Mr. B is a 27-year-old male who presented to Georgia Pain Physicians in 2002 with a 6-year history of severe facial pain. He had been diagnosed as having an under developed maxilla as an adolescent and had a series of planned surgeries on his face beginning in 1996 to correct the deformity. Following the second surgery, he developed severe facial pain in the maxillary division of his trigeminal nerve. He had five additional surgeries on his face in an effort to remedy the pain syndrome but to no avail.
Upon initial presentation to our clinic, he was given the tentative diagnosis of atypical facial pain or atypical trigeminal neuralgia in that his pain was constant with intermittent exacerbations. A brain MRI was obtained to evaluate for a mass or vascular structure compressing his trigeminal system but the scan was within normal limits. The first clinical step was to maximize membrane stabilizer medication. After four months of titrating medications, he was taking 3,600mg of Neurontin, 2,500mg of Depakote, and 600mg of Topomax in divided doses. He noted a 20-30% improvement in his pain but the cognitive effects of the medications were intolerable.
The next clinical approach was to perform both a series of Gasserian ganglion blocks as well as sphenopalatine ganglion blocks. Both procedures reduced his pain dramatically but only for 3-5 days at a time. After much deliberation and discussion with the patient and the patient's family, the decision was made to pursue the least invasive option first. We scheduled and performed a pulsed radiofrequency lesion of his Gasserian ganglion in January 2003. This provided 70% pain relief immediately following the procedure and over the last 4 months his pain has consistently been controlled with an acceptable range of 3-5/10. There were no complications from the procedure. The patient and the patient's family view the procedure's outcome as excellent.