Trigeminal neuralgia and facial spasm are the most common cranial nerve disorders. Modern medicine has made it clear that the main cause of these two diseases is the neurological hyperfunction syndrome caused by the compression of microvessels into the physiological weak zone of the nerve roots, and microvascular decompression surgery cures the disease by pushing the responsible vessels that compress the nerve away from the physiological weak zone and relieving the nerve from compression. It is the preferred treatment method in the international neurosurgical community. Many of the patients with trigeminal neuralgia and facial spasm we treated came to our center for lock-hole surgery only after they had gone through many hospitals, applied many treatments that were ineffective and spent a lot of money, and even after some of them had caused facial palsy, strabismus, facial sensory disorders and other sequelae, but still could not solve their pain. Although the patient is cured after surgery, the sequelae caused by the previous treatment have been difficult to get better, forming a very regrettable end. Many patients lack knowledge about this disease, and even some medical workers have misconceptions about the treatment of this disease. In response to this situation, we have written the following article in order to provide an understanding of the standard treatment of trigeminal neuralgia and facial spasm for the majority of patients.
Trigeminal neuralgia is a recurrent severe pain of pins and needles and burning in the trigeminal nerve distribution area of one side of the face. The pain often occurs suddenly without aura and lasts for a few seconds or minutes, with intervals as normal. As the disease progresses, the frequency of attacks increases, the pain level worsens, and the intervals shorten. Some patients have “trigger points”, which can cause painful episodes by slight touching of this area. The trigger points are mostly located at the affected side of the mouth and nose, and patients often refuse to talk, wash their faces, eat, brush their teeth, etc. because of fear of pain.
Facial muscle spasm is a recurrent involuntary twitching of the facial nerve innervated expression muscles, mostly on one side of the face, also known as hemifacial spasm, bilateral seizures are rare. It starts as an involuntary twitch from the lower eyelid of one side, which can last from a few seconds to several minutes, with intervals as normal. As the disease progresses, the spasm may extend to half of the affected side of the face, and even the broad neck muscles may spasm together and cause the head to shake. In severe cases, the spasm continues without intervals, seriously affecting the patient’s social and cosmetic appearance, and also affecting the patient’s vision, leading to difficulties in work, study, reading, driving and other activities. Mostly after the onset of middle age, patients under 30 years old are rare, slightly more women than men, children are rarely seen.
Myth 1: Trigeminal neuralgia in the guise of toothache
Liu, a 20-year-old master in Yangpu District, has been suffering from “toothache” for 20 years. At the beginning, several teeth on the lower right side of his mouth were often painful, like many needles sticking in the flesh, and radiated to the front of his right ear. After having a large tooth removed by a dentist, the pain seemed to go away. The pain returned after three months, and although the dentist took x-rays to make sure the root of the tooth was fine, Mr. Ding asked the doctor to remove the other large tooth next to it. 20 years later, he went from one dental clinic to another, and finally had all the teeth on the lower right side removed, but the toothache still haunted him, causing him to bang his head against the wall during episodes of severe pain, and even to think of suicide.
According to my years of clinical experience, I suggested the patient to have a cranial MRI examination.
Myth 2: Is it really a case of jumping from the left eye to the right eye? Be wary of facial muscle twitches?
Three years ago, Master Zhang developed a left eye corner jumping, which can jump more than 10 times a day, ranging from 3 – 5 minutes each time. The family and friends said, moncler outlet online, Zhang will be rich, recently there will be fortune, not said “left eye jumping money, right eye jumping disaster”, moncler left eye jumping, is a happy event. Master Zhang cheerfully did not take it seriously, and did not think about the matter of wealth. But a few months later, the fortune was not issued, the left eye but jumping more powerful, can jump to more than 20 times a day, long time to 10 minutes, serious when the eyes can not open, the corners of the mouth followed by twitching. The family then realized that moncler outlet online what may not come to fortune, this may be a disease. This year, the children took Zhang moncler to Shanghai Quyang Hospital Brain Center for consultation, was diagnosed with facial muscle spasm.
Myth 3: Injections on the face can cure trigeminal neuralgia and facial muscle spasm with no side effects.
Trigeminal nerve peripheral branch closure (injection) is a common method of clinical treatment for trigeminal neuralgia in the past. The injection sites are mainly the bone holes through which the trigeminal nerve branches pass, such as the supraorbital hole, infraorbital hole, inferior alveolar hole, chin hole and pterygopalatine hole. The drugs used include anhydrous ethanol, phenol solution, etc. The peripheral branch of trigeminal nerve closure treatment has a limited range of pain relief. The principle is that the peripheral branch of trigeminal nerve is destroyed, and as a result, facial sensory disorder is caused, thus relieving pain, with an efficiency rate of 80% and a recurrence rate of 90% within one year.
