Painful facial twitches

Introduction Trigeminal neuralgia, also known as painful convulsions. Sometimes called "face pain", it is easy to be confused with toothache. It is a kind of paroxysmal severe neuropathic pain that occurs repeatedly in the facial trigeminal nerve distribution area. Trigeminal neuralgia is one of the common diseases in neurosurgery and one of the internationally recognized intractable diseases. Most trigeminal neuralgia starts at the age of 40, mostly in middle-aged and elderly people, especially in women. The disease is characterized by sudden onset, sudden arrest, lightning-like, knife-like, burning, intractable, and unbearable severe pain in the area of the trigeminal nerve in the head and face.

Cause

The etiology and pathogenesis are still unclear, but most of them believe that the lesion is around the trigeminal nerve, that is, within the sensory root of the trigeminal semilunar. According to microsurgery and electron microscopy, it may be related to factors such as small vessel malformation and bone deformity in the rock bone, which may cause pain. Chinese medicine believes that it is due to "wind and cold dampness" and the head is hit by heavy cold.

an examination

Clinical features: sudden onset, without any aura, mostly on one side. At the time of attack, the pain is as severe as knife cutting and electric shock, lasting for a few seconds to 1-2 minutes, often accompanied by facial muscle twitching, tearing, salivation, facial flushing, conjunctival hyperemia and other symptoms. As the condition worsens, the interval is getting more and more Short, more frequent episodes, after a strong painful stimulation, the patient's mental stress is extremely tense, unforgettable for life, causing great pain.

Differential diagnosis

1. Toothache: Trigeminal neuralgia is often misdiagnosed as toothache. It is often removed from healthy teeth, and even the removal of all teeth is still ineffective, so it should be noted. The pain caused by dental disease is persistent pain, which is mostly limited to the gingival part. There are local toothaches and pathological lesions. X-ray and dental examination can confirm the diagnosis.

2, sinusitis: such as frontal sinusitis, maxillary sinusitis, etc., for localized persistent pain, may have fever, nasal congestion, concentrated phlegm and local tenderness.

3, glaucoma: unilateral glaucoma acute misdiagnosis as the first pain of the trigeminal nerve, glaucoma for persistent pain, no radiation, may have vomiting, accompanied by balloon-bound membrane congestion, anterior chamber shallowing and increased intraocular pressure.

4, temporomandibular arthritis: pain is limited to the temporomandibular joint cavity, persistent, joint pain, joint movement disorders, pain and mandibular movements are closely related, feasible X-ray and specialist examination to assist diagnosis.

5, migraine: the pain area beyond the scope of the trigeminal nerve, there are many visual auras before the attack, such as blurred vision, dark spots, etc., may be accompanied by vomiting. Pain is persistent and long, often half a day to 1-2 days.

6, trigeminal neuritis: short history, pain persistence, trigeminal nerve distribution area allergic or hypothyroidism, may be associated with dyskinesia, in the affected trigeminal nerve branch has obvious tenderness. Neuritis often occurs after a cold or paranasal sinusitis.

7, cerebellar pons tumor: pain episodes can be the same as or similar to trigeminal neuralgia, but more common in young people under the age of 30, more trigeminal nerve distribution area feels hypothyroidism, and can gradually produce other symptoms and signs of cerebellar pons. More common cholesteatoma, meningioma, acoustic schwannomas followed, the latter two have other cranial nerve involvement, ataxia and increased intracranial pressure are more obvious. X-ray film, CT intracranial scan and MRI can help confirm the diagnosis.

8, tumor invasion of the skull base: the most common for nasopharyngeal carcinoma, often accompanied by nasal sputum, nasal congestion, can invade most brain nerves, neck lymph nodes, for nasopharynx examination, biopsy, skull base X-ray examination, CT and MRI can confirm the diagnosis.

9, glossopharyngeal neuralgia: easy to trigeminal third pain mixed, different parts of glossopharyngeal neuralgia, soft palate, tonsil, throat wall, tongue root and external auditory canal. The pain is induced by swallowing action. The pain can disappear after the pharyngeal area is swallowed with 1% pantocaine or cocaine.

10, trigeminal semilunar tumor: visible ganglion cell tumor, chordoma, Mai's nest meningioma, etc., may have persistent pain, patients with trigeminal sensation, dyskinesia. The skull base X-ray may have changes such as bone destruction.

11, facial neuralgia: more common in young people, the pain beyond the scope of the trigeminal nerve, can extend to the back of the ear, the top of the head, the neck, and even the shoulder. Pain persistence, up to several hours, independent of movement, not afraid of touch, can be bilateral pain, can be heavier at night.

Clinical features: sudden onset, without any aura, mostly on one side. At the time of attack, the pain is as severe as knife cutting and electric shock, lasting for a few seconds to 1-2 minutes, often accompanied by facial muscle twitching, tearing, salivation, facial flushing, conjunctival hyperemia and other symptoms. As the condition worsens, the interval is getting more and more Short, more frequent episodes, after a strong painful stimulation, the patient's mental stress is extremely tense, unforgettable for life, causing great pain.

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