Severe lancinating pain on one side of the face is not an uncommon problem among some people. While this can be due to common illnesses like Sinusitis, ear infections, dental problems and sometimes certain eye problems, idiopathic pain is well-known.
Trigeminal Neuralgia
(or Tic Douloureux in French), is a condition which causes severe pain on one side of the face. Once routine causes mentioned above have been ruled out, Trigeminal Neuralgia is diagnosed clinically.
This is usually due to an abnormal blood vessel looping over the nerve carrying sensations of one side of the face, known as the Cranial Nerve V, called the Trigeminal nerve. This pain can initially be controlled with analgesics specific to pain arising from the nerve. However, the medicines will have to be given in increasing doses and may become ineffective after some time. The side effects of the medicines, especially drowsiness and imbalance, also become a constraint to medical treatment.
Neurosurgery offers many alternative means of controlling Trigeminal Neuralgia. From radiofrequency ablation or chemical ablation by alcohol injections of the trigeminal ganglion to Gama knife ablation, there are various means of treating this.
The definitive treatment, however, is removing the blood vessel looping over the nerve at its origin. This is done by an operation in which, a piece of PTFE wool is inserted between the blood vessel and the nerve. In most cases, this will permanently cure the pain.
Involuntary uncontrollable twitching of a part around the eye or the full face is a very irritating and troublesome problem in some people. Occasionally, this can be so severe that a person cannot see or eat properly and can be debilitated to the point of being rendered dysfunctional and depressed.
Blepharospasm or Hemifacial spasms, as these conditions are known, are treated with antispasmodic drugs or sometimes with Botulinum toxin injections, which paralyse the twitching muscles. The effect of the medicine or Botulinum toxin is temporary, and treatment has to be given periodically. These modalities also have side effects and may become ineffective after a certain period.
These spasms or twitching can be treated by alternative means just like Trigeminal Neuralgia as mentioned above. If on an investigation by MRI or MR Angiography, any blood vessel is seen looping over the facial nerve (Cranial Nerve VII), it can be surgically separated from the nerve for permanent cure.
The onus of diagnosing these conditions lies with the Doctor to whom the patient presents initially. A high index of suspicion, appropriate investigation and prompt referral to the specialist surgeon can alleviate the patients’ misery in these conditions, which in the past was called “Suicide Pain”.
Dr.Ashish Kumar Shrivastava I HOD & Sr Consultant Neurosurgery I Dharamshila Narayana Superspeciality Hospital, Delhi