I am looking for a solution for my 75-year-old mother. For the last three years, her wellbeing has deteriorated due to pain and discomfort on the right side of her face. We have seen various specialists, but nothing seems to help.
There can be many causes of right facial pain. We just have to think of the structures on and under our skin in that area, and rule them out one by one for diagnosis.
Possible tissues or organs that are situated on the side of our face include our sinuses, salivary glands, eye, ear, muscles, facial bones, joints, nerves and blood vessels, not forgetting the other organs near that area.
How could they possibly be affected?
Let’s go through the list of organs and structures, and see how they are most commonly affected:
♦ Sinusitis: An infection and inflammation that can affect your right sinus, as well as your left sinus or both sinuses together.
♦ A deviated nose septum, leading to blockage on the right side of your nasal passages that subsequently results in infection and inflammation.
♦ Right temporomandibular joint disorders: This joint is located at the base of your right jaw. It could have been fractured in the past during a sports injury or damaged from other reasons. But now, it can give pain.
♦ Right salivary gland infection, especially in the parotid gland.
♦ Mumps: This is a famous childhood disease caused by a virus that produces swelling of our parotid glands, among other viral symptoms. This is now mostly prevented by the MMR (measles, mumps and rubella) vaccine.
♦ Trigeminal neuralgia (See below)
♦ Acoustic neuroma: A tumour of the nerves in the ear
♦ Multiple sclerosis: A chronic condition that damages the sheaths of nerve cells in the brain and spinal cord.
♦ Temporal arteritis: This is an inflammation of the temporal artery, which is at our forehead.
♦ Polymyalgia rheumatica: An inflammatory disorder that causes pain in muscles.
♦ Fibromyalgia: A rheumatic condition that causes musculoskeletal pain all other the body.
♦ Glaucoma: This is a condition where the pressure in the eyeball is increased, resulting in gradual loss of sight.
♦ Hypoparathyroidism: Lowered activity of the parathyroid gland, which sits in your neck.
My mother has been diagnosed to have trigeminal neuralgia. In 2008, she fell on her face. Now, she is occasionally unable to sleep through the entire night. When the pain attacks her, she will have a mental block. Her movements are also very rigid.
Trigeminal neuralgia is a chronic pain condition that affects your trigeminal nerve. This is our fifth cranial nerve, which carries sensation from our face to our brain. It is a huge nerve because it supplies our whole face, and has three big branches for our upper, middle and lower face.
Naturally, there is a right nerve and a left nerve for either side of our face. If the right side of your face is affected, then one of the causes might be a right-sided trigeminal neuralgia. This condition affects women more than men, especially in those older than 50.
What are the symptoms of trigeminal neuralgia?
Pain – severe, excruciating pain. Even the mildest sensations on your face can trigger this pain, which can be blinding and come suddenly. For example, the pain can be triggered if someone touches your face with a piece of cotton or if you are applying makeup.
Even talking, brushing your teeth, smiling, or even going out into a windy day can trigger a bout of intense pain. Initially, the attacks will be short and mild, but they will get progressively longer and more frequent.
What causes it?
Damage to the trigeminal nerve. Anything that compresses the nerve’s base, like a blood vessel as a result of ageing, or a tumour or injury, can cause this. It is best to scan for other corresponding diseases.
After being diagnosed, my mother has been taking amitriptyline and clonazepam to help her to sleep. Is that the right treatment?
Amitriptyline is an antidepressant. I don’t know what other disorders your mother has and her doctor is the best assessor of all her illnesses. But for trigeminal neuralgia, the treatment is usually anticonvulsants (e.g. carbamazepine or clonazepam) to block the pain signals to your brain or antispasmodic agents, and even Botox injections.
There is also surgery to remove the blood vessel around the nerve root, which can be done by gamma knife, which uses radiation to “cut”. You can also inject glycerol into the trigeminal nerve or use balloon compression. The side effect is facial numbness, but that may be a small price to pay for a life without pain.