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The trigeminal or fifth cranial nerve carries sensation from the face to the brain.

It consists of three separate branches, the upper or ophthalmic branch covers the sensation from the forehead and around the eye, the maxillary or middle branch covers the area over the cheek, and the lower or mandibular branch covers the area of the lower jaw.

Tic douloureux or trigeminal neuralgia is a disorder where there are paroxysms of severe pain in the distribution of the nerve, usually of one branch. The cause is unknown and it tends to affect those over 50 years of age and women more than men.

The spasms of pain may occur spontaneously or may be triggered by eating, smiling or other muscular movements. There may be long remissions between attacks.

There are other causes of pain in the face but the attacks of this disorder are so typical that diagnosis is not usually difficult.

Pain-relieving drugs are of little use, as the attacks come on suddenly and then depart before any pain-relieving drug could work; but considerable relief can usually be obtained by the use of drugs to control epilepsy.

Where this fails to control the paroxysms of pain, injection of the nerve with alcohol or operations to divide the nerve may give relief.

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The Australian College of General Practitioners, in an endeavor to upgrade the status of general practitioners and to broaden their knowledge, has introduced a post-graduate diploma. This is obtained by examination.

But the prerequisite is at least five years’ graduation and at least three years in general practice.

The universities also award post-graduate diplomas, such as the MS (Master of Surgery), the DPM (Diploma of Psychological Medicine), or the DA (Diploma of Anaesthetics). So by checking the letters after a doctor’s name one can usually determine his speciality and how well qualified he is in that branch.

The various medical colleges also conduct training courses and award fellowships to indicate a doctor has gained special knowledge and training and may be considered a specialist in that branch of medicine.

However, it is well to remember that a string of post-graduate diplomas and degrees alone does not necessary make a brilliant doctor.

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