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Facial Pain May Be Caused From Neck
Ms. Yang, 40 yrs old, has suffered facial pain on her right side face since December 2017, with soreness on her neck and shoulders. After being examined by her family doctor, she was suspected to have trigeminal neuralgia. She was prescribed steroids and anti-inflammatory medication, the condition was relieved but soon relapse after she stopped taking the medications. Her facial pain was suspected to be caused by inflammation of the gums, however, as time progresses on, the symptoms shows no sign of improvements. In 2018 January, doctor gave Ms. Yang an MRI scan of her brain and trigeminal nerve, the report does not particularly show anything unusual and then she was prescribed medication and also did not show any improvements for her symptoms.
After Ms. Yang was introduced to our center by a friend, the magnetic resonance scanning was done on the cervical spine and found her C3/4 disc protruding and the right intervertebral foramen stenosis.This may cause Miss Yang’s right facial pain, she was then treated with Cox® Decompression Manipulation, then after two months of treatment, her condition improved greatly.
Fig 1 - Cervical disc protrusion causing facial pain
Fig 2 - neck strain can ofter leads to cervical disc protrusion
Why does cervical spondylosis cause tingling or pain in the face?
The cervical spine is the most flexible part of the spine. For this reason, it is also susceptible to various injuries, Cervical disc herniation is one of them which may due to injury, poor posture and poor lifestyle.
In recent years, many studies and reports have pointed out that cervical disc herniation compressed on spinal nerve can cause pain, tingling and numbness in the neck, shoulders, arms and hands. However, it may also cause symptoms of tingling or pain in the face, clinically known as cervicogenic facial pain. We have a set of trigeminal nerves extending from the brainstem, this nerve fiber originates from the cranial nerve III. Then extends to C3 of the sensory nerve that transmit pain and other feelings such as pressure, touch, temperature to the brain.
Magnetic resonance imaging (MRI) scanning scan revealed the right intervertebral foramen stenosis and slight disc herniation in the C3,4. This is the right-side pain that Miss Yang suffered from.
How to diagnosis:
To correctly diagnose this condition, must first rule out the possibility of other causes. Any type of facial sensation is associated with the trigeminal nerve, which is the cranial nerve directly from the brain. When these trigeminal nerve disorders are found, there are different areas of facial sensations and pains. In most cases, it feels like numbness or stinging on one side of the face.
Other possibilities for causing facial pain:
Trigeminal neuralgia:
There are twelve pairs of cranial nerve. The fifth pair is called the trigeminal nerve, from the brain stem extending towards the face. Since this nerve has three branches, controlling the forehead, the face and the lower jaw respectively, it is called the trigeminal nerve. Trigeminal neuralgia is caused by the nerve being compressed by adjacent blood vessels. The feeling is very painful, described as an electric shock and knife cutting on one side, each pain can last for a few seconds to a few minutes, or it may be intermittent, with some patients having pain on both sides and in the gums. The diagnostic method can use magnetic resonance imaging (MRI) scanning to review at the trigeminal nerve is compressed by the blood vessel. If the drug is ineffective, microvascular decompression surgery can be performed by a neurosurgeon.
Bell’s Palsy disease:
Symptoms includes facial muscle imbalance, pouting, drooping at the corner of the mouth, unable to laugh, eyes not able to close properly, water leaks from mouth when drinking, dry eyes. The cause of Bell’s Palsy is that the body is to resist a certain virus, but with the immune system overreaction, it causes the cranial nerve 7 to be damaged and inflamed. Most patients gradually recover within one to three months.
Multiple sclerosis:
Multiple sclerosis is a disease of the central nervous system (brain and spinal cord) which is also considered to be an autoimmune disease. The immune system in the patient’s body cannot distinguish which cell is their own, which cause them to attack their own tissue, causing the myelin sheath to be damaged (causing the nerve to fail to transmit the message normally), also causing some patients to have facial pain.
