Trigeminal neuralgia, facial muscle spasm is our most common cranial nerve disease, modern medicine has been clear, the main cause of these two diseases for the microvessel compression to the nerve root physiological weakness and lead to hyperfunction syndrome, microvascular decompression by the responsibility of compressing the nerve blood vessels pushed away from the physiological weak area, so that the nerves relieve compression, thereby curing the disease, is the cause of the treatment of the disease fundamental method, is the international neurosurgical community respected.
Trigeminal neuralgia is a sharp, pinprick, burning-like pain that recurs in the distribution area of the trigeminal nerve on one side. Pain often occurs without warning, suddenly, for seconds and minutes, intermittently as usual. As the course of the disease progresses, the frequency of attacks increases, the degree of pain increases, and the interval shortens. Some patients have a "trigger point", this part of the slight touch can cause pain attacks, trigger points are mostly located on the affected side of the mouth and nose, patients often refuse to speak, wash their faces, eat, brush their teeth, etc. due to fear of pain, severe pain makes patients feel pain, and even suicidal thoughts, which seriously affects the quality of life of patients.
Facial muscle spasm refers to the repeated involuntary convulsions of facial innervated expression muscles, mostly one side attack, also known as hemiparal spasm, bilateral seizures are rare. It begins with involuntary twitching from one side of the lower eyelid and can last from seconds to minutes, with intermittent periods as usual. As the disease progresses, spasms can extend to half of the affected side of the face, and even the latissimus cervical muscle spasms along with it, causing the head to flutter. In the emotional tension, when speaking is more likely to induce, severe cases continue to spasm, no intermittent period, seriously affect the patient's social, beauty, but also affect the patient's vision, resulting in work, study, reading, driving and other activities to achieve difficulties. It is more common in patients under 30 years of age, slightly more in women than in men, and rarely in children.
Myth 1: Trigeminal neuralgia cloaked in toothache
Ms. Liu has had "toothache" for 20 years. At first, several teeth on the lower right side of her mouth often ached, like many needles stuck in the flesh and radiated to the front of her right ear. The pain seems to disappear after having the doctor at the dental office pull out a large tooth. But after three months the toothache recurred, and although the dentist took X-rays to determine that there was no problem with the root of the tooth, Ms. Liu still asked the doctor to remove another large tooth next to it. For 20 years, she went to one dental clinic after another, and finally pulled out all the teeth in the lower right side, but the toothache still wrapped around her, and when the pain attacked, she hit her head against the wall and even had suicidal thoughts.
Myth 2: Is it really the left eye jumping wealth and the right eye jumping disaster?
5 years ago, Aunt Ma appeared to have a jump in the corner of her left eye, and she could jump more than 10 times a day, jumping for 3-5 minutes each time. Family and friends all say that Aunt Ma is going to get rich, and there will be fortune in the near future, don't they all say "left eye jumping wealth, right eye jumping disaster", Aunt Ma's left eye jumping, is a happy event. Aunt Ma didn't take it seriously, and didn't think about the fortune. However, after a few months, the money did not fall, but the left eye jumped even more, jumping to more than 20 times a day, for a long time to 10 minutes, when the eyes could not be opened, the corners of the mouth also twitched. The family realized that Aunt Ma might not be out of luck, it might be a disease.
Myth 3: Face injections can cure trigeminal neuralgia and facial muscle spasms without side effects.
Peri-branch closure (injection) of the trigeminal nerve is a common method of clinical treatment of trigeminal neuralgia in the past. The injection site is mainly the bone hole through which the trigeminal nerve branch passes, such as the supraorbital foramen, the suborbital foramen, the inferior alveolar foramen, the chin foramen, the pterygum and so on. Drugs used include absolute ethanol, phenol solutions, etc. The treatment of the perigeminal branch closure is limited in the scope of pain relief, and its principle is that the pericminal branch of the trigeminal nerve is damaged, and thus causes facial sensory impairment, thereby relieving pain, with an efficiency of 80%, and a recurrence rate of 90% within one year.
