Percutaneous balloon compression developed for managing orofacial pain

PBC is an interventional technique that alleviates pain by inserting a small balloon into the trigeminal ganglion near the base of the skull and inflating it to compress the nerve’s pain fibers. Credit: The University of Hong Kong

The pain management teams at the LKS Faculty of Medicine of the University of Hong Kong (HKUMed) and Queen Mary Hospital (QMH) have introduced percutaneous balloon compression (PBC) as a novel treatment option for patients suffering from debilitating chronic facial pain. The teams began performing this sophisticated neuroablative procedure in 2024, and so far, 40 patients have benefited from this powerful and durable treatment.

Chronic orofacial pain, including conditions such as trigeminal neuralgia—characterized by sudden, severe, electric shock-like facial pain—and pain from herpes zoster, imposes a significant burden on patients. It often causes psychological distress and functional impairment, severely impacting their quality of life.

Dr. Stanley Wong Sau-ching, Clinical Associate Professor in the Department of Anesthesiology, School of Clinical Medicine, HKUMed, said, “Traditional pain management methods for orofacial pain often involve neuropathic pain medications, but some patients experience inadequate relief and intolerable side effects with varied success rates. Thanks to the introduction of PBC, patients who are unable or unwilling to undergo more invasive surgeries now have a promising alternative for pain management.”

Emerging as an effective alternative for pain relief

PBC is an interventional technique designed to alleviate pain associated with the trigeminal nerve, which is responsible for facial sensation. The procedure involves inserting a tiny balloon through the cheek into the trigeminal ganglion near the base of the skull and inflating it with contrast medium to gently compress the nerve’s pain fibers. Proper placement is confirmed by fluoroscopic imaging, which shows the characteristic pear-shaped appearance of the balloon.

Dr. Timmy Chan Chi-wing, Consultant in the Department of Anesthesia, Pain and Perioperative Medicine at QMH, explained the significance of the PBC treatment: “The introduction of PBC marks a substantial advancement in our ability to manage complex orofacial pain.

“Unlike the traditional technique using radiofrequency ablation (RFA), which requires awake sensory testing to locate the precise pain area, patients are anesthetized throughout the whole PBC procedure, making it a more comfortable experience for patients. PBC provides broader coverage of the trigeminal nerve branches, making it effective for facial pain involving the ophthalmic, maxillary, and mandibular regions in a single intervention.”

“It is especially beneficial for patients with ophthalmic division (V1) or multi-branch involvement,” added Dr. Lau Yiu-chung, Associate Consultant, Department of Anesthesia, Pain and Perioperative Medicine at QMH. “PBC is a safe and highly effective option, especially concerning ophthalmic complications. It complements our existing expertise in RFA, allowing us to tailor appropriate treatment for individuals experiencing pain in different areas.”

Proven long-term efficacy: Over 70% pain-free after a decade

International data and emerging local experience confirm the strength of PBC, achieving an initial pain relief rating exceeding 80%, comparable to that of RFA. Notably, meta-analyses suggest that PBC has a modest advantage in durability at the one-year mark, with a statistically lower recurrence rate. Additionally, over 70% of patients remain pain-free after 10 years, making PBC a reliable choice for sustained relief.

“In the past two years, the HKU-QMH pain management team has performed 40 PBC procedures for conditions such as trigeminal neuralgia and postherpetic neuralgia. Early results have shown encouraging outcomes in relieving patients’ pain and improving overall functions,” said Dr. Timmy Chan Chi-wing.

While facial numbness and chewing muscle weakness are common side effects of PBC, they are usually temporary and well-tolerated. PBC also demonstrates a lower risk of eye-related complications than RFA, particularly for patients with ophthalmic division (V1) pain.

Procedures under general anesthesia—ideal for complex cases

The decision between PBC and RFA depends on the type and number of branches of the trigeminal nerves involved, patient health, and clinical expertise or preference. PBC may be advantageous for pain involving the ophthalmic division (V1), when multiple branches of the trigeminal nerves are involved or for patients who prefer to avoid awake sensory testing. RFA remains an excellent treatment option for orofacial pain, especially for isolated lower-facial pain where selective lesioning is desirable.

“The addition of PBC to Hong Kong’s pain treatment options offers new hope for patients with challenging facial pain conditions,” concluded Dr. Stanley Wong Sau-ching. “We can now tailor treatment to the individual. PBC offers durable relief with a strong safety profile, particularly for complex cases. Optimal management is about having the right tool for the right patient.”