Facial pain and trigeminal neuralgia

Hentschel K et al. Facial Pain. The Neurologist 2005; 11:244-249

Pearls with trigeminal neuralgia

Up to ten percent of patients harbor an intracranial lesion.

More than half of patients achieve remission periods of 6 months or more.

Early treatment with anti HSV medicine and corticosteroids accelerates healing and reduces the duration of postherpetic pain.

The surgical procedures of choice for trigeminal neuralgia for the 30 % of patients who are refractory is a percutaneous radiofrequency or glycerol trigeminal rhizotomy. Complications include corneal anesthesia, anesthesia dolorosa, dysethesias, and masseter muscle weakness and are uncommon. Microvascular decompression is definitive, but is reserved because of the need for a craniotomy. Gamma knife radiosurgery is gaining popularity.

Rare causes of facial pain that need consideration include:
* NASOPAHRYNGEAL CARCINOMA
* PULMONARY CARCINOMA WITH INVASION OF THE VAGUS NERVE presenting as ache in ear
* MANDIBULAR/MAXILLARY CAVITIES ,ABSCESSES, CRACKED TOOTH SYNDROME
* CAROTIDYNIA OR CAROTID DISSECTION
* VASCULAR SUGGESTIVE OF MIGRAINE OR CLUSTER HEADACHE
* POST-TRAUMATIC OR POSTSURGICAL PAIN
* POSTERIOR FOSSA TUMORS