It's not a toothache
Dr. U.S. SRINIVASAN
Suffering from pain on one side of the face? It may not be due to your teeth.
IN AGONY?: It could be neuralgia.
TOOTHACHE is always thought of as toothache. The person suffering from intolerable pain always approaches a dentist for treatment. Once a dentist looked into the mouth of a patient ready to pull out the offending tooth. To his surprise, he saw 32 beautifully maintained teeth. Unable to figure out the cause of the pain, he put the patient on painkillers.
In three days she was back with severe pain. The perplexed dentist wrote out a new prescription but there was no relief. The patient complained of severe pain while eating cold items, while smiling, even while brushing her teeth. Also the pain was confined to the right side of her face.
Suddenly something clicked in the dentist's mind. He wrote out a prescription for Carbamazepine and told his patient to take it thrice a day. After a fortnight, she is relieved of the pain. The dentist explained that her problem was called Trigeminal Neuralgia and renewed the prescription for a year. The patient was also to come for periodic monthly check ups.
A year later, things were back to square one. The pain had returned. So the dentist referred his patient to a neurosurgeon. He explained to his patient that Trigeminal Neuralgia did not originate in a dental problem but was due to the irritation of the Trigeminal nerve. Painkillers could not cure this and if the effects of the drug Carbamazepin also wore off, then a neurosurgeon had to be consulted.
The patient visited the neurosurgeon as advised. He ordered a CT scan of the brain in order to remove any possibility of space occupying lesions like tumours or blood vessel malformations compressing the Trigeminal nerve and causing the pain. But the scan was normal.
The neurologist discussed the various options for pain relief. He pointed out that irrespective of the procedure there is a 10 per cent chance of recurrence at the end of five to 10 years, which may need alternative procedures. All procedures had a 95-98 per cent success rate though it could be life threatening in a few.
After thinking it over and discussions with her family and the neurosurgeon, the patient opted for Retrogasserian ganglion glycerol injection, which was minimally invasive with less risk and good long-term results.
Options for pain relief
Retrogasserian Ganglion Glycerol Injection involves injecting glycerol into the Gasserion ganglion of the nerve located within the brain under x-ray guidance.
Percutaneous Trigeminal Nerve Compression compresses the same ganglion using a Fogarty's catheter.
Percutaneous Electrocoagulation uses the principle of thermocoagulation and destroys the pain fibres in the same ganglion to relieve the pain.
Microvascular Decompression involves opening the back of the skull and under microscopic magnification lifting the blood vessel that is compressing the Trigeminal Nerve, which is considered by many as the source of pain.
The Gamma Knife procedure directs gamma rays at the Gasserian ganglion to eliminate the pain.
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