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Facial Pain & Spasm Referral Guidelines

WHEN TO REFER TO NEUROSURGERY FOR SUSPECTED TRIGEMINAL NEURALGIA, GLOSSOPHARYNGEAL NEURALGIA, OR HEMIFACIAL SPASM

Facial pain and involuntary facial movements can be challenging to diagnose. When symptoms mimic dental or ENT conditions but don't respond to standard treatments — or when facial twitching/spasms are present — a neurosurgical evaluation may be appropriate.

Key Features of Neuralgic Facial Pain & Hemifacial Spasm:

  • Sudden, brief, shock-like or stabbing pain (neuralgia)
  • Involuntary, repetitive contractions or twitching of one side of the face (hemifacial spasm)
  • Typically unilateral
  • Triggered by everyday actions like chewing, swallowing, talking, or even cold air
  • Pain-free intervals between attacks (especially in early stages of neuralgia)
  • Episodes lasting seconds to 2 minutes (neuralgia)
  • No obvious structural cause on imaging or physical exam

Refer to Neurosurgery If Your Patient Has:

  1. Paroxysmal Facial, Throat, Ear, or Jaw Pain / Involuntary Facial Twitching
    • Trigeminal Neuralgia (CN V): Pain in cheek, jaw, lips, teeth, or eye
    • Glossopharyngeal Neuralgia (CN IX): Pain near the throat, tonsil, tongue base, or deep ear
    • Hemifacial Spasm: Persistent or intermittent twitching of the eyelid, cheek, mouth, or chin on one side of the face
  2. Recurring Episodes with Pain-Free Intervals
    • Attacks may cluster over days or weeks, then remit
    • Chronic or progressive episodes may increase in frequency
  3. Pain or Spasm Not Explained by ENT or Dental Findings
    • Normal X-rays, oral exams, and ENT workups
    • No relief from antibiotics, guards, root canals, standard dental/ENT treatment
  4. Specific Triggers
    • Trigeminal Neuralgia: Chewing, brushing teeth, speaking, light touch, cold air
    • Glossopharyngeal Neuralgia: Swallowing, yawning, coughing, laughing
    • Hemifacial Spasm: Often worsens with stress, fatigue, or facial movement; may occur spontaneously
  5. Neurologic or Vagal Signs
    • Facial numbness, tingling, weakness (TN)
    • Dizziness, syncope, bradycardia during attacks (GN)
    • Changes in balance, hearing, or swallowing
  6. Failure or Intolerance of Medical Therapy
    • Inadequate relief with carbamazepine, oxcarbazepine, gabapentin, or botulinum toxin (for hemifacial spasm)
    • Side effects that limit use
  7. Atypical Presentation or Red Flags
    • Bilateral pain or spasms
    • Constant burning/aching with intermittent shocks
    • History of multiple sclerosis or skull base tumor

 

Neurosurgical Treatment Options

We offer advanced, minimally invasive, and surgical solutions tailored to each individual’s condition and goals, including:

  1. Microvascular Decompression (MVD):
    Surgical procedure to relieve vascular compression of the affected cranial nerve — offers immediate, lasting relief for neuralgias and hemifacial spasm.
  2. Stereotactic Radiosurgery (CyberKnife):
    Noninvasive, pinpoint radiation to disrupt pain signals at the trigeminal nerve root.
  3. Glycerol Rhizotomy:
    Outpatient needle procedure to selectively damage pain fibers and reduce nerve activity (for trigeminal neuralgia).
  4. Botulinum Toxin Injections:
    Minimally invasive option for hemifacial spasm symptom control.

To Refer a Patient
Tel: 973.993.7100
atlanticbrainandspine.org

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