Uncle Li from Shantou, Guangdong is 64 years old this year. More than ten years ago, the right side of his face was often in pain. The uncomfortable feeling was like being stabbed by an electric shock, a knife or a needle. , so that he could not sleep well all night.
At first, Uncle Li thought it was a “toothache”. He went to the dentist repeatedly for many years, pulling out a tooth every time until all the teeth on half of his face were pulled out, and the pain still persisted. Not getting better.
On May 27, he came to our hospital to see a doctor and finally found the “real killer”.
According to Uncle Li, the “toothache” started suddenly, and he has long since forgotten the exact time it started and whether there was any special reason.
Image source: Zhanku Hailuo
Only the level of pain was fresh in his memory:
“When you open your mouth, it’s like being poked by a power source. From your mouth to your ears, it’s like being electrocuted, and your eyes can’t help but weep. I don’t even dare to open my mouth. When I eat, when I see something delicious, I really want to eat it, but I don’t dare to eat it. I’m so hungry, but my mouth hurts and I don’t want to eat it.”
“I’ve always thought, this life is so hard!”
(Image source: Uncle Li interview video)
But the more severe the pain, the more convinced Uncle Li was that it was a toothache, “I have seen at least 10 dental clinics, and every time I go to the dentist, I will have a tooth pulled out, and I will feel better after pulling it out. After a while, the pain continues. None of the doctors told me that you might not have a toothache but something else“.
The tooth is extracted, and naturally it has to be replanted. It cost Uncle Li more than 100,000 yuan to replant the half-mouth teeth.
But until all the teeth were extracted, his pain showed no sign of getting better. Only then did Uncle Li realize that he was not a “toothache” at all.
Later, Uncle Li was diagnosed with “trigeminal neuralgia” in a local top-grade hospital, and he followed the local doctor’s suggestion to take carbamazepine orally. strong>. This is an anti-epileptic drug, but it can also be used as the drug of choice for the treatment of trigeminal neuralgia.
Taking carbamazepine, the initial effect was not bad. Uncle Li’s right half of his face was much more relaxed, and it was not as painful as before.
But slowly, the drug became less and less effective, and then became almost useless. Even brushing his teeth, washing his face, shaving, talking, drinking water, or even a gust of wind, the right half of Uncle Li’s face would be in severe pain.
In desperation, he embarked on the road of seeking medical treatment, and tried many methods, but the pain did not improve at all, and it became more frequent.
Uncle Li came to our hospital through a friend’s introduction and was admitted to neurosurgery.
After careful inspection, I found that the pain location on the right half of Uncle Li’s face happened to be in the area innervated by the branches of the trigeminal nerve, and the pain characteristics were also typical of trigeminal neuralgia, indicating that he was suffering from The diagnosis from the local hospital was not wrong.
Knowledge points
Trigeminal neuralgia is one of the most common types of neuralgia, mostly occurring in middle-aged and elderly people over the age of 40. Pain often occurs in the innervation of the trigeminal nerve.
The trigeminal nerve roughly innervates 3 areas, namely the forehead and around the eyes, around the upper jaw, and around the lower jaw (see picture below).
We have one or more sensitive “trigger points,” or “trigger points,” on our faces, mostly on the nose, lips, cheeks, eyebrows, tragus, etc. Brushing your teeth, washing your face, shaving, eating, drinking, talking, etc., can all touch a “trigger point” that can cause pain.
Trigeminal neuralgia has the title of “the best pain in the world”, and it can feel any kind of pain, such as acupuncture-like pain, electric shock-like pain, knife-like pain, tearing Pain and so on.
Each episode of pain lasts a few seconds or tens of seconds and is brief but recurring. Patients are often unbearable and anxious.
How did Uncle Li get his trigeminal neuralgia?
I gave Uncle Li an MRI checklist, and I saw from the imaging report that the root of the right trigeminal nerve was compressed by a small blood vessel.
Knowledge points
Primary is mainly due to the compression of the trigeminal nerve by the blood vessels near the trigeminal nerve.
Secondary is usually caused by the trigeminal nerve itself, or by nearby tumors, vascular malformations, inflammation, or demyelinating lesions.
Uncle Li’s trigeminal neuralgia is caused by the compression of nearby blood vessels, which is primary.
The diagnosis is correct and the root cause of the disease has been found, but the medicine has not been cured before, is there any help now?
Yes! Surgery can cure this disease.
Knowledge points
Trigeminal neuralgia can be treated with medication and surgery. In addition, botulinum toxin injection, nerve branch blocking therapy, balloon compression therapy and radiofrequency thermocoagulation therapy can be used to temporarily relieve pain.
The principle is that for patients with mild pain, drug therapy is preferred. Carbamazepine or oxcarbazepine is usually taken by mouth, but as the pain attacks become more frequent and severe, the effect of the drug will gradually disappear.
If the drug effect is not good, the drug is allergic, the pain is severe and seriously affects life, it is necessary to consider radical surgery, that is, microvascular decompression of the trigeminal nerve.
This surgery is done under general anesthesia through a small incision behind the ear. Using the magnification, focus, and illumination of the operating microscope, the doctor slowly places a spacer on the lesion to separate the blood vessels compressing the trigeminal nerve.
Many people worry about whether surgery on the face will damage other nerves and lead to complications?
Complications of microvascular decompression of the trigeminal nerve are rare and may include hypoalgesia on the ipsilateral face. The long-term (10-year) recurrence rate after treatment is relatively low. According to our clinical statistics, it is about 2% to 10%.
Of course, everyone is right, try not to have surgery if you can, and it’s best if you can’t have surgery. Therefore, it is emphasized that people with mild pain can give priority to drug treatment.
But in a situation like Uncle Li, I have been in pain for many years, and the effect of drug treatment is not good, so I chose to have surgery.
My team performed microvascular decompression of the trigeminal nerve for Uncle Li after thorough preoperative preparation.
Image source: Zhanku Hailuo
After the operation, the pain on the right side of Uncle Li’s face disappeared immediately.
“I can finally brush my teeth, wash my face, eat, drink, and shave!”
Uncle Li’s problem has been solved, but there are still many people who are being tortured by “the first pain in the world”, but they don’t know what happened to them.
Clinically, it is often misdiagnosed as toothache. Many patients still suffer from unbearable pain after tooth extraction, so they go to the doctor again.
How do you differentiate between the two types of pain?
Toothache is generally a persistent dull pain, mostly confined to the gums, and exposure to cold and hot food can induce soreness, with no obvious “trigger point”.
Trigeminal neuralgia is short-lived, severe pain that often has distinct trigger points (see image below).
If you can’t tell the difference, please go to the Neurosurgery of a regular medical institution in time.
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