Facial nerve endings injection of botulinum toxin on local muscle spasms can have a certain alleviating effect, mainly because botulinum toxin can block the conduction of facial nerve endings to facial muscles, is a conservative peripheral treatment method, can have a certain effect, the ideal relief time in 3 to 6 months, but can cause dry eyes, strabismus and even long-term sequelae such as facial paralysis.
Therefore, both methods will cause a loss of nerve function, which is a treatment that patients who cannot tolerate surgery to alleviate pain can be taken, and it is a last resort.
Myth 4: "Acupuncture" and Traditional Chinese medicine can cure facial muscle spasm and trigeminal neuralgia.
Acupuncture treatment is convenient to apply clinically and has basically no side effects. For a short period of time, some patients may be effective, and most patients are ineffective. And even effective patient efficacy is not consolidated and will soon recur. Traditional Chinese medicine is generally less effective in treating these two diseases, and there is no cure at all. The cause of this disease is the compression of blood vessels near the nerve roots, that is, the center, so relieving compression is the most fundamental treatment.
Myth 5: Oral carmaxipine western medicine can cure facial muscle spasm and trigeminal neuralgia.
Patients with trigeminal neuralgia can choose carbamazepine, phenytoin and other drugs orally at the beginning of the disease, which has a certain efficacy and about 60% can be better controlled. Long-term use should pay attention to the production of toxic side effects, and women of childbearing age should take into account the teratogenic effects of drugs. In the later stages of the disease, the drug is often stopped because of toxic side effects or decreased efficacy of the drug, and the symptoms recur. Oral medications for facial muscle spasms are rarely effective.
Myth 6: Surgery will be dangerous, even life-threatening, and there is really no way to take surgery.
Modern medicine has confirmed that trigeminal nerve and facial nerve microvascular decompression surgery is an extremely delicate cranial nerve surgery that requires a physician with a considerable foundation of microsurgery. Surgery exposes and dissects the nerves involved, finding compression vessels. Under the premise of completely retaining the normal function of nerves and blood vessels, the blood vessels that compress the nerves are pushed away to achieve the purpose of treatment. The operation is performed in a narrow gap between the brainstem, cerebellum and skull wall, and there is no damage to brain tissue, nerves and blood vessels, and the safety of surgery is quite high. The overall surgical outcome can reach 95%, with almost lifelong recurrence, which is much higher than other treatments. Of course, there are some risks associated with surgery, but the chances of serious complications such as death are comparable to those of appendicitis surgery.
Myth 7: The complications of surgery are very serious, which can lead to crooked faces and numbness of the face.
Complications of surgery include hearing loss and facial sensory loss, but with the improvement of microsurgical techniques, the incidence of these complications is low in large neurosurgical institutions, and except for hearing loss (incidence of about 1%) which is difficult to recover, most cranial nerve injuries have mild symptoms and can be gradually recovered.
Myth 8: The surgical trauma is very large, and the large scar affects the beauty.
Microvascular decompression takes a vertical incision behind the ear, about 6 cm long, and then opens a bone window with a diameter of 2 cm, finds the relevant nerve roots and compresses the blood vessels under the microscope, pushes the blood vessels away from the nerve roots without damaging the nerves and blood vessels, and uses a special material "teflon pad cotton" to open the blood vessel pads, so that the nerve roots are relieved of compression and the disease is cured. Scars are hidden inside the hair and do not affect beauty at all.
Myth 9: Microvascular decompression surgery is very expensive, or conservative treatment is cost-effective.
After a single treatment of microvascular decompression surgery, there is no follow-up cost. Once cured, the patient's quality of life has been completely improved, and there has been no longer any concern about the disease. Although acupuncture, taking medicine, and injections feel cheap, because they cannot be cured, they need to be repeatedly carried out, and the total cost is far greater than that of surgical treatment, and the haze of disease has always plagued patients, seriously affecting the quality of life of patients. Some patients have detours to treat at a cost of no less than 100,000 yuan.
In short, there are more treatment methods for facial muscle spasm and trigeminal neuralgia, as a doctor, I do not want patients to take too many detours in the process of treating diseases, the above is the experience summarized by Director Jia Dong of Tangdu Hospital in clinical practical work, take it out and share it with the majority of patients, hoping to help more patients.