Cases reported "Facial Pain"

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1/40. Maxillofacial osteonecrosis in a patient with multiple "idiopathic" facial pains.

    Previous investigations have identified focal areas of alveolar bone tenderness, increased mucosal temperature, abnormal anesthetic response, radiographic abnormality, increased radioisotope uptake on bone scans, and abnormal marrow within the quadrant of pain in patients with chronic, idiopathic facial pain. The present case reports a 53-year-old man with multiple debilitating, "idiopathic" chronic facial pains, including trigeminal neuralgia and atypical facial neuralgia. At necropsy he was found to have numerous separate and distinct areas of ischemic osteonecrosis on the side affected by the pains, one immediately beneath the major trigger point for the lancinating pain of the trigeminal neuralgia. This disease, called NICO (neuralgia-inducing cavitational osteonecrosis) when the jaws are involved, is a variation of the osteonecrosis that occurs in other bones, especially the femur. The underlying problem is vascular insufficiency, with intramedullary hypertension and multiple intraosseous infarctions occurring over time. The present case report illustrates the extreme difficulties involved in the diagnosis and treatment of this disease.
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2/40. Frontal intraosseous cryptic hemangioma presenting with supraorbital neuralgia.

    Primary intraosseous cranial hemangiomas are rare benign tumors comprising 0.2% of all osseous neoplasms. Symptomatic cranial cryptic hemangiomas are extremely rare. We report the case of a 43-year-old man with a cryptic hemangioma of the superior orbital rim. Radiological investigations revealed it to be an intraosseous cryptic mass which was totally excised and the supraorbital nerve was decompressed, relieving the patient of his symptoms. Histopathology showed features of an intraosseous hemangioma.
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3/40. The "missing link" in the origin of trigeminal neuralgia: a new theory and case report.

    Tic Douloureux (trigeminal neuralgia) has afflicted mankind for centuries, perhaps for all time. This sharp stabbing paroxysm of pain along the branches of the trigeminal nerve is described as "...one of the most painful problems that plagues mankind." Many theories about the cause of trigeminal neuralgia have been previously presented. Often these theories build on the previous foundations when new research presents itself. The complete picture still eludes researchers today. Much of the mechanism has been proposed, but researchers lacked one essential component. There has never been an answer to why these pains only occur in cranial segments and why, thankfully, TN is rare. What sets the stage for the development of TN? The unique neurophysiology of the trigeminal nerve and the accompanying ability of the Temporomandibular joints to create a sensitized neural system are the last piece of the puzzle. This central sensitization of the trigeminal nerve allows the development of a small cluster of neurons that act as a central trigger for the paroxysmal pain. The role of the TMJ in trigeminal neuralgia is illustrated by this case report.
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4/40. Neurovascular compression of the trigeminal and glossopharyngeal nerve: three case reports.

    trigeminal neuralgia (TN) is a frequent cause of paroxysmal facial pain and headache in adults. Glossopharyngeal neuralgia (GPN) is less common, but can cause severe episodic pain in the ear and throat. Neurovascular compression of the appropriate cranial nerve as it leaves the brain stem is responsible for the symptoms in many patients, and neurosurgical decompression of the nerve is now a well accepted treatment in adults with both TN and GPN who fail to respond to drug therapy. Neither TN nor GPN are routinely considered in the differential diagnosis when assessing children with paroxysmal facial or head pain, as they are not reported to occur in childhood. case reports of three children with documented neurovascular compression causing severe neuralgic pain and disability are presented. The fact that these conditions do occur in the paediatric population, albeit rarely, is highlighted, and appropriate investigation and management are discussed.
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5/40. meningioma manifested as temporomandibular joint disorder: a case report.

    Pain in the temporomandibular joint (TMJ) and the surrounding region constitutes a symptom of TMJ disorders. Various dental causes usually stimulate the trigeminal nerve, developing facial pain which triggers trigeminal neuralgia. However, trigeminal neuralgia may also arise from irritation of the endocranial root of the nerve, due to occult damage which has not yet manifested other symptoms, for example a meningioma. In this manner, the actual cause of pain in the ipsilateral half of the face may be interpreted incorrectly and may possibly be attributed to a TMJ dysfunction syndrome. This results in long-term frustration and burdening of the patient. The case of a 47-year-old woman is presented who complained of symptoms of a painful TMJ disorder. She was initially treated with the appropriate dental procedures and, upon continuation of the pain, was examined with CT scanning, which proved to be negative despite the existence of a cerebral lesion. Further investigation with MRI, however, revealed a meningioma of 5 mm size, in the region of the cerebellopontine angle.
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6/40. multiple sclerosis presenting to the dental practitioner: a report of two cases.

    In this paper, two patients are described who presented with trigeminal neuralgia which turned out to be an early symptom of multiple sclerosis. General dental practitioners need to be aware of the possible causes for atypical facial pain, especially in patients under 40 years.
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7/40. Enigmatic pain referred to the teeth and jaws.

