 92% of cases. The anatomical proximity of the trigeminal nerve to infected structures favors nerve irritation or compression. Early recognition of this etiology and the appropriate use of imaging are crucial for differential diagnosis and proper therapeutic choice, preventing complications and the chronification of pain. This study highlights the importance of a multidisciplinary approach and points to the need for future research with larger samples and longer follow-up.