Managing facial pain and spasms caused by vascular compression

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Did you ever stop to consider what makes the human face so expressive? It’s capable of such a wide array of movements — from obvious to subtle — that can convey a world of meaning without a word being spoken. That world of facial language and its other functions are made possible by the facial nerves.

“Two types of nerves figure prominently in facial function,” explains Dr. Marc Otten, Director of Columbia Neurosurgery at NewYork-Presbyterian Lawrence Hospital in Bronxville. “The first is the trigeminal nerve, which carries sensory information from the face, and the other is the facial nerve, which controls the muscles of the face. When blood vessels compress the trigeminal nerve or facial nerve as it exits the brainstem, it can cause intense electric shock, or disfiguring and debilitating spasms.”

Like other nerves in the body, the trigeminal and facial nerves are subject to disorders. People with dysfunction of the trigeminal nerve may not be able to eat, drink, or go out in the cold without experiencing excruciating pain. For people with facial nerve dysfunction, facial expressions can be compromised, as can the ability to eat, drink, or speak normally. It can also become difficult to open the eyes to drive or walk, leading to dangerous situations.

Many conditions can cause nerve disorders; trauma, skull base fractures, injuries to the face, nervous system diseases (such as stroke), infections of the ear or face, tumors and various toxins. Says Dr. Otten, “When there is excess pressure on the nerves – either as a result of tumors or blood vessels pushing up against them — it causes abnormal stimulation to the area. The result is spasms or tics.”

Common nerve disorders

  • Trigeminal neuralgia (tic douloureux):  A chronic pain condition caused by irritants to the trigeminal nerve. Flare-ups, which can last a few weeks or months and then disappear for a time, manifest as intense bursts of pain in part of the face, usually one side of the jaw or cheek. The pain may be burning or sharp, and so severe that the patient is unable to eat or drink. A flare-up begins with intermittent tingling, numbness, or electric shock-like sensations in the cheek or jaw that can last from a few seconds to two minutes. They may become more and more frequent until the pain almost never stops, and be so intense that it has been linked to depression and disability. “Most common over-the-counter and prescription pain medicines don’t work with this condition,” notes Dr. Otten. “Typically anticonvulsant medicines are prescribed, as are tricyclic antidepressants to help relieve pain. If medicines have failed, surgery may be an option. Unfortunately, many people resort to tooth extractions and extensive oral surgery before they even receive the correct diagnosis. This is why we are hoping to raise awareness about this condition.”
  • Hemifacial spasm (tic convulsif): A condition that causes frequent uncomfortable “tics,” or muscle spasms on one side of the face. As the condition worsens, the tics can become more and more frequent and intrusive. “The source of the problem is a nerve, but the manifestation is the tic, which is a muscular contraction,” explains Dr. Otten. “As the disorder progresses, patients may report spasms in the muscles of the lower face, which may cause the mouth to be pulled to one side. Hemifacial spasm may ultimately affect all the muscles on one side of the face, in an almost continuous state of contraction.” The first line of treatment usually consists of a series of Botox injections to help stop the spasms. In severe cases, a surgical procedure called microvascular decompression may be used, which involves repositioning the artery that irritates the nerve as it comes out of the brainstem.
  • Glossopharyngeal neuralgia: This involves recurring attacks of severe pain in the back of the throat, the area near the tonsils, the back of the tongue, part of the ear, and/or the area under the back of the jaw. “The pain is due to irritation of the glossopharyngeal nerve, which helps move the muscles of the throat and carries information from the throat, tonsils, and tongue to the brain,” says Dr. Otten. The same anticonvulsant and tricyclic antidepressants used to treat trigeminal neuralgia may help the condition. For permanent relief, however, surgery may be needed.

Dr. Otten concludes, “Facial pain and convulsions caused by nerve disorders can vary in severity, depending upon the extent of the injury to the nerve. Symptoms can range from mild twitching or pain to full contraction of the muscles, or debilitating pain. It’s important to keep in mind, however, that these symptoms don’t necessarily imply a vascular compression. Each patient’s physician needs to make a careful investigation in order to make the right diagnosis. Once that has been established, a treatment plan should be individualized for maximum benefit to the patient.”

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