244 Westchester Avenue, White Plains, NY
Alain C. J. de Lotbinière, MD, CM, FACS, FRCSC
914-948-6688

Causes

The cause of persistent idiopathic facial pain (PIFP) is usually an injury to the trigeminal nerve or its branches as opposed to a vessel pressing upon the nerve, although this may be present as well. A typical example would be the pain that occurs with postherpetic neuralgia, in which the cause is the herpes virus destroying a portion of the nerve resulting in a painful numbing sensation often described as a burning, searing pain.

Other causes include trauma to the face, whether as a result of an accident or from surgery such as a dental procedure (tooth extractions, root canal procedures, etc.) or facial reconstruction following a fracture.

Treatment

Unlike trigeminal neuralgia, PIFP responds poorly to the usual medications utilized to treat trigeminal neuralgia and neuroablative needle procedures rarely help the patient, on occasion making the pain worse. Fortunately, there are some neurosurgical interventions for the treatment of PIFP that have proven successful in a significant number of patients. These include stimulation of the trigeminal nerve or its branches, motor cortex or deep brain stimulation, and in some cases lesioning of the trigeminal nerve pathways within the brainstem (nucleus caudalis dorsal root entry zone lesioning).

X-ray of motor cortex stimulator in place

X-ray of motor cortex stimulator in place

It is important to note that patients with longstanding trigeminal neuralgia may also develop persistent pain between attacks when they occur in clusters, the pain being referred to as type 2 trigeminal neuralgia by some practitioners.

Dr. de Lotbiniere’s familiarity with the treatment of PIFP and the various neurosurgical interventions utilized to treat it is well established, his experience in utilizing the neurosurgical techniques mentioned above extending back over 20 years.