1/258. Facial canal decompression leads to recovery of combined facial nerve paresis and trigeminal sensory neuropathy: case report.BACKGROUND: Trigeminal sensory neuropathy is often associated with facial idiopathic nerve paralysis (Bell's palsy). Although a cranial nerve viral polyneuropathy has been proposed as the usual cause, in many instances the etiology remains unclear. This case report of recovery of both trigeminal and facial neuropathy after surgical decompression of the facial nerve suggests an anatomic link. methods: A case of a 39-year-old woman presenting with recurrent unilateral facial paralysis is summarized. Her fifth episode, which did not spontaneously recover, was associated with retroorbital and maxillary pain as well as sensory loss in the trigeminal distribution. RESULTS: A middle cranial fossa approach for decompression of the lateral internal auditory canal, labyrinthine segment of the facial nerve and the geniculate ganglion was performed. The patient's pain and numbness resolved immediately postoperatively, and the facial paralysis improved markedly. CONCLUSION: This result implicates a trigeminal-facial reflex as hypothesized by others. It suggests that decompression of the facial nerve can lead to improvement in motor and sensory function as well as relief of pain in some patients with combined trigeminal and facial nerve dysfunction.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/258. Elongated stylohyoid process: a report of three cases.The stylohyoid process is part of the stylohyoid chain--the styloid process, the stylohyoid ligament, and the lesser cornu of the hyoid bone. The stylohyoid chain is derived from the second branchial arch. Mineralisation of the stylohyoid ligament and ossification at the tip may increase the length of the styloid process. An elongated stylohyoid or styloid process is considered to be the source of craniofacial and cervical pain commonly known as Eagle's syndrome. In some instances the stylohyoid process may be considerably elongated, yet remain asymptomatic. This paper reports three patients with elongated stylohyoid processes discovered incidentally on routine radiographic examination.- - - - - - - - - - ranking = 0.33333333333333keywords = pain (Clic here for more details about this article) |
3/258. Apical transportation revisited or 'where did the K-file go'?CASE REPORT: This case report describes the outcome of a number of retreatments on a failed root filling in a maxillary first molar. The patient wanted all amalgams replaced by tooth-coloured Cerec restorations, including one in a symptomless maxillary molar. This tooth had a pulpotomy or a poorly done root-canal treatment 10 years earlier. The molar was root-canal retreated before placing the Cerec restoration and the palatal canal was filled 5 mm short of the radiographic apex. About 1 year later the patient presented with pain. Suspecting that a second mesiobuccal canal (MB-2) had not been located, a second non-surgical retreatment was instituted. MB-2 was not found and the palatal canal was retreated a third time, setting the working length 2 mm short of the radiographic apex. Because pain persisted palatally an apicectomy was performed and the tooth became symptomless. The resected palatal root apex was subsequently serially cross-sectioned, photographed and the canals analysed. Obvious apical transportation occurred during the cleaning and shaping procedures. Analyses of the canals showed that despite the retreatments, 11% of the canal cross-sectional area remained uncleaned although 7% of the root area was 'shaped'. Radiographically, the obturated palatal canal appeared reasonably well centred. However, this was disproved by the cross-sections, indicating that in this case, the clinician did not know where the K-Files had 'gone'. Apically, the obturated canal was certainly not within the natural canal. The pain located palatally was probably due to inadequate cleaning and shaping of the apical part of the root canal and its accessory canals.- - - - - - - - - - ranking = 1.0001120303569keywords = pain, area (Clic here for more details about this article) |
4/258. 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.- - - - - - - - - - ranking = 1.3333333333333keywords = pain (Clic here for more details about this article) |
5/258. Cranial arteritis: a medical emergency with orofacial manifestations.BACKGROUND: Cranial arteritis, or CA, a vascular disease affecting primarily elderly people, may result in permanent blindness if untreated. Since it frequently mimics temporomandibular joint, myofascial or odontogenic pain, dentists must be familiar with this condition. CASE DESCRIPTION: The authors present reports of two patients who had signs and symptoms of CA, some of which were suggestive of other head and neck pain disorders. In both cases, the diagnosis of CA was confirmed by temporal artery biopsy, and treatment with systemic steroids resulted in rapid resolution of symptoms. CLINICAL IMPLICATIONS: Prompt diagnosis and treatment of CA not only results in resolution of symptoms, but also may prevent blindness, the most serious sequela of the condition.- - - - - - - - - - ranking = 0.66666666666667keywords = pain (Clic here for more details about this article) |
6/258. Why is depression comorbid with chronic myofascial face pain? A family study test of alternative hypotheses.A number of explanations have been proposed to account for findings that rates of depression are elevated in persons with chronic, non-malignant pain disorders (CNPDs); for example, that CNPDs are variants of depression (e.g. 'masked depression'), that the stress of living with CNPDs contribute to the onset of depression ('diathesis-stress'), or that the correlation of CNPDs and depression is a methodological artifact of studying treatment-seeking samples. These alternative hypotheses are tested for one specific CNPD, chronic myofascial face pain, using a family study methodology. The procedure was to conduct direct psychiatric interviews with 106 patients with a history of carefully diagnosed myofascial face pain, 118 acquaintance controls without personal histories of myofascial face pain, and a random sample of adult first degree relatives of these case and control probands. The probands were further subdivided into four roughly equal samples consisting of cases with and without personal histories of major depressive disorder (MDD), and controls with and without personal histories of MDD. Dates of initial onsets of myofascial face pain and MDD in patient probands were obtained from interviews and records. The main results were that, compared to control probands without personal histories of MDD, MDD and depressive spectrum disorders (DSD) were elevated in the first degree relatives of control probands with personal histories of early onset MDD, but not in the first degree relatives of myofascial face pain probands with or without personal histories of early or late onset MDD. This outcome is consistent with the hypothesis that living with chronic myofascial face pain contributes to elevated rates of depression. It is inconsistent with the alternative hypotheses that this CNPD is a variant of depression or that the elevated MDD rates are simply an artifact of selection into treatment. The implications of these results and additional results consistent with them are discussed.- - - - - - - - - - ranking = 3.6666666666667keywords = pain (Clic here for more details about this article) |
7/258. 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.- - - - - - - - - - ranking = 3.0001120303569keywords = pain, area (Clic here for more details about this article) |
8/258. An unusual cause of unilateral facial pain.Cardiac pain that is referred to the face is a common symptom in patients with angina pectoris, but unilateral facial pain referred from a non-ischaemic cardiac source is rare. We report a case of unilateral facial pain that occurred in relation to a large pericardial effusion and which resolved on drainage of the effusion.- - - - - - - - - - ranking = 2.3333333333333keywords = pain (Clic here for more details about this article) |
9/258. 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.- - - - - - - - - - ranking = 1.3333333333333keywords = pain (Clic here for more details about this article) |
10/258. Infraorbital hypesthesia after maxillary sinus barotrauma.We report a case of a diver who suffered an episode of maxillary sinus barotrauma that presented with decreased sensation over the cutaneous distribution of the infraorbital nerve after an ascent which produced facial pain and crepitus. This case illustrates a potential confusion between a decompression sickness etiology and a barotraumatic etiology for the observed sensory deficit. The clinical features of this case were most consistent with a barotraumatic etiology for the findings noted. The anatomy of the trigeminal nerve and previous reports of cranial nerve deficits following barotrauma are reviewed.- - - - - - - - - - ranking = 0.33333333333333keywords = pain (Clic here for more details about this article) |
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