Dr. ADITYA GUPTA
People often ignore pain in their face, jaw and the nose area, which can be devastating and such symptoms should seldom be ignored. This intense, stabbing, electric shock-like pain can be an underlying cause of some major complication in the head. The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye and is caused by irritation of the trigeminal nerve, which sends branches to the forehead, cheek and lower jaw. It usually is limited to one side of the face, but is one of the worst pains that can affect a human being.
Understanding the Trigeminal Nerve
Of the 12 pair of cranial nerves in the head, the trigeminal nerve is the fifth pair responsible for providing sensation to the face. Branching itself to the right and left part of the head into three each side and provides sensations throughout the face.
Trigeminal Neuralgia – Prevalence
While the disorder can occur at any age, it is most common in people over the age of 50. The National Institute of Neurological Disorders and Stroke notes that trigeminal neuralgia is more common in women than in men. Additionally, there is evidence that the disorder runs in families, likely as a result of an inherited blood vessel formation. Hypertension and multiple sclerosis also are risk factors.
Why is this pain caused?
The cause of the pain usually is due to contact between a healthy artery or vein and the trigeminal nerve at the base of the brain. This places pressure on the nerve as it enters the brain and causes the nerve to misfire. Other causes of trigeminal neuralgia include pressure of a tumor on the nerve or multiple sclerosis, which damages the myelin sheaths. Development of trigeminal neuralgia in a young adult suggests the possibility of multiple sclerosis.
How to identify the condition?
Most patients report that their pain begins spontaneously and seemingly out of nowhere. Other patients say their pain follows a car accident, a blow to the face or dental surgery. In these cases, it is more likely that the disorder was already developing, and the dental work caused the initial symptoms to be triggered coincidentally.
Pain often is first experienced along the upper or lower jaw, so many patients assume they have a dental abscess. Some patients see their dentists and actually have a root canal performed, which inevitably brings no relief. Unfortunately, many patients come for further diagnosis to neurosurgeons only after getting their teeth removed. When the pain persists, patients realize the problem is not dental-related.
The symptoms of several pain disorders are similar to those of trigeminal neuralgia. Temporal tendinitis involves cheek pain and tooth sensitivity, as well as headaches and neck and shoulder pain. This condition is called a “migraine mimic” because its symptoms are similar to those of a migraine. Ernest syndrome is an injury of the styomandubular ligament, which connects the base of the skull with the lower jaw, producing pain in areas of the face, head and neck. Occipital neuralgia involves pain in the front and back of the head that sometimes extends into the facial region.
How it is diagnosed?
The diagnosis is mainly clinical, depending on the type of pain, location, episodic nature and trigger points on the face and head. Magnetic resonance imaging (MRI) can detect if a tumor or multiple sclerosis is irritating the trigeminal nerve. However, unless a tumor or multiple sclerosis is the cause, imaging of the brain will seldom reveal the precise reason why the nerve is being irritated. The vessel next to the nerve root is difficult to see even on a high-quality MRI. Tests can help rule out other causes of facial disorders. Trigeminal neuralgia usually is diagnosed based on the description of the symptoms provided by the patient.
Minimally invasive treatment- Cyberknife M6
If the medications have proven to be ineffective then doctors may recommend patients for the surgical procedures. However, in some cases surgical procedures like Microvascular decompression, sterotactic rhizotomy which involves scars, incision requires high expertise and skills where Cyberknife a minimally invasive procedure has proven to be a boon for the patients with Trigeminal Neuralgia. The newly advanced procedure is highly cost effective and doesn’t involve any major scars and incisions.
Cyberknife radiation surgery reduces the risks of further complications. With the use of latest image guidance and computer assisted robotic system, the procedure delivers multiple beams of high frequency radiation to the actual sites from all the directions, thereby preventing damage to the healthy cells. Another advantage is that Cyberknife M6 can automatically track and detect any movement to correct the delivery of radiation beams to the exact treatment location.
During the procedure, the robotic arm slowly moves around the patient and they will not feel anything. The single session lasts for 30 minutes and there is shorter stay at the hospital. The procedure is completely painless and 100% safe without any side effects eliminates the use of anesthesia which is required in other surgical methods. In over 80% of the cases patients recover within single treatment and get back to normal activity within 2 months after the procedure. And over 10% of the patients may get immediate relief from pain.
(Dr Aditya Gupta is Director, Neurosurgery and Cyberknife Centre, Artemis Hospital)
