Percutaneous balloon compression provides durable relief of orofacial pain

treatment option for patients suffering from debilitating chronic facial pain in Hong Kong.

“With PBC, patients who are unable or unwilling to undergo more invasive surgeries now have a potential alternative for pain management, as traditional modalities for orofacial pain, including neuropathic pain medications, often provide inadequate pain relief and some patients experience intolerable side effects,” said leader of the research team, Dr Stanley Sau-Ching Wong from the Department of Anaesthesiology, HKU.

PBC is an interventional technique designed to alleviate pain associated with the trigeminal nerve, which is involved with facial sensation. During the procedure, a tiny balloon is inserted through the cheek into the trigeminal ganglion near the base of the skull and inflated with contrast medium to gently compress the nerve’s pain fibres. Proper placement is confirmed by fluoroscopic imaging showing the characteristic pear-shaped appearance of the balloon.

“The introduction of PBC marks a substantial advancement in our ability to manage complex orofacial pain,” noted co-leader of the team, Dr Timmy Chi-Wing Chan from the Department of Anaesthesia, QMH.  “Unlike the traditional technique using radiofrequency ablation [RFA], which requires awake sensory testing to locate the precise pain area, patients are anaesthetized throughout the whole PBC procedure, making it a more comfortable experience. PBC provides broader coverage of trigeminal nerve branches, making it effective for facial pain involving the ophthalmic, maxillary, and mandibular regions in a single intervention.”

“PBC is especially beneficial for patients with ophthalmic division [V1] or multibranch involvement,” added Dr Yiu-Chung Lau from the Department of Anaesthesia, QMH, another co-leader of the team. “PBC is safe and highly effective, especially for ophthalmic complications. While RFA remains an excellent treatment option for orofacial pain, especially for isolated lower-facial pain where selective lesioning is desirable, PBC complements our existing expertise in RFA, allowing us to tailor appropriate treatment for individuals experiencing pain in different areas.”

According to the researchers, the effectiveness of PBC is supported by evidence from international data and emerging local experience, which showed initial pain relief rating exceeding 80 percent, comparable to that of RFA. Meta-analyses have also found a modest advantage in durability with PBC vs RFA, with a statistically lower pain recurrence rate at 1 year. Additionally, >70 percent of PBC-treated patients remained pain-free after 10 years, making PBC a reliable choice for sustained relief. [Pain Physician 2023;26:E823-E832; Acta Neurol Belg 2023;123:2295-2302; Front Surg 2025;12:1596722; Front Neurol 2023;14:1178335; Clin Neurosurg 2009;56:73-78]

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

“Over the past 2 years, the HKU-QMH pain management team has performed 40 PBC procedures for conditions such as trigeminal neuralgia and postherpetic neuralgia. Early results showed encouraging outcomes in relieving patients’ pain and improving overall function,” said Chan.