Facial Pain and Spasm Center

Medically reviewed by Facial Pain and Spasm Center ·4 min read

Board-certified neurosurgeons · 12 NJ hospital affiliations

In short

The Atlantic Brain and Spine Facial Pain and Spasm Center provides comprehensive evaluation and surgical treatment for cranial nerve pain syndromes and facial movement disorders including trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and related conditions. The center integrates neurosurgery, neurology, and neuroradiology to ensure accurate diagnosis and individualized treatment planning before any surgical intervention is undertaken.

Key takeaways

The Facial Pain and Spasm Center specializes in the evaluation and surgical treatment of trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, and other cranial nerve pain syndromes.
Accurate diagnosis is the foundation of effective treatment many patients are misdiagnosed for years before a cranial nerve pain syndrome is correctly identified.
Microvascular decompression (MVD) provides the most durable long-term pain relief for appropriate candidates with neurovascular compression.
CyberKnife radiosurgery is available as a non-surgical option for patients not suitable for open surgery.
Dr. Ronald P. Benitez and the ABS team have extensive experience with MVD for all cranial nerve pain syndromes.

FACIAL PAIN AND SPASM CENTER AT A GLANCE

Conditions treated	Trigeminal neuralgia, hemifacial spasm, glossopharyngeal neuralgia, geniculate neuralgia, atypical facial pain
Surgical treatment	Microvascular decompression (MVD) the most durable available option
Non-surgical options	CyberKnife radiosurgery, percutaneous rhizotomy, Botox injection (hemifacial spasm)
Diagnosis	Clinical evaluation + high-resolution posterior fossa MRI + diagnostic nerve blocks where applicable
Key surgeons	Dr. Ronald P. Benitez, Dr. Yaron A. Moshel
Referrals	Accepts referrals from neurology, dentistry, pain management, and ENT

Timing and stay vary by patient and complexity. Your surgeon will confirm what to expect in your case.

Conditions treated at the Facial Pain and Spasm Center

Trigeminal neuralgia

The most common cranial nerve pain syndrome sudden, electric shock-like facial pain triggered by touch, eating, or speaking. Usually caused by superior cerebellar artery compression of CN V. Surgical treatment: MVD for trigeminal neuralgia.

Hemifacial spasm

Involuntary, uncontrollable twitching of one side of the face from PICA or AICA compression of the facial nerve (CN VII). Surgical treatment: MVD for hemifacial spasm. Non-surgical: Botox injection every 3 to 4 months.

Glossopharyngeal neuralgia

Severe shock-like pain deep in the throat and ear triggered by swallowing, from compression of CN IX/X. Surgical treatment: MVD for glossopharyngeal neuralgia.

Geniculate neuralgia (nervus intermedius neuralgia)

Deep ear pain from compression of the nervus intermedius (a branch of CN VII). Rare; treated with decompression of the nervus intermedius at the same posterior fossa approach used for MVD.

Atypical facial pain

Facial pain that does not fit the classic pattern of trigeminal neuralgia constant rather than episodic, bilateral, or associated with sensory loss. Often does not have a neurovascular compression etiology and may respond better to medical management or other approaches. Careful diagnostic evaluation is essential before surgical intervention.

Our diagnostic approach

Accurate diagnosis before treatment is the cornerstone of the Facial Pain and Spasm Center’s approach. Many patients arrive after years of treatment for dental pain, TMJ disorder, or migraine conditions that share some features with cranial nerve pain syndromes but require entirely different treatment.

The evaluation includes:

Detailed clinical history: The character, location, duration, and triggers of the pain are highly diagnostic. Classic TN pain (episodic, electric, triggered by light touch) is very different from atypical facial pain (constant, diffuse, poorly localized).
High-resolution posterior fossa MRI: Thin-cut MRI sequences through the posterior fossa with dedicated nerve-vessel contact sequences identify neurovascular compression at the root entry zone.
Diagnostic nerve blocks: For glossopharyngeal neuralgia and atypical facial pain, diagnostic injection of local anesthetic near the relevant nerve confirms the diagnosis before surgery is recommended.
Multidisciplinary input: Neurology, neuroradiology, and pain management may be involved in complex diagnostic cases before a surgical recommendation is made.

Benefits and risks

Potential benefits

Specialized center focused exclusively on cranial nerve pain reducing diagnostic delay
MVD provides the highest long-term pain relief rates for neurovascular compression syndromes
Non-surgical options available for patients not suitable for open surgery
Botox injection for hemifacial spasm is available for patients who prefer non-surgical management

Possible risks

Individual risks vary by treatment see individual procedure pages for MVD and CyberKnife risk details
Misdiagnosis of atypical facial pain as TN can lead to surgery that does not relieve pain emphasizing the importance of careful pre-operative evaluation
Not all facial pain has a surgical solution the center is candid about which conditions benefit from surgery and which do not
Medical management of cranial nerve pain carries its own side effect profile (carbamazepine, oxcarbazepine)

Your surgeon will review the benefits and risks specific to your diagnosis during your consultation.

What recovery looks like

Recovery varies by treatment. For surgical treatments, see the individual procedure pages. For non-surgical options:

Botox injection (hemifacial spasm) Outpatient injection. Onset of effect within 3 to 7 days. Duration of effect 3 to 4 months. Repeat injections required.
CyberKnife (trigeminal neuralgia) Outpatient treatment. Pain relief onset 1 to 3 months after treatment. See CyberKnife page for details.
MVD Hospital stay 2 to 4 nights. Full activity in 4 to 6 weeks. Immediate or near-immediate pain relief in most cases. See individual MVD pages.
Long-term follow-up All patients have scheduled follow-up to assess treatment response, medication changes, and recurrence.

Frequently asked questions

How do I get a referral to the Facial Pain and Spasm Center?

Self-referral is accepted. Patients may call Atlantic Brain and Spine directly to schedule a consultation. Referring physicians neurologists, dentists, pain specialists, and ENT physicians may also refer patients directly. Bring any prior MRI imaging and medical records to your consultation.

Can trigeminal neuralgia go away on its own?

Spontaneous remissions occur in a small percentage of patients, but most patients with TN experience progressive severity and frequency of attacks over time. Medical management with carbamazepine provides reasonable control for many patients initially, but medication efficacy often decreases over years while side effects accumulate. For patients with intractable or poorly controlled TN, surgical evaluation is appropriate.

Is surgery the only option for trigeminal neuralgia?

No. Medical management with carbamazepine or oxcarbazepine is always tried first. Surgical options include MVD, CyberKnife radiosurgery, and percutaneous procedures (balloon compression, glycerol injection, radiofrequency thermocoagulation). The appropriate treatment depends on the patient’s age, health, MRI findings, medication response, and the specific variant of TN.

What is atypical trigeminal neuralgia?

Atypical TN (Type 2 TN) involves more constant, aching, or burning pain in addition to episodic attacks in contrast to classic TN (Type 1), which is purely episodic electric pain. Atypical TN has a less predictable response to MVD than classic TN, and careful patient selection and counseling about realistic expectations are essential before surgical intervention.

This page is for general education and does not replace medical advice. Treatment decisions should be made with a qualified neurosurgeon based on your individual diagnosis and imaging. To discuss your options, call Atlantic Brain and Spine Brain Tumor Care at 973.993.7322 or request a consultation.