Several disorders that cause facial pain can be successfully treated by neurosurgical procedures. It is important to accurately diagnose the disorder and identify the best treatment for each disorder. In the absence of randomized prospective studies, standardized methods of reporting, and standardized outcome criteria, it is difficult to compare the results of various surgical procedures and the different reported series of the same surgical procedure. Nevertheless, several important observations emerge from reviews of the literature and personal experience.
General Observations on Facial Pain
- Accurate diagnosis is required.
- The diagnosis of typical Trigeminal Neuralgia (TGN) is seldom difficult.
- In general, the length of the list of the patients symptoms is directly proportional to the likelihood of treatment failure.
- Medical treatment should be explored before surgery is contemplated.
- There is no successful surgical procedure for treatment of atypical facial pain.
- It is more difficult to treat neuropathic than neuralgic pain.
- Patients with dysesthetic pain seldom respond to ablative surgery.
- There is no single superior treatment for facial pain. The treatment should be individualized. Patients should have access to a broad spectrum of treatment options.
- The results of surgical treatment diminish as facial pain becomes more chronic.
Results for Trigeminal Neuropathic Pain
Patients who experience pain distributed in the trigeminal nerve may have the typical symptoms of TGN. The following concepts and observations should be remembered in assessing and treating these patients:
Recognize patients with neuroma
Patients who experience facial pain after trauma or facial surgery may harbor a neuroma. These patients usually describe constant, dull, and burning pain along the distribution of a branch of the trigeminal nerve. A Tinelâs sign and temporary relief with a lidocaine block can establish the diagnosis. These patients can improve after peripheral neurectomy.
Treatment of patients with dysesthesia
Dysesthesia (troublesome numbness) that develops after percutaneous destructive procedures is usually mild and temporary. There is no good treatment for patients with persistent dysesthesia. Destructive procedures are not recommended because they usually worsen the symptoms. MVD has generally not been successful. Techniques such as trigeminal stimulation, motor cortex stimulation, caudalis DREZ surgery, and PSR nucleotomy-tractotomy require further evaluation.
Through the Trigeminal Neuralgia Association (TNA), local support groups are available. The support group provides an opportunity for patients and their families to share experiences, receive support, and learn about advances in treatments, pain control, and medications. Additional information is available on the web at www.tna-support.org or facial-neuralgia.org
If you would like information about the Greater Cincinnati Trigeminal Neuralgia Support Group, please call the Mayfield Clinic at (513)569-5290. For support outside Greater Cincinnati, please contact the Trigeminal Neuralgia Association at 800-923-3608.
The following journal articles and books formed the basis of our observations along with our own personal experience. Bibliography listing.
originally published > Tew JM, Taha JM: Therapeutic Decisions in Facial Pain. Clinical Neurosurgery 46:410-431, 2000