Hemifacial spasm results from vascular compression of the facial nerve (the seventh nerve).  Trigeminal neuralgia results from vascular compression of the trigeminal nerve (the fifth nerve).  Hemifacial spasm usually begins with intermittent twitching around the eye on one side of the face.  Over time the twitching spreads to involve the rest of the face.  It is usually painless.

Medications are usually not effective.  Many patients get botox injections every 3-4 months to control.  A more permanent cure can be provided by the same microvascular decompression operation used for trigeminal neuralgia.  But in this disease its usually a different artery and, of course, its a different nerve (the facial nerve).  The operation typically takes about an hour.  Most patients spend two nights in the hospital and a couple of weeks at home recuperating before resuming full normal activities.

Surgery is very safe but, as in all operations, there is a small chance of a complication.  Potential complications include failure to relieve spasm, hearing loss, infection, bleeding, CSF leak, hydrocephalus, and others.

“Anesthesia dolorosa” is Latin for “painful numbness.”  When we perform a radio frequency lesion, we deliberately make the painful part of the face numb.  It’s exactly the same feeling as a novocaine injection.  The vast majority of patients find the numbness to be vastly preferable to the pain of trigeminal neuralgia.  Usually they rapidly adjust to the numb feeling.  A small number of patients, however, find the numbness to be very painful.  They describe the feeling as “woody, thick, burning, crawling.” In fact, this is what novocaine feels like.  Once the nerve is numb there is no reliable surgical treatment for anesthesia dolorosa.  In about half the cases, the numbness gradually fades, the anesthesia dolorosa goes away, but the trigeminal neuralgia recurs.

If you have had novocaine for dental procedures and remember that feeling as particularly uncomfortable, you may not want to have a radio frequency lesion for trigeminal neuralgia.  Painful numbness can also follow microvascular decompression or radiosurgery, although less frequently.

I have found the patients with anesthesia dolorosa often feel better after taking an older antidepressant medication called Elavil.  This medication works directly on the pain and also on the depression which frequently accompanies chronic pain.

Rarely, a nerve in the mouth may be injured during a dental procedure, like a tooth extraction or a root canal.  This leads to the immediate onset of a constant, burning, or aching pain in the distribution of the trigeminal nerve supplying that tooth, including the face.  There is often some numbness.

This is NOT trigeminal neuralgia.  It is rarely relieved by the medications, like carbamazepine, that are so effective for trigeminal neuralgia.  This type of pain is NOT treatable with neurosurgical procedures like microvascular decompression, radio frequency lesion, or radiosurgery.  Nerve burning procedures, like RFL, may actually make this kind of pain worse!

Oral surgeons may be able to help.  Otherwise, pain management is the best option.

Facial pain is a debilitating, life-altering experience.  Many patients who would benefit from surgery spend years getting dental work and medical treatment.  At the University of Florida, we are willing to see any and all patients with intractable facial pain.  We will evaluate you promptly and, hopefully, help find a medical or surgical solution.

Herpes zoster is a virus that causes chicken pox in childhood.  In adult life, if it recurs, it causes “shingles”, an outbreak of small lesions on the skin.  They usually occur in the distribution of a nerve root.  If the nerve root is the trigeminal nerve, the outbreak will occur on the face, usually in V1, the forehead and eye.  The outbreak is painful.  If you have this you should seek immediate medical attention, since early drug treatment can prevent chronic pain.

About 10% of people with a zoster infection develop chronic pain in that distribution.  It’s called “postherpetic neuralgia.”  The best medical treatments involve topical application of capsaicin cream.  It burns, a lot.  But if you use it for 2-3 weeks the postherpetic pain often diminishes.

If your pain is totally incapacitating, you may be a candidate for an operation called the “nucleus caudalis dorsal root entry zone lesion (DREZL) procedure.  This involves surgery, under general anesthesia, where a needle is placed into the pain center of the brainstem and lesions are made.  At UF, we have performed many of these procedures.