Medicine: Tic Tactics

By doctors and patients familiar with it, tic douloureux or trigeminal neuralgia is considered the most painful of human ills. It is a nerve affliction which usually strikes one side of the jaw, occasionally both. The slightest stimulus on certain “trigger areas” of the face may set off lightning-like flashes of agony. Living in dreadful anticipation of the next attack, victims sometimes go weeks without shaving or washing their faces. Cause of tic douloureux is not definitely known. Tooth and sinus infections, circulatory disorders, sudden changes of climate have all been suspected.*

Various medications have been used for relief of tic, such as alcohol injections, salicylates, trichlorethylene. Latest proposed treatment is Vitamin B<SUB>1</SUB> (TIME, May 8). But all these treatments are palliative, none gives permanent relief. Surgical cutting of nerves in the face was tried as early as 1748. Since then the surgical technique has been refined to include cutting of nerve roots and ganglions in the brain.

In Milwaukee last week Dr. Roland Metzler Klemme, St. Louis surgeon, described what he considers the best modern technique for relief of tic douloureux. It is a brain operation performed with the patient in a sitting position, under local anesthetic. Dr. Klemme makes a hole about the size of a quarter in the skull under the temple, lifts up the brain, exposes the root of the fifth cranial nerve, which serves the upper and lower jaws and the eyes. He delicately separates the fibres, severs only the sensory jaw fibres. In this way he has successfully relieved some 200 tic sufferers. In no case has the pain recurred.

Dr. Klemme described the operation at a meeting of the American Dental Association. The dentists were interested because tic douloureux is often mistaken for jumping toothaches or nerve pain following extractions and dental anesthesias.

*In Milwaukee last week a Wisconsin dentist, Dr. T. A. Hardgrove, gave it as his opinion that pockets of typhoid germs are responsible for tic douloureux, said he had tried typhoid vaccine with success.