Name of the Procedure:

Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital, mental, or inferior alveolar branch

Summary

This procedure involves the intentional destruction of specific branches of the trigeminal nerve using a neurolytic agent. It aims to alleviate chronic facial pain by damaging the nerve fibers that transmit pain signals.

Purpose

Medical Condition or Problem:

• Chronic facial pain (like trigeminal neuralgia)
• Persistent pain after dental procedures

Goals or Expected Outcomes:

• Alleviation or significant reduction of chronic facial pain
• Improvement in quality of life and daily functioning

Indications

Specific Symptoms or Conditions:

• Severe, chronic facial pain unresponsive to other treatments
• Recurrent episodes of pain affecting areas innervated by the trigeminal nerve branches

Patient Criteria:

• Patients with diagnosed trigeminal neuralgia or other facial pain disorders
• Patients who have not achieved pain relief from medications or other less invasive treatments

Preparation

• Fasting may be required for a few hours before the procedure.
• Patients may need to adjust or discontinue certain medications as per their doctor’s advice.
• Diagnostic imaging or nerve function tests may be conducted to identify the precise location for treatment.

Procedure Description

1. The patient is positioned comfortably, and the treatment area is sterilized.
2. Local anesthesia is applied to numb the skin and subcutaneous tissues.
3. Using imaging guidance, a needle is inserted near the targeted nerve branch.
4. A neurolytic agent (such as phenol or alcohol) is injected to destroy the nerve fibers.
5. The needle is removed, and the area is cleaned and bandaged.

Tools and Technology:

• Imaging equipment (ultrasound, CT scan, or fluoroscopy)
• Specialized needles
• Neurolytic agents

Anesthesia:

• Local anesthesia is usually sufficient, though sedation options are available if needed.

Duration

The procedure typically takes around 30 to 60 minutes.

Setting

The procedure is usually performed in an outpatient clinic or a surgical center.

Personnel

• Interventional Radiologist or Pain Specialist
• Nursing staff
• Anesthesiologist (if sedation is required)

Risks and Complications

Common Risks:

• Bruising or swelling at the injection site
• Temporary numbness or weakness ##### Rare Risks:
• Allergic reaction to the neurolytic agent
• Infection
• Unintentional damage to surrounding nerves

Possible Complications:

• Persistent numbness
• Neuropathic pain management involves follow-ups

Benefits

• Significant pain reduction or complete pain relief
• Improvement in the ability to perform daily activities
• Reduced need for pain medications

Recovery

• Most patients can go home the same day.
• There may be mild discomfort or swelling for a few days.
• Follow-up appointments to monitor effectiveness and address any complications.
• Patients should avoid strenuous activities for a few days.

Alternatives

• Medications (anticonvulsants, antidepressants)
• Nerve blocks or steroid injections
• Surgical options (microvascular decompression, radiofrequency ablation)

Pros and Cons of Alternatives:

• Medications: less invasive but may have side effects and vary in effectiveness.
• Nerve blocks: temporary relief but may require repeated treatments.
• Surgery: longer-lasting relief but higher risk and longer recovery.

Patient Experience

• Patients may feel a brief sting or pressure during the injection.
• Post-procedure pain management includes over-the-counter pain relievers and cold compresses.
• Most patients report significant pain relief shortly after the procedure.