Management of trigeminal neuralgia in sclerosteosis
A 40-year-old male patient started his symptoms at the age of 10. At the beginning, he presented intermittent right side facial muscle paralysis and jaw pain. Over the years the symptoms progressed to bilateral facial muscle paralysis, bilateral hypoacusia, headaches, and right side facial pain (jaw, teeth, and tongue).\nIn 2002, he underwent a dental procedure in another institution because of his jaw pain. In 2004, at the age of 30, the patient moved to São Paulo where he was diagnosed with sclerosteosis and TN affecting the right mandibular branch - V3 []. The facial pain was controlled for one year with carbamazepine 1200 mg per day, but side effects limited the maintenance of this medication. Gabapentin was also tried but there was a poor response, so surgical treatment was advised. A percutaneous balloon compression (PBC) was performed in 2005 and the patient had pain control for one year without the use of medications. In 2006, due to recurrence of pain, gabapentin and phenytoin were tried with partial improvement, when a percutaneous radiofrequency rhizotomy (RFR) of the right V3 was performed.\nThe patient had a 2-year period with no facial pain and another 2 years with the pain under control with the use of gabapentin. The control of the TN became worse, despite the increasing doses, and combination of medications. Another percutaneous RFR was performed to treat his right V3 pain in 2012 []. It should be noted that the difficulty in the percutaneous procedures increased over the years due to stenosis of the foramen ovale. However, today his neuralgia is controlled with no medications and he presents with hypoestesia in the right V3 territory.