A 36 year old Male with right facial pain
An otherwise healthy 36 year old man presents to clinic with a 1 year history of progressively disabling right sided facial pain. He describes the pain as sudden and electrical in nature, occurring either without warning or in response to benign stimuli including light touch, wind, eating and facial expressions such as smiling. These symptoms occur exclusively in the right side of his face, under his eye and along his jaw line and affect his ability to eat as well as to perform at his job. He was treated with carbamazepine by another doctor and this initially helped greatly, but his symptoms have now returned despite high doses of this medication that are now causing him dizziness and cognitive dysfunction.
Medications: carbamazepine 400 mg twice daily
Neurologically intact, patient winces to light touch on the right face in V2 and V3 distributions but denies numbness to any sensory modality. Otherwise unremarkable.
The patient is discharged on postoperative day 2 with complete resolution of his symptoms. By his 4 week postoperative visit he is thrilled to report that he has weaned off carbamazepine with continued pain relief. He denies any facial numbness or other neurologic symptoms.