Patient Story: Lee Roy Nail - Trigeminal Neuralgia

Published on Thursday, October 7, 2021

By: Rachel Browning Truong, rbrowning2@umc.edu

Imagine excruciating pain every time you put a mask on, brush your teeth, or even kiss your spouse. Lee Roy Nail of Stewart, Mississippi, lived that pain for years. With a constant sensation of burning from his eyebrow all the way down to his chin and across to his ear, the pain was so bad that he couldn’t shave. His beard was so long that his kids and their friends referred to him as “lumberjack.”

Nail tried everything to reduce his agony. Dental work didn’t help, medications didn’t last. “I don’t know how many doctors we went to,” said Nail’s wife, Karol. “One of them even told us it was all in his head! That he was making up the pain in his mind.”

The pain was, in fact, in his head, but it was very real. Nail had a rare condition called Trigeminal Neuralgia. The trigeminal nerve splits into three parts or “divisions” that provide sensation from the face. Any of these three divisions can get compressed, causing debilitating pain. This compression is often caused by a normal artery in the neighborhood of the trigeminal nerve. One can imagine with every heartbeat, the offending artery pushes against the trigeminal nerve, sending a painful signal to the brain.

A difficult disease to diagnose, Trigeminal Neuralgia typically causes electric, shock like pain that is triggered by movement like chewing, talking or even laughing. Unfortunately for Nail, he felt constant burning as well as episodes of triggered pain. Referred to UMMC Neurosurgery by a neurologist in Tupelo, Nail fell into the hands of neurosurgeon Dr. Omar Chohan.

Though Nail’s referral to UMMC was for radiation treatment, Dr. Chohan knew of a less abrasive, surgical approach, which had the potential for a better outcome. Though the surgery wasn’t a guarantee for relief, Nail jumped on the opportunity to ease his pain. “I would have done anything to keep from feeling like my face was constantly on fire,” Nail said.

Dr. Chohan and his team performed a microvascular decompression. This surgery is an open skull base procedure where the surgeon separates the trigeminal nerve from the artery causing compression by placing a cotton-like sheet or padding between the two.

“These cases are always very rewarding for both patient and surgeon. If successful, the result is almost immediate,” said Dr. Chohan.

Fortunately for Nail, he woke up pain-free for the first time in years. The operation worked. “The surgery was worth the risk,” Nail said, “I can actually sleep on that side again!” Now, only a few weeks after surgery, he has a clean shaved face and needs a new nickname!