Posted by: wockhardthospitals | July 29, 2009

57 year old finally smiles after a decade of facial pain! Minimally invasive Microvascular Decompression (MVD) surgery

Doctors at Wockhardt Hospitals give him a new lease of life by relieving him of his 10 years of facial pain

Dr. Rajakumar and Patient Ramesh

A Team of doctors at Wockhardt Hospitals put the smile back on the face of Mr. B M Ramesh. Dr. Deshpande V Rajakumar, Consultant Neurosurgeon, Wockhardt Hospitals performed a minimally invasive Microvascular Decompression (MVD) surgery to relieve Mr. Ramesh of his facial pain.

Mr. B M Ramesh, a 57 year old gentleman and a former journalist who hails from Mysore, was compelled to take early retirement from his job as he was suffering from excruciating pain on the right side of his face. He was suffering from this unbearable facial pain for the past 10 years and was under medication for a long period. But nothing really brought him relief and in due course of time he became refractory to even maximum dose of medication. Since then he continued to live with his pain, managing himself by avoiding the precipitating factors, restricting his social life to within home and the medication. He was barely able to speak, chew food as jaw opening and sensory stimulus to upper jaw triggered the pain on the right side. At times he even used to keep a piece of wood in between his teeth to avoid biting his own tongue due to sheer pain.

Having suffered for so long Mr. Ramesh finally visited Wockhardt Hospitals where he was diagnosed with a neuro disorder called – Trigeminal Neuralgia, a disorder of one or both of the facial trigeminal nerves (the fifth cranial nerve, also called the fifth nerve or simply V which is responsible for sensation in the face) and was advised a minimally invasive surgery for the same.

According to Dr. Deshpande V Rajakumar, Consultant Neurosurgeon, Wockhardt Hospitals, “Trigeminal neuralgia is an uncommon disease with an incidence 4.7 per 100,000 (prevalence of 155 per million) and occurs more frequently in the middle or later age groups, more in females than in males. It is more common on the right side of the face rather than the left side. It generally affects the lower jaw zone (mandibular) more than the upper jaw (maxillary). It was Mr. Ramesh’s courage that kept him going on for so many years”.

He also added, “It is fortunate that 70-80% of patients respond well to medical therapy and can either be pain free or tolerably relieved of pain. Unfortunately 30% of the patients become refractory to it after 2years and some develop drug intolerance due to adverse effects. About half of all patients eventually require surgery for pain relief. Microvascular Decompression is the only surgical option that allows for obtaining long-term pain relief while avoiding any sensory disturbance. In our opinion, it still remains the treatment of choice for all patients with drug-resistant typical Trigeminal Neuralgia.”

Trigeminal Neuralgia is one of the worst known facial pains. The pain is paroxysmal or episodic in occurrence; each episode consists of a cluster of lancinating or ‘electric shock’ like pains, severe to excruciating in intensity lasting from a few seconds to a few minutes and keeps recurring, at a variable frequency, leaving a pain free interval between the episodes.

The pain is usually precipitated by a sensory stimulus or a ‘trigger’ such as

  • light touch on that side of face, a breeze of wind or a splash of water on the face

  • acts of swallowing food or liquids

  • mastication(chewing/biting)

  • talking

These factors often lead to bad oral hygiene and weight loss. Some describe the pain like ‘bursting of a cracker on the face’ or like ‘thrusting an electric solder into the face’. The intensity of Trigeminal Neuralgia’s pain has ruined several academic careers, wrecked marriages and also forced people to commit suicide. Many patients have had multiple tooth extractions and some have had a complete new set of dentures done before they are correctly diagnosed and treated.

Addressing the media Mr. B M Ramesh said, “I am utterly grateful and happy that I can smile again. I thank the doctors at Wockhardt Hospitals for their utmost care and concern. If I had come here earlier I wouldn’t have lost those years of my life and wouldn’t have had to suffer the agonizing pain which altered my personality over the years. After this surgery I feel I have been gifted a new life and I look forward to resuming back my normal life”

Microvascular Decompression (MVD) surgery is done through an approach behind the ear. A 5 cm long skin cut is made and a 3cm diameter bone is removed using a high speed drill. Now the covering of the brain is opened and the area of trigeminal nerve is reached with gentle retraction of brain (cerebellum), all this is done under high magnification using the microscope.

The blood vessel compressing the trigeminal nerve near its entry into the brainstem is moved away and kept separated by interposing a Teflon patch in between. This patch prevents the pulsations of the blood vessel being transmitted to the nerve root. Now the brain covering is stitched back, bone is replaced and then the skin stitched.

Mr. Ramesh was relieved of the pain immediately after being awake from anesthesia. He went home on the 3rd day after surgery. Microvascular Decompression has given him a new lease of life and he can look forward to his normal routine once again


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