Atypical Facial Pain

Atypical facial pain is a disorder that causes persistent pain, usually on one side of the face. The pain is often described as sharp, aching, burning, crushing, or dull, and it is typically located along the trigeminal nerve, which carries sensation from the face to the brain.

Atypical facial pain is different from other facial pain conditions because it lasts for a longer period of time and doesn’t appear to be caused by an underlying medical condition. Possible causes of atypical facial pain may include dental or sinus infections, facial or nerve trauma, or inflammation of a ligament or tendon in the jaw.

A similar disorder, trigeminal neuralgia, sends sudden, intense, electric shock-like pain to the forehead, cheeks, jaw, gums, and around the eyes. It is caused by the irritation of the trigeminal nerve, and can be triggered by simple acts such as washing the face, brushing teeth, and eating or drinking. Unlike atypical facial pain, trigeminal neuralgia episodes last only a few seconds to a few minutes, and can come in volleys lasting up to 2 hours.

Diagnosis of atypical facial pain can be a challenge due to its similarity to other facial pain conditions. First, the Temple neurosurgeons at Jeanes Hospital will perform a complete neurological evaluation to rule out other possible conditions. Next, they follow up with imaging testing, such as skull X-rays and MRI or CT scans, to help pinpoint the source of your pain.

Atypical Facial Pain Treatment at Jeanes Hospital

Because there are many possible causes of atypical facial pain, the use of medication is considered more effective than surgery in reducing or blocking the pain. Since each patient’s condition is unique, our Temple neurologists will develop a personalized treatment plan with the right medication or combination of medications to alleviate pain symptoms.

Medications for atypical facial pain include:

  • antidepressants or anticonvulsants, which have been found to be effective in reducing the volume of pain signals sent to the brain
  • muscle relaxants and antispasmodics, which block pain signals from the nerve

For patients who don’t respond to medication, the Temple neurologist may recommend a trigeminal nerve block. This procedure involves injecting a steroid pain medication into the affected area. While pain relief begins in 2 to 3 days, the length of time that it lasts is different with each patient. Often, a serious of injections are required to get longer relief.

For patients with trigeminal neuralgia, Temple neurosurgeons can perform the following surgical options to alleviate the pain:

  • Microvascular decompression – With this procedure, an opening is made in the skull to identify and move the blood vessel that is pressing against the trigeminal nerve, giving the nerve room to recover and reduce or eliminate the pain.
  • Percutaneous stereotactic rhizotomy – This procedure involves a inserting a hollow needle through the cheek to the trigeminal nerve. A heating current then destroys the part of the nerve that sends pain signals to the brain.
  • Percutaneous glycerol rhizotomy – This procedure involves injecting glycerol into the area where the nerve splits into 3 branches to carefully damage the nerve and interfere with the pain signals
  • Percutaneous balloon compression – In this procedure, a needle passes through the cheek to the trigeminal nerve. A balloon is inserted in the nerve and then inflated to press against and damage pain-inducing fibers, after which the balloon is removed.
  • Stereotactic radiosurgery – This non-invasive procedure provides a highly-concentrated single dose of radiation to a targeted part of the trigeminal nerve. A lesion then develops in the nerve, interrupting pain signals to the brain.

To schedule an appointment with a Temple neurosurgeon or neurosurgeon at the Jeanes Hospital Neurosciences Center, click here or call 215-728-CARE (2273).

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