    A number of obscure syndromes can mimic dental or jaw pain in the absence of pathosis within these structures. This enigmatic dental pain includes conditions such as pretrigeminal neuralgia, complex regional pain syndrome, temporal tendinitis, and carotodynia. Each of these syndromes is described through a pertinent case report to illustrate appropriate diagnosis and treatment.
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8/40. Oral and maxillofacial surgery in patients with chronic orofacial pain.

    PURPOSE: In this investigation, we evaluated a population of patients with chronic orofacial pain who sought treatment at a pain center in an academic institution. These patients were evaluated with respect to 1) the frequency and types of previous oral and maxillofacial surgery procedures, 2) the frequency of previous significant misdiagnoses, and 3) the number of patients who subsequently required surgical treatment as recommended by an interdisciplinary orofacial pain team. The major goal of this investigation was to determine the role of oral and maxillofacial surgery in patients with chronic orofacial pain. patients and methods: The study population included patients seen at the Center for Oral, Facial and Head Pain at new york Presbyterian Hospital from January 1999 through April 2001. (120 patients; female-to-male ratio, 3:1; mean age, 49 years; average pain duration, 81 months; average number of previous specialists, 6). The patient population was evaluated by an interdisciplinary orofacial pain team and the following characteristics of this population were profiled: 1) the frequency and types of previous surgical procedures, 2) diagnoses, 3) the frequency of previous misdiagnoses, and 4) treatment recommendations made by the center team. RESULTS: There was a history of previous oral and maxillofacial surgical procedures in 38 of 120 patients (32%). Procedures performed before our evaluation included endodontics (30%), extractions (27%), apicoectomies (12%), temporomandibular joint (TMJ) surgery (6%), neurolysis (5%), orthognathic surgery (3%), and debridement of bone cavities (2%). Surgical intervention clearly exacerbated pain in 21 of 38 patients (55%) who had undergone surgery. Diagnoses included myofascial pain (50%), atypical facial neuralgia (40%), depression (30%), TMJ synovitis (14%), TMJ osteoarthritis (12%), trigeminal neuralgia (10%), and TMJ fibrosis (2%). Treatment recommendations included medications (91%), physical therapy (36%), psychiatric management (30%), trigger injections (15%), oral appliances (13%), biofeedback (13%), acupuncture (8%), surgery (4%), and Botox injections (1%) (Allergan Inc, Irvine, CA). Gross misdiagnosis leading to serious sequelae, with delay of necessary treatment, occurred in 6 of 120 patients (5%). CONCLUSIONS: Misdiagnosis and multiple failed treatments were common in these patients with chronic orofacial pain. These patients often have multiple diagnoses, requiring management by multiple disciplines. Surgery, when indicated, must be based on a specific diagnosis that is amenable to surgical therapy. However, surgical treatment was rarely indicated as a treatment for pain relief in these patients with chronic orofacial pain, and it exacerbated and perpetuated pain symptoms in some of them.
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9/40. Idiopathic trigeminal neuralgia complicated by lingual nerve dysesthesia.

    The treatment of facial pain disorders has become a multifaceted discipline that involves numerous scientific fields. Diagnostic and treatment modalities may be beneficial to the patient but at times may also complicate the problem and compromise the outcome. We present an interesting case of left trigeminal neuralgia complicated by unassociated lingual nerve dysesthesia.
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10/40. Progression of preexisting trigeminalgia to Tolose-Hunt-like syndrome. The importance of neuroimaging for early differential diagnosis.

    Recurrent unbearable, paroxysmal, unilateral facial pain in the distribution of one or more branches of the trigeminal nerve often provoked by sensory stimuli is typical for idiopathic trigeminal neuralgia. The less frequent localization in the area of ophthalmic branch (5%) is particularly controversial and should be distinguished from pathological lesions in the brainstem and middle and posterior cranial fossa and from diseases of the orbit and eye. This case study presents a 79-year-old woman with typical clinical features of 1st division trigeminalgia without any neurological loss and with normal results of laryngological, ophthalmological, and stomatological examinations as well as neuroimaging CT, and MR /MRA evaluation. Only the evoked potential blink and masseter reflexes demonstrated the pathological values in the early phase of illness. After 1 year of pharmacological treatment no improvement was achieved and the pain became neuropathic and paresis of 3rd, 4th and 6th nerves developed, as observed in Tolose-Hunt syndrome. MRI of the orbit revealed a pathological mass in its apex with a connection to the superior orbital fissure. However, treatment with steroids was completely ineffective. Surgical resection of the tumor (leiomyosarcoma) only partially reversed oculomotor palsy and diminished aching. In differential diagnosis of idiopathic and symptomatic trigeminalgia, early MR and MRA imaging is the most essential and sometimes may be the best single test to evaluate lesions even in distant areas of the nervous system branches.
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