Reasonable Hypothesis SOP [1] | 79 of 2015 |
Balance of Probabilities SOP [2] | 80 of 2015 |
SOP Bulletin 184 [3]
ICD Coding
There are two SOPs concerning the trigeminal (5th cranial) nerve, being trigeminal neuralgia and trigeminal neuropathy. The trigeminal nerve provides sensation to the face, the top of the head, gums and anterior tongue, and motor function to the muscles of mastication (chewing).
Trigeminal neuropathy is a disease or injury of the trigeminal nerve or ganglion which involves loss of function of the trigeminal nerve, with objective signs as well as symptoms.
Trigeminal neuralgia is a paroxysmal facial pain disorder in the trigeminal nerve sensory distribution which is precipitated by various innocuous stimuli and the paroxysms are of short duration and are separated in time by asymptomatic intervals.
There are other facial pain syndromes that are not covered by either SOP.
To confirm the diagnosis a report from a specialist neurologist is required.
* another SOP applies - the SOP has the same name unless otherwise specified
The clinical onset is the earliest time prior to the confirmation of the disease, that the pathognomonic set of symptoms could be documented.
The natural history of trigeminal neuropathy depends on the cause of the pathology. If the cause is an injury, and the injury agent has ceased, the trigeminal neuropathy should not worsen over time but be fixed. If the neuropathy is part of a progressive neurological disease (malignancy, diabetes mellitus, multiple sclerosis), the natural history of the neuropathy will generally track that of the underlying disease.
If it is thought that there is a clinical worsening, it is recommended that an expert opinion be sought from a neurologist to evaluate whether the clinical worsening was out of keeping with the natural history of the underlying pathology.
Links
[1] http://www.rma.gov.au/SOP/15/079.pdf
[2] http://www.rma.gov.au/SOP/15/080.pdf
[3] https://clik.dva.gov.au/system/files/media/SOP%20Bulletin%20184.pdf