Face ache is acuteness, convulsive to deformation, what disease is this after all?
Reporter Zhang Hua of jinyang.com correspondent Gao long
One side of the face pain, such as knife cutting, electric drill, the degree of pain is more than labor pain; the other side of the face convulsions all day long, often involuntary mouth crooked eyes slanting drool. I’m afraid many people can’t hold on to this kind of life pain, but unfortunately, Ms. Chen (a pseudonym) has been suffering for nearly three years. Recently, the neurosurgery department of the second people’s Hospital of Guangdong Province successfully rescued him from his “miserable life” for three years.
Severe pain in the right face and convulsion in the left face
Recently, Zhang Yong, director of Neurosurgery Department of the second people’s Hospital of Guangdong Province, received a special patient in his consulting room. She rubbed the corner of her clothes tightly with one hand, and covered her red and swollen right face gently with the other hand. Saliva flowed from the corner of her mouth from time to time; her left face was also twitching intermittently, and her expression looked stiff and numb. “At a glance, she was in great pain.” Zhang Yong sighed.
When Zhang Yong asked about her illness, she could only grin softly and say it in a low voice. The patient pauses every few words and covers his mouth with his hands. Seeing his mother’s pain, his son told him about his illness.
It turns out that the woman sitting next to Zhang Yong is Ms. Chen, 50, from Heyuan. She has had symptoms like this for nearly three years. Since 2015, inexplicably, Ms. Chen’s right face began to have the pain of knife cutting and electric drill. To the local hospital, the doctor diagnosed as “right trigeminal neuralgia”, and opened a painkiller, but the situation did not greatly alleviate.
Less than a year later, the pain in Ms. Chen’s right face didn’t relieve much, and her left face began to twitch from her lower eyelids. Her eyes gradually became smaller, and then the corners of her mouth began to twitch unconsciously. Later, the whole left face was deformed. “My mother now dare not be looked directly at, not attack when it’s OK, make up when brush your teeth, drink cold water or eat, even talk, can suddenly induce pain.” Ms. Zhou’s son said.
In the past three years, Ms. Zhou’s family has tried to see a doctor repeatedly, acupuncture and massage. No effect, and the frequency of attack is getting higher and higher.
Two intractable diseases in one face
After detailed examination, Zhang Yong’s team quickly determined that the cause of Ms. Chen’s abnormal pain was caused by two kinds of intractable neurological diseases. The diagnosis: Ms. Chen’s right face with trigeminal neuralgia (V1, V2), left face with hemifacial spasm Cohen III.
It is understood that trigeminal neuralgia is a rare and sporadic facial pain. Some people once had “face pain to suicide”, which is also known as “the first pain in the world”.
The main cause of Ms. Chen’s severe pain in her right face is the “No.1 pain in the world”, while the facial nerve in her left face is subject to pathological stimulation due to the compression of blood vessels, resulting in abnormal nerve impulse and facial muscle twitch. Zhang Yong said, “Ms. Chen’s condition is not complicated, but it is very special. One side of her face is trigeminal neuralgia, and the other side is facial spasm. It is very rare!” Zhang Yong said. Ms. Chen’s disease may be due to the vulnerability of her own nerves, coupled with the disease attack caused by vascular compression.
The rarity of the case is also in the treatment. The situation of Ms. Chen’s two sides of the face is caused by nerve compression in different parts, which needs to be treated separately. Zhang Yong said that it was difficult to control her condition with drugs, and both of them were very stubborn. If we use the previous method of microvascular decompression, it means two craniotomy. For an elderly patient over 50 years old with poor physical condition and fear of surgery, the risk of two craniotomy is too high.
One operation to save left and right facial symptoms
In order to avoid multiple operations and achieve minimally invasive research, the team of Chief Physician Zhang Yong put forward bold ideas after careful thinking and repeated verification, and finally worked out the best solution to solve two problems with only one anesthesia minimally invasive craniotomy: percutaneous balloon compression for right trigeminal neuralgia and minimally invasive craniotomy for left hemifacial spasm.
Director Zhang Yong’s team used o-arm + intraoperative real-time image fusion technology to place a microsphere Capsule on the affected area for 90 seconds under the condition of complete visualization. The whole operation only took 20 minutes. The symptoms of Ms. Chen’s trigeminal neuralgia were relieved. Hemifacial spasm was also successfully relieved after minimally invasive craniotomy.
After the operation, the patient’s left facial convulsion disappeared and the right facial pain disappeared. The operation was smooth and successful.