Botulinum toxin injection into the facial nerve endings can have certain relief effect on local muscle spasm, mainly because botulinum toxin can block the conduction of facial nerve endings to facial muscles, which is a conservative peripheral treatment method and can have certain effect with ideal relief time in 3-6 months, but it can cause dry eyes, strabismus and even long-term sequelae such as facial paralysis.
Therefore, both methods can cause the loss of nerve function and are treatments that can be taken by patients who cannot tolerate surgery in order to relieve pain as a last resort.
Myth 4: “Acupuncture” and TCM can cure facial muscle spasm and trigeminal neuralgia.
Acupuncture treatment is easy to apply in clinical practice and basically has no side effects. It may be effective in some patients for a short period of time, but not in most patients. Moreover, even for those patients who are effective, the effect is not consolidated and relapses soon. Chinese medicine treatment for these two diseases is generally less effective, and a cure is not even possible. The cause of this disease is the nerve root, that is, the central vicinity of the compression by blood vessels, so lifting the compression is the most fundamental treatment.
Myth 5: Western drugs such as oral carbamazepine can cure facial muscle spasm and trigeminal neuralgia.
Patients with trigeminal neuralgia can choose to take drugs such as carbamazepine and phenytoin sodium orally at the beginning of the disease, which has certain efficacy and about 60% can be better controlled. Long-term use should pay attention to the toxic side effects, and women of childbearing age should take into account the teratogenic effects of the drugs. In the later stages of the disease, drugs are often stopped because of toxic side effects or reduced efficacy, and symptoms recur. Oral medications for facial spasm are rarely effective.
Myth 6: Surgery can be dangerous or even life-threatening, and there is really no way to take surgical treatment again.
Modern medicine has confirmed that facial nerve microvascular decompression surgery is an extremely delicate cranial nerve surgery that requires a physician with a considerable foundation in microsurgery to perform. The surgery reveals and dissects the nerve in question and finds the compressing vessels. The nerve is then nudged out of the way while preserving the normal function of the nerve and blood vessels. The surgery is performed in a narrow space between the brainstem, cerebellum, and cranial wall, so there is no damage to brain tissue, nerves, or blood vessels. The total surgical effect can reach 98%, and there is almost no recurrence for a lifetime, which is much higher than other treatments. Of course, there are some risks, but the chance of serious complications such as death is similar to that of appendicitis surgery.
Myth #7: Complications of surgery are serious and can lead to a crooked face and numbness of the face.
Complications of lock-hole surgery include hearing loss and facial sensory loss, but with the improvement of microsurgery techniques, the incidence of these complications is very low in large neurosurgical medical institutions, and except for hearing loss (incidence of about 1%) which is more difficult to recover, most of the symptoms of cranial nerve injury are mild and can mostly be recovered gradually.
Myth 8: The surgery is very traumatic and the large scar affects the beauty.
The general microvascular decompression surgery is very traumatic, but our center adopts the lock-hole radical surgery to minimize the trauma. The lock-hole radical surgery is a creative application of the most advanced international lock-hole surgical technique to eradicate cranial nerve diseases by microvascular decompression. A horizontal incision of only 3.5cm in length is made in the hairline behind the ear (traditional surgery is a vertical incision of about 7cm in length), and then a bone hole of 1.5cm in diameter is opened as the “locking hole” (traditional bone window of 3-4cm in diameter is very traumatic). Then, under the microscope, the nerve root and the compressed blood vessel are found through the “locking hole”, and the blood vessel is pushed away from the nerve root without damaging the nerve or the blood vessel, and the blood vessel is padded with a special material called “teflon pad”, so that the nerve root is released from compression and the disease is treated. The nerve root is released from compression and the disease is cured. The scar of the surgery is small, only 3.5 cm long, and the scar is hidden inside the hair, which does not affect the beauty at all.
Myth 9:. Microvascular decompression surgery is very expensive, or conservative treatment is cost-effective.
The total cost of microvascular decompression with locking holes is about 20,000 yuan in most neurosurgical treatment centers. However, after one treatment is cured, there is no more follow-up cost. With a single cure, the patient’s quality of life is completely improved and he or she has no more worries about the disease from then on. Although acupuncture, medicine and injection feel cheaper, the total cost is far greater than surgical treatment because they cannot be cured and need to be repeated, and the haze of the disease always haunts the patient and seriously affects the patient’s quality of life.
In conclusion, there are more treatment methods for facial spasm and trigeminal neuralgia, as a doctor, and do not want patients to take too many detours in the process of treating the disease, the above is my simple experience in the actual clinical work, take out and share with the majority of patients, hoping to help more patients.