The trigeminal nerve is the nerve that supplies sensation to your face. In a condition called trigeminal neuralgia that nerve starts sending out signals of severe pain, rather than what is actually happening on your face. This is a chronic pain condition that affects the 5th cranial nerve, which is one of the most widely distributed nerves in the head.
What causes trigeminal neuralgia?
Trigeminal neuralgia (TN) is usually caused when a blood vessel presses on the trigeminal nerve as it exits the brain stem. The compression causes the protective coating around the nerve, the myelin sheath, to wear away or become damaged, allowing the faulty signals to be sent to the brain. TN can also occur in a person with multiple sclerosis.
What are the symptoms?
The symptoms of TN are not pleasant — sudden, severe, and stabbing pain in the face. Since the trigeminal nerve is responsible for sensation all around the face, the pain can be anywhere but is more frequent on one side of the jaw, cheek, or mouth.
The pain comes on suddenly and only lasts from a few seconds to a few minutes, but it is so severe it can be incapacitating. Due to the area of the pain, sometimes TN is misdiagnosed as a severe toothache.
TN pain is triggered by seemingly harmless normal tasks such as shaving, brushing your teeth, applying makeup, talking, eating, drinking, or even encountering a slight breeze. These activities usually cause a slight vibration in the cheek area and that can be all that is needed to trigger an outbreak of pain.
How we treat trigeminal neuralgia
At Texas Neurosurgery, we generally use three methods to treat TN.
- Procutaneous method — In this method a needle or probe is inserted through the cheek to deaden the nerve or the signal coming from the nerve. This will result in some sensory loss and facial numbness.
- Gamma knife surgery — In this method, a scalpel is never actually used. Instead computer imaging directs highly focused beams of radiation at the site where the trigeminal nerve exits the brain stem. This causes the slow formation of a lesion on the nerve that disrupts the transmission of sensory signals to the brain. The pain relief isn’t instant with this method, but comes within several weeks. Unfortunately, about one half of those treated will likely have a recurrence of pain within three years. Like the procutaneous method, there will be some loss of facial sensation with gamma knife surgery.
- Microvascular decompression — While this method is the most invasive, it also have the lowest probably of the pain returning. A small opening is made through the mastoid bone behind the ear. Then an endoscope is inserted and our surgeons move the blood vessel away from the nerve it is compressing. We place a soft cushion between the nerve and the vessel to maintain the separation.
If you’re having severe facial pain, it could be trigeminal neuralgia and not a toothache. Call the team at Texas Neurosurgery, 214-823-2052, and let us help you.
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