Overview

Several disorders that cause facial pain can be successfully treated by neurosurgical procedures. It is important to accurately diagnose the disorder and identify the best treatment for each disorder. In the absence of randomized prospective studies, standardized methods of reporting, and standardized outcome criteria, it is difficult to compare the results of various surgical procedures and the different reported series of the same surgical procedure. Nevertheless, several important observations emerge from reviews of the literature and personal experience.

General Observations on Facial Pain

• Accurate diagnosis is required.
• The diagnosis of typical Trigeminal Neuralgia (TGN) is seldom difficult.
• In general, the length of the list of the patients symptoms is directly proportional to the likelihood of treatment failure.
• Medical treatment should be explored before surgery is contemplated.
• There is no successful surgical procedure for treatment of atypical facial pain.
• It is more difficult to treat neuropathic than neuralgic pain.
• Patients with dysesthetic pain seldom respond to ablative surgery.
• There is no single superior treatment for facial pain. The treatment should be individualized. Patients should have access to a broad spectrum of treatment options.
• The results of surgical treatment diminish as facial pain becomes more chronic.

These observations can serve as general guidelines for treatment of:

• Trigeminal Neuralgia (TGN)
• Recurrent Trigeminal Neuralgia
• Facial Pain with Multiple Sclerosis and Tumors
• Trigeminal Neuropathic Pain
• Vagoglossopharyngeal Neuralgia
• Cluster Headache

Sources

Through the Trigeminal Neuralgia Association (TNA), local support groups are available. The support group provides an opportunity for patients and their families to share experiences, receive support, and learn about advances in treatments, pain control, and medications. Additional information is available on the web at www.tna-support.org or facial-neuralgia.org

If you would like information about the Greater Cincinnati Trigeminal Neuralgia Support Group, please call the Mayfield Clinic at (513)569-5290. For support outside Greater Cincinnati, please contact the Trigeminal Neuralgia Association at 800-923-3608. 

The following journal articles and books formed the basis of our observations along with our own personal experience. Bibliography listing.

updated: 6.2004
originally published > Tew JM, Taha JM: Therapeutic Decisions in Facial Pain. Clinical Neurosurgery 46:410-431, 2000