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Nerve Disorder Can Cause Sudden Facial Pain | |
| By DR. JEFFREY L. NELSON New York University Medical Center For AP Special Features Anyone who experiences sudden facial pain should suspect a condition called trigeminal neuralgia. It's a disorder of a major facial nerve that causes intense, short-lived spasms of pain, sometimes compared to a series of electric shocks and often followed by a steady, dull ache. It most often strikes after age 60. There can be remissions lasting as long as six months, but sooner or later, the pain almost always recurs. Trigeminal neuralgia sometimes is due to compression of the trigeminal nerve by an artery in the skull or by a growth called a neuroma. In many cases, however, there is no clear cause. Trigeminal neuralgia (often called by its French name, "tic doloreux") can be triggered by chewing, taking hot or cold drinks, or tooth brushing. With the onset of pain, many victims go to the dentist, assuming that teeth are the cause. They might go to a neurologist for help only after having one or more teeth pulled without relief. To make the diagnosis, the neurologist looks at the pattern of the pain. If it occurs in the mouth, cheek and nose on one side of the face, it's most likely trigeminal neuralgia. But care must be taken when making the diagnosis, since infections of the sinuses, ears or teeth can cause a pattern of pain similar to that of trigeminal neuralgia. Trigeminal neuralgia in younger patients can suggest multiple sclerosis. Treatment usually starts with medications. About two-thirds of patients are helped by epilepsy drugs, including carbamazepine (Tegretol), phenytoin (Dilantin) and valproic acid. Analgesics such as opiates can help but are not recommended for chronic treatment. When drugs are not effective, surgery is an alternative. One procedure, percutaneous rhizotomy, introduces a probe through a small opening at the base of the skull and damages the malfunctioning nerve with a heated wire or an injection of glycerol. However, this procedure might leave part of the face permanently numb, And, a small percentage of patients suffer continued pain. A surgical procedure that can help selected patients is insertion of a "cushion" made of surgical sponge between the nerve and the artery that is pressing on it. --- Dr. Jeffrey L. Nelson is Clinical Associate Professor of Neurology at New York University School of Medicine. Copyright 1996 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. | |