1/6. 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.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/6. herpes zoster in hiv infection with osteonecrosis of the jaw and tooth exfoliation.BACKGROUND: herpes zoster (HZ) infection of the trigeminal nerve is associated with complications such as postherpetic neuralgia, facial scarring, loss of hearing ability and conjunctivitis. Until 2005, postherpetic alveolar necrosis and spontaneous tooth exfoliation have been described in 20 cases unrelated to hiv infection. OBJECTIVE: The aim of this study was to describe hiv infection in patients (two women, two men, average age 30 years) who suffered from HZ attacks to their trigeminal nerves. MAIN OUTCOME MEASURES: None of the patients had received antiherpetic medications or antiretroviral therapy. hiv infection was only diagnosed after the development of HZ. Facial scarring with depigmentation and hyperesthesia (postherpetic neuralgia) was diagnosed in all four patients. Oral findings consisted of spontaneous loss of both maxillary or mandibular teeth. osteonecrosis of varying extent was also found. Treatment consisted of extractions of teeth and administration of antibiotics and analgesics. Healing of alveolar wounds was unremarkable. CONCLUSION: Complications affecting the alveolar bone and teeth seem to be rare in hiv-infected patients.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/6. Etiology and treatment of idiopathic trigeminal and atypical facial neuralgias.In a series of sixteen patients with idiopathic trigeminal neuralgia and twenty-one patients with atypical facial neuralgia, it was found that the painful phenomena associated with both disorders were, in nearly all instances, closely related to the presence of maxillary or mandibular bone cavities at previous tooth extraction sites. Standard oral surgical procedures for curettage of the cavities, together with administration of antibiotics, were employed in the successful treatment of both the trigeminal and atypical facial neuralgias, with complete pain remissions for periods varying from 2 months (for most recently treated cases) up to 9 years. The observations and results of this study suggest that dental and oral disorders may play a role in the genesis of trigeminal and atypical facial neuralgias.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/6. Further observations on dental parameters of trigeminal and atypical facial neuralgias.One hundred thirty-one patients with primary trigeminal neuralgia and 77 patients with atypical facial neuralgia or pain were treated by oral surgical procedures, with complete or almost complete pain remission in 88% of the cases and without persistent residual anesthesias, dysesthesias, or dysalgesias. The following conditions were related to patients' pain perceptions: cavities in alveolar bone at tooth extraction sites, bone fistulas, periodontal infections, and maxillary sinus infections draining into alveolar bone. The bone cavities and fistulas mentioned above were usually not visualized by standard x-ray diagnostic procedures, and their detection required a new diagnostic approach which is described. Microbiologic findings indicated involvement of a mixed, variable flora in the above conditions. Histopathologic observations of scrapings from involved bone showed a variable incidence of bone necrosis, predominantly chronic inflammatory cell populations and fibrous tissue.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/6. facial neuralgia associated with recurrent herpes simplex.At least seven cases of facial neuralgia associated with recurrent herpes simplex have been reported in the medical literature. This condition has not been reported in the dental literature. A case of facial neuralgia associated with recurrent herpes simplex in a 34-year-old woman at varying intervals over a 20-year period is reported. Tension applied to the commissure on the right side of the patient's mouth during routine dental procedures can cause the neuralgia to develop, and she reports having undergone extraction of the permanent right mandibular first molar at the age of 15, when a similar neuralgia was present.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/6. Exogenous estrogen may exacerbate thrombophilia, impair bone healing and contribute to development of chronic facial pain.A 32 year old white female, in apparently good health, failed to respond to conservative wound care for alveolar osteitis after a routine mandibular first molar extraction. curettage and biopsy of necrotic alveolar bone from the #30 socket escalated her pain such that hospitalization was necessary for pain management with intravenous morphine. Twelve months prior to admission she had been placed on exogenous estrogen (Premarin, 0.625 mg/day) after a partial oophorectomy. While hospitalized, she was found to have resistance to activated protein c (APCR). Premarin was discontinued. After discharge, weekly changes of an antibiotic impregnated dressing allowed for progressive regeneration of bone and epithelium with gradual reduction in her pain. She was found to be heterozygous for the mutant factor v Leiden, a heritable factor for increased tendency to form thrombi, so-called thrombophilia. We speculate that the exogenous estrogen administration exacerbated the thrombophilia associated with the factor v Leiden mutation by compounding the patient's resistance to activated protein c thereby contributing to her development of osteonecrosis and severe alveolar neuralgia.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |