Cases reported "Facial Pain"

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1/12. Phase II therapy for a chronic pain patient: a clinical report.

    One of the roadblocks to success in treating temporomandibular joint dysfunction (TMD) patients is an accurate diagnosis. The terms "TMJ" or "TMD" are not specific enough to provide definitive treatment. Initially the disorder must be classified as a muscular or an internal derangement problem. Once accomplished, the further diagnostic breakdown of the problem will prepare the patient and the doctor for the scope of treatment necessary and the prognosis. This lack of a specific diagnosis can lead to inappropriate treatment and inadequate communication among clinical dentists, academia and patients. Our patients and the profession will continue to suffer until a single diagnostic system is universally agreed upon and utilized.
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2/12. Neuropathic orofacial pain. Part 2-Diagnostic procedures, treatment guidelines and case reports.

    Neuropathic orofacial pain can be difficult to diagnose because of the lack of clinical and radiographic abnormalities. Further difficulties arise if the patient exhibits significant distress and is a poor historian regarding previous diagnostic tests and treatments, such as somatosensory local anaesthetic blockade. Valuable information can be obtained by utilising the McGill Pain Questionnaire that allows the patient to choose words that describe the qualities of his/her pain in a number of important dimensions (sensory and effective). Basal pain intensity should be measured with the visual analogue scale, a simple instrument that can evaluate the efficacy of subsequent treatments. The dentist or endodontist can employ sequential analgesic blockade with topical anaesthetics and perineural administration of plain local anaesthetic to ascertain sites of neuropathology in the PNS. These can be performed in the dental chair and in a patient blinded manner. Other, more specific, tests necessitate referral to a specialist anaesthetist at a multidisciplinary pain clinic. These tests include placebo controlled lignocaine infusions for assessing neuropathic pain, and placebo controlled phentolamine infusions for sympathetically maintained pain. The treatment/management of neuropathic pain is multidisciplinary. Medication rationalisation utilises first-line antineuropathic drugs including tricyclic antidepressants such as amitriptyline and nortriptyline, and possibly an anticonvulsant such as carbamazepine, sodium valproate, or gabapentin if there are sharp, shooting qualities to the pain. mexiletine, an antiarrhythmic agent and lignocaine analogue, may be considered following a positive patient response to a lignocaine infusion. All drugs need to be titrated to achieve maximum therapeutic effect and minimum side effects. Topical applications of capsaicin to the gingivae and oral mucosa are a simple and effective treatment in two out of three patients suffering from neuropathic orofacial pain. Temporomandibular disorder is present in two thirds of patients and should be assessed and treated with physiotherapy and where appropriate, occlusal splint therapy. attention to the patient's psychological status is crucial and requires the skill of a clinical psychologist and/or psychiatrist with pain clinic experience. Psychological variables include distress, depression, expectations of treatment, motivation to improve, and background environmental factors. Unnecessary dental treatment to "remove the pain" with dental extractions is contraindicated and aggravates neuropathic orofacial pain.
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3/12. Sympathetic activity-mediated neuropathic facial pain following simple tooth extraction: a case report.

    This is a report of a case of sympathetic activity-mediated neuropathic facial pain induced by a traumatic trigeminal nerve injury and by varicella zoster virus infection, following a simple tooth extraction. The patient had undergone extraction of the right lower third molar at a local dental clinic, and soon after the tooth extraction, she became aware of spontaneous pain in the right ear, right temporal region, and in the tooth socket. At our initial examination 30 days after the tooth extraction, the healing of the tooth socket was normal; however, the patient had a tingling and burning sensation (dysesthesia) and spontaneous pain of the right lower lip and the right temporal region, both of which were exacerbated by non-noxious stimuli (allodynia). The patient also showed paralysis of the marginal mandibular branch of the facial nerve, taste dysfunction, and increased varicella zoster serum titers. A diagnostic stellate ganglion block (SGB) 45 days after the tooth extraction using one percent lidocaine markedly alleviated the dysesthesia and allodynia. These symptoms are characteristic of neuropathic pain with sympathetic interaction. The patient was successfully treated with SGB and a tricyclic antidepressant.
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4/12. Eagle syndrome: entrapment of the glossopharyngeal nerve? Case report and review of the literature.

    Eagle syndrome is characterized by unilateral pain in the oropharynx, the side of the face, and the earlobe. It is caused by an elongated styloid process; resection of the elongated process eliminates the pain. Although quite rare, this syndrome is well represented in the oral, ear, nose, and throat surgery literature. In the neurosurgical literature, on the other hand, there is little if any mention of Eagle syndrome. The author presents a case of a woman who suffered from severe pain in the throat, the side of the face, and the ear. After the diagnosis of Eagle syndrome was made based on radiographic findings and was confirmed using a local anesthetic block, resection of the elongated styloid process was performed, resulting in complete and lasting pain relief. Eagle syndrome, which is caused by compression of the glossopharyngeal nerve as it passes the elongated styloid process, may be classified as an entrapment syndrome deserving of neurosurgical attention. The goal of this report is to familiarize neurosurgeons with Eagle syndrome and its diagnostic work up and treatment.
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5/12. Orofacial complications associated with forward repositioning of the mandible in snore guard users.

    snoring and obstructive sleep apnea (OSA) result from a collapse of the tongue, soft palate, and pharynx, causing temporary airway blockage. Acrylic mandibular advancement splints and Herbst appliances are used to relieve snoring and mild OSA. Repositioning the mandible forward may have an adverse effect on the orofacial and dentoalveolar structures of susceptible individuals. This article reports two cases in which orofacial complications developed following the utilization of snore guard appliances.
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6/12. injections of botulinum toxin type a produce pain alleviation in intractable trigeminal neuralgia.

    To report the effects of local injections of botulinum toxin type A regarding pain relief and long-term control in a patient with intractable trigeminal neuralgia. The patient was a 75-year-old man with trigeminal neuralgia in the left hemifacial region. His pain was unbearable and could not be controlled by carbamazepine, amitriptyline, or blocked by infiltration of a glycerol solution or phenol. The authors evaluated pain intensity, quality, and location using a visual analog scale to establish the efficacy of botulinum toxin type A injections. Two units of botulinum toxin type A (Botox) were subcutaneously injected once in eight points distributed along the territory of V1 and V2. Visual Analog Scores were measured at baseline and at 7, 30, 60, and 90 days after treatment. The authors also examined the patient's general condition and daily life activities. The Visual Analog values were, respectively, 82, 54, 25, 25, and 45 mm at each follow-up examination. No side effects were observed on the site of injection and on the patient's clinical state. The authors have been able to reduce trigeminal neuralgia pain with botulinum toxin type A injections in the V1, V2 territory during all the period of study, as well as to withdraw all medication. Interestingly, there was concomitant reduction of pain also in V3, which was not injected.
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7/12. Diagnosing and treating the patient with restricted mandibular opening: a new approach.

    patients with a restricted mandibular opening and related pain require a systematic process for differential diagnosis and treatment planning. This article considers the differential diagnostic process, treatment planning, and treatment delivery for a patient seeking a second opinion before surgery for a closed lock. A closed lock occurs when the disc in the joint has been pulled off the head of the condyle and forward, blocking the condyle from translating forward.
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8/12. Intranasal sphenopalatine ganglion block: minimally invasive pharmacotherapy for refractory facial and headache pain.

    facial pain and headache of various etiologies are oftentimes unresponsive to conventional therapies. Transnasal sphenopalatine gangion block provides a safe, low-cost, therapy that, if effective, oftentimes can be self-administered for pain relief.
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9/12. An unusual case of sympathetically maintained facial pain complicated by telangiectasia.

    A 32-year-old woman with a history of maxillary sinusitis, multiple surgical interventions in the maxillary sinus, and a hyperalgesic, erythematous skin lesion in her left infraorbital area, had severe burning pain in the left face. The dermal lesion was diagnosed as atypical telangiectasia and the sinus pathoses determined to be unrelated to her symptoms. Two diagnostic stellate ganglion blocks were performed with concurrent bilateral monitoring of blood flow in the infraorbital skin. blood flow was significantly increased in the painful erythematous patch although no significant change in flow occurred in the unaffected contralateral skin. The changes correlated to patient's relief from pain. The patient's symptoms were subsequently controlled with an oral sympatholytic agent. This article demonstrates the usefulness of laser doppler flowmetry to establish the diagnosis of sympathetically maintained facial pain despite several confounding conditions and supports the theory that sympathetically maintained pain involves altered function of alpha-1 adrenoreceptors.
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10/12. Occipital neuralgia manifesting as orofacial pain.

    This is a case report and brief review of the literature on occipital neuralgia presenting as dental pain. A patient with a chief complaint of long-standing pain in the maxillary right posterior quadrant was evaluated. Dental examination demonstrated the pain was not of odontogenic origin. The patient was referred to a neurologist who was a chronic pain specialist and was diagnosed with a rare neurologic disorder, occipital neuralgia referring to the facial region. After conservative treatment, local nerve blocks, and physical therapy, the patient reported a dramatic improvement of symptoms and total absence of all orofacial pain. The case demonstrates an unusual cause of orofacial pain.
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