Posttraumatic Facial Pain

Treatment of facial pain must distinguish between classic trigeminal neuralgia, due to chronic, intracranial, vascular compression and posttraumatic facial pain due to direct injury to one or more branches of the trigeminal nerve. This chapter describes an approach to treating posttraumatic facial pain that is based upon the principles of peripheral nerve surgery. A neuroma is resected and the proximal end must be implanted in an area away from direct trauma. No randomized controlled studies exist. The evidence for the approach listed for each branch of the trigeminal nerve is Level IV from small cohort series of patients. Approaches to the cervical plexus and occipital nerves are included to complete the approach to pain in the entire craniofacial region.