Epidural Heat treatment of facial pain (Sweet-procedure)
The trigeminal nerve is the facial nerve with three branches in the face. With Trigeminal Neuralgia this nerve causes painful, violent shooting, electrical, sensations. The pain can sometimes occur in the upper branch (forehead and eye), the middle branch (upper jaw and nose) and the lower branch (lower jaw). Typical symptom of Trigeminal Neuralgia is that the pain can be generated by a stimulus that is not normally painful. For example, by touching the skin, eating, talking, brushing teeth, shaving or a cold gust of wind.
The pain symptoms may spontaneously disappear for months or even years, but may also suddenly come back. In most cases there is no obvious cause for the emergence of Trigeminal Neuralgia. Very rarely the pain is caused by an abnormally positioned blood vessel, pressed right up against the nucleus of the facial nerve (the ganglion gasseri) in the brain. If Trigeminal Neuralgia is diagnosed, the attending physician will first prescribe medication. The most used medication for the treatment of facial pain are carbamazepine (Tegretol) or gabapentin (Neurontin). These medications were originally developed for the treatment of epilepsy, but also have a dampening effect on the activity of nerve cells. Because the effect of the drugs is not limited to the damping of the facial nerve, side effects may occur, like drowsiness, dizziness, or lethargy.
Trigeminal Neuralgia is a form of facial pain, with which intense painful, shooting, electrical sensations occur in the catchment area of the facial nerve (trigeminal nerve). The pain may occur in the upper branch (forehead and eye), the middle branch (upper jaw and nose) and the lower branch (lower jaw). Typical symptom of Trigeminal Neuralgia is that the pain can be generated by a stimulus that is not normally painful. For example, by touching the skin, eating, talking, brushing teeth, shaving or a cold gust of wind. The pain symptoms may spontaneously disappear for months or even years, but may also suddenly come back. In most cases there is no obvious cause for the emergence of Trigeminal Neuralgia. Only in rare cases, neurologist have found an abnormally positioned blood vessel, pressed right up against the nucleus of the facial nerve (the ganglion gasseri) in the brain, causing the pain. Your doctor will treat the pain by blocking the nerve responsible for your pain. This is done by the controlled application of heat through a needle that is inserted with the aid of fluoroscopy. By means of a block, the pain conduction in the affected nerve root is influenced, so that in many cases a reduction in pain occurs.
Preparing for the treatment The treatment is performed during a short stay at the OCP Medical Center and is performed by an anesthesiologist. The treatment is performed in the operating room and you will be sedated (no anesthetic) in combination with a local sedation. Therefore, you should fast for at least 6 hours leading up to the treatment. This means that up to six hours before arriving you can have a cracker or biscuit without butter, and with just a little bit of sweet toppings for breakfast, and up to four hours before arriving you can only drink clear liquid drinks (water, tea, apple juice, or clear lemonade). Coffee is not allowed. You may take prescription medication with a sip of water. The treatment You’ll arrive at the clinic about an hour before the treatment. You will be escorted to your private room, where you can change into a gown. Afterwards you will be brought to the treatment room, where you’ll lie on the operating table, on your back. Additionally, your head may be fixed to the table with a strap, because you can not make any sudden movements during surgery. Because the treatment and anesthesia can affect your ability to react, you can not drive on the day of the treatment. You need to make sure someone else can bring you home. A few days after the surgery you may do whatever feels okay, but keep in mind that physically demanding work is not allowed. Gradually you will notice that you are capable of doing more and more. Beforehand an IV will be placed, which will first provide antibiotics and will provide medication during the procedure, making you calmer, and possibly doze off a bit during the operation. You will also be connected to a monitor so that we can monitor your vitals during the surgery. After disinfection, the anesthetist inserts a special needle, with the aid of fluoroscopy, through the cheek, near the core of the facial nerve (ganglion gasseri), to treat the nerve with heat. When the needle is inserted, a small current is used to make sure the needle is in the right place. If you feel a slight tingling in the affected part of your face, the needle is in the right place. Then, the tip of the needle is heated to a certain temperature for 3 minutes. The anesthesiologist will test if the feeling in the affected area of the facial nerve has changed. If this is the case, the treatment is finished.
After the treatment If the treatment is finished, you will be brought to the recovery room. Afterwards you will be taken back to your room. The department nurse will help you and answer any questions you might have. After an hour of bed rest you can go home, unless something else is decided on consultation with the doctor. Since the treatment and anesthesia can affect your ability to react, you should not drive on the day of the treatment. You need to make sure someone else can bring you home. The following days you may do what feels okay, but physical labor is not allowed in the beginning. Along the way you’ll notice that you can do more and more. Possible side effects Hypersensitive reaction to iodine or the use of antibiotics. Some patients respond to the contrast fluid used during the procedure.
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Introducing our Pain Specialist
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