Question:
I am
a 65 year old female and for the last year or so I have been experiencing
strange sensations on the left side of my face.
The eustachian
tube feels momentarily blocked i.e. when I lean forward to stand up
from a seated position there is a "buzz" in my ear, the
left eyelid feels as if it is flickering or twitching (but it isn't),
the left cheek is often flushed.
This
happens about three or four times a day, and usually towards the end
of the day.
There
is also some pain and tenderness in front of the ear, and sometimes
the glands on the left side of my neck are swollen.
I have
Rheumatoid arthritis (diagnosed in 2005).
Are the
above symptoms related, even though they occur unilaterally?
If not,
what could be the problem?
I worry
the there might be a space occupying lesion or something in the parotid.
Wendy
Answer:
Dear
Wendy,
The trigeminal
nerve comes out just below the ear and handles the sensation and the
facial muscles on each side.
A common
cause of facial pain includes Trigeminal neuralgia.
Trigeminal
neuralgia affects the trigeminal nerve, one of the largest nerves
in the head.
The most
frequent cause of trigeminal neuralgia is a blood vessel pressing
on the nerve near the brain stem.
Usually,
the pain is felt on one side of the jaw or cheek, but some people
experience pain at different times on both sides. The attacks of pain
may be repeated one after the other.
They
may come and go throughout the day and last for days, weeks, or months
at a time. At times,the attacks can disappear for months or years.
The disorder is more common in women than in men and rarely affects
anyone younger than 50.
Magnetic
resonance imaging (MRI) can be used to determine whether a tumor or
multiple sclerosis is irritating the trigeminal nerve. Otherwise,
no test can determine with certainty the presence of trigeminal neuralgia.
Tests can, however, help rule out other causes of facial disorders.
If medications
are ineffective or if they produce undesirable side effects, neurosurgical
procedures are available to relieve pressure on the nerve or to reduce
nerve sensitivity.
Some
patients report having reduced or relieved pain by means of alternative
medical therapies such as acupuncture, chiropractic adjustment, self-hypnosis
or meditation.
A. Vilches
and M. J. Burke from Burnley General Hospital, UK, sent a Letter to
the Editor of Rheumatology the journal of the British Society for
Rheumatology on January 2001 presenting one case of TSN or Trigeminal
sensory neuropathy in a patient with RA or rheumatoid arthritis
The title
of the letter was: Trigeminal sensory neuropathy and rheumatoid arthritis:
case study of a rare association , and they said that the differential
diagnosis of TSN was wide and in many cases remained unexplained and
they found a lengthy duration of symptoms over a period of several
years with little change or improvement
