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Trigeminal nerve damage

      Re: Trigeminal nerve damage

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Posted by ccf neuro M.D.* on November 23, 1997 at 15:15:15:

In Reply to: Trigeminal nerve damage posted by Nancy Blonshnine on November 10, 1997 at 15:45:20:
  In May of 1996 I had upper and lower eye lid surgery, lip enhancement and a full facelift.  This procedure was done at two separate times, eyes and lips on May 16th and facelift on May 19th.
  Everything was fine until one week after the facelift when I started feeling a tickling in my right eye (like a hair was in my eye).  Eight days later, my left eye felt very dry and by the end of the day my right eye kicked in with this dry feeling.  I went back to my plastic surgeon, who immediately sent me to two opthomologists; all of whom could find nothing wrong.
  The discomfort was so intense that I literally packed ice on my eyes, secured by an ace bandage and continued 24 hours a day, for the next four weeks.  The pain, or pressure if you will, appeared to come from the back of my head and all around the incisions.  I also noticed when I scratched the left side of my crown, that when I did so it felt like a tremor was reaching my left temple.
  The vice like feelings from my incisions have practically subsided; however, the discomfort is now localised immediately under my eyes and sometimes around the incisions above my eyes.  This pressure feeling is almost constant, with the feeling of sandpaper in my eyes always.  In order to get some relief, I find myself pushing on the check bone immediately under and along the lower eye.  I also hold ice packs on these areas to the point where I get a burning feeling.  As you can imagine, I look like I have been in the boxing ring with Mike Tyson.
  The last physician I saw was an opthomologist at the Mayo Clinic in Jax.  He said that he felt that I needed an MRI and didn't think there was a problem with my eyes.
  I am under the care of a neurologist; however, although he believes it is trigeminal nerve damage he has not seen this caused from cosmetic surgery.  I am on 1800 mg. of Neurontin per day and 15 mg. of Restoril at night.  I don't believe that the medication is relieving any of my discomfort; however, I was taking tegretol at one stage, which also didn't seem to help.
  I would really like to know if you have ever come across these symptoms; as I find it hard to believe that I am the only person in the world that this has happened to.
  I thank you in anticipation
There is a small nerve on each side of the face called the infraorbital nerve. It comes out of a small hole at the bottom center portion of the bony orbit (the part of the skull your eyes sit in), and you can feel where it is if you put your finger on the ridge of bone just beneath the ridge of bone under your lower eyelid on each side of your face. It is conceivable that damage, irritation, or scarring to this nerve could cause the symptoms you are describing, although it is most unusual for such a small nerve to not completely and easily heal even if it was cut in half during surgery, much less moved around a bit. It is possible to administer a nerve block or cortisone injection to this nerve, but if it is blocked using anesthetic, this will make the eye go numb, resulting in a very high risk of corneal abrasion since you would not be able to sense dust or foreign bodies in the eye. Other options for irritated or poartially damaged nerves include anticonvulsant type drugs like dilantin (phenytoin) or Tegretol (carbamezapine), or tricyclic antidepressant drugs, which at doses much smaller than those used to treat depression produce gradual changes in the chemical balnce of small nerve fibers that produce the pain. All of these drugs have significant side effects, however, and should not be used for something that is merely a nuisance--- but from your description of things your symptoms have gone far beyond the nuisance level!! Neurontin is sometimes effective in alleviating such discomfort, although I've not been especially impressed with it. Its major good pint, however, is that it has for all intents and purposes no side effects and no drug interactions, making it an easy and safe first choice drug. Another "closet" drug is known as mexilitine, essentially a pill version of novacaine. it should not be used as first line treatment however as serious side effects may result, especially in persons with heart trouble. If medication cannot control your symptoms to your satisfaction or causes too many undesirable side effects, a steroid injection and/or block into the infraorbital nerve foramen may be worth considering. If you would be interested in seeing a Cleveland Clinic neurologist about your problem, the number is 1-800-223-2273. since you apparently live in or near Florida, I would also draw your attention to the Cleveland Clinic Florida, located in Fort Lauderdale; I would suggest Dr. Maurice Hanson or Virgil Salanga if you decide to head down there. There is a 1-800 number for CCF Florida but I don't know it off the top of my head. 1-800 directory assistance should have it. Remember, information provided in the forum is intended for general medical informational purposes only, and that the actual diagnosis and treatment of your specific medical condition should be strictly in conjunction with your treating physician(s). we hope you find the information helpful and a solution to your problem. Good Luck!!!

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