Interventional Management of Facial Pain: A Retrospective Case Series

Chronic facial pain is initially managed with conservative measures and medications but can also be treated with interventional procedures in refractory cases.

We report a case series of 20 patients with atypical trigeminal neuralgia who had inadequate pain relief with medical management. Patients presented with pain in various distributions of the trigeminal nerve, with 75% having unilateral pain and 25% having bilateral pain. Approximately half (n = 9) of patients reported inciting events, including postsurgical, traumatic, or postinfectious etiologies; whereas, the remaining (n = 11) had no identifiable inciting etiology. Patients underwent infraorbital, supraorbital, supratrochlear, zygomaticotemporal, or trigeminal nerve blocks (NBs), based on pain distribution.

Although patients varied on the amount of efficacy and length of response, on average, patients experienced an 80% improvement of their pain over a 3-month period. The findings suggest that interventional techniques, such as ultrasound-guided NBs, are an option for providing significant pain relief for patients with facial pain who are not adequately managed with medication or amenable to surgery, but they may require relatively frequent repeating of these procedures.