New Treatment For Severe Facial Pain

Trigeminal neuralgia is facial pain that feels like an electric shock where just touching the skin can bring agonizing pain. Now state-of-the-art technology and a new understanding of the condition is helping doctors help patients find relief.

There are several different types of treatment for trigeminal neuralgia. The first line of treatment is typically an oral medication, like anticonvulsants, tricyclic antidepressants and muscle relaxants.

Oral medications don’t always provide adequate relief. In addition, for some people the drugs can cause side effects leading to extreme tiredness and functional impairment during the day.

Another procedure is a surgical treatment, called microvascular decompression. The goal of decompression is to move or remove the structure compressing the nerve (usually a blood vessel). A tiny incision is made behind the ear, then doctors cut a nickel-sized hole into the skull. Using a high-powered surgical microscope, the surgeon locates the trigeminal nerve and blood vessel pinching the nerve. Next, the fibers holding the blood vessel in place are snipped and the vessel is gently moved away from the nerve. A small piece of Teflon padding is placed against the blood vessel to hold it in place and keep it away from the nerve. A drop of biological glue holds everything in place. Then the incision is closed.

Martin says after microvascular decompression, the tissue surrounding the nerve will usually regenerate. As the cover heals, nerve transmission returns to normal and the pain goes away.

Before surgery, Martin uses high definition MRI scanning and CT scanning techniques to obtain three-dimensional images of the blood vessel and nerve. With computer software, those images can be manipulated to develop a very clear picture of the area and the position of the blood vessel in relation to the nerve. The images enable him to develop a surgical plan and mentally rehearse the procedure before making any incisions. Martin says if he can’t see the blood vessel on the images, there is a good possibility the surgery may not be effective and patients should continue using medications.

Dr. Martin says microvascular decompression is the most effective surgical procedure for trigeminal neuralgia, but there are some risks, like hearing problems, facial weakness, double vision, stroke or death.