Classification of facial pain: a 13-year population-based study

2015 ◽  
Vol 42 (S1) ◽  
pp. S41-S41
Author(s):  
L Barchet ◽  
AM Kaufmann
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
International Association ◽  
Population Based ◽  
Classification Systems ◽  
Trigeminal Neuropathy ◽  
Diagnosis And Classification ◽  
Criteria For Diagnosis

Introduction: Accurate diagnosis and classification of facial pain is critical for assigning surgical treatment, avoiding misdirected interventions and studying outcomes. We conducted a population-based longitudinal study of patients with facial pain and compared diagnostic classification systems. Methods: Medical records for all Manitobans presenting to our centre with a primary complaint of facial pain from 2001 to 2013 were reviewed. We then applied diagnostic criteria from the International Classification of Headache Disorders (IHS-3), the International Association for the Study of Pain (IASP) and Burchiel’s system for comparisons. Results: There were 534 patients with facial pain (3.4/100,000/year) and two-thirds of these had conditions potentially amenable to neurosurgical interventions. Our most common diagnoses were typical trigeminal neuralgia(50%), atypical trigeminal neuralgia(7%), idiopathic trigeminal neuropathy(7%), idiopathic facial pain(11%); average ages were 65±14(22-99), 60±18(32-86), 55±16(28-83) and 48±12(28-82) with a female proportion of 55%, 59%, 65% and 80%, respectively. Other classification systems included no criteria for idiopathic trigeminal neuropathy. The classifications of “trigeminal neuralgia type-1 and type-2” did not differentiate between surgical and non-surgical candidiates. Conclusion: Published classification systems of facial pain have differing criteria for diagnosis of trigeminal neuralgia and none defines a large group with idiopathic trigeminal neuropathy. This may lead to considerable variability in determinations of potential surgical candidates and comparing outcomes of treatment.

scholarly journals P.086 The clinical significance of trigeminal neuralgia nomenclature

2016 ◽  
Vol 43 (S2) ◽  
pp. S40-S40
Author(s):  
SV Nolin ◽  
L Barchet ◽  
A Kaufmann
Keyword(s):  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
Classification Systems ◽  
Headache Disorders ◽  
Trigeminal Neuropathy ◽  
Study Population ◽  
Surgical Treatments

Background: A diagnosis of trigeminal neuralgia (TN) may be broadly applied to many neuralgic facial pains, while more stringent criteria are required for management decisions, outcome assessment, and pathophysiological correlations. Our aim was to evaluate existing classification systems of facial pain. Methods: The study population was comprised of 534 Manitobans referred to neurosurgery for facial pain from 2001 to 2013. A retrospective chart review identified presenting features; pain distribution, nature, and duration. The recorded diagnoses (rDx) were then re-classified according to the International Classification of Headache Disorders (ICHD-3) and Burchiel System of TN1 and TN2. Results: There was complete correlation between rDx and ICHD-3 for typical TN (tTN) in 266(49.8%) patients, atypical TN (aTN) in 39(7.3%), and idiopathic facial pain (IFP) in 59(11%). Idiopathic trigeminal neuropathy (iTn) in 35(6.6%) was not classified in ICHD-3. Burchiel-TN1 included heterogeneous diagnoses including tTN (266), aTN (27), iTn (2) and IFP (8); Burchiel-TN2 included aTN (10), iTn (23), and IFP (15). Another 135(25.5%) had other facial pain diagnoses. Conclusions: Classification of TN is especially important when selecting and evaluating surgical treatments. Diagnostic criteria should clearly differentiate between unique conditions and ideally have basis on underlying etiology. The ICHD-3 nomenclature best satisfies these aims although should be expanded to include iTn.

The challenges of diagnosing diabetes in childhood

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Mairi Pucci ◽  
Marco Benati ◽  
Claudia Lo Cascio ◽  
Martina Montagnana ◽  
Giuseppe Lippi
Keyword(s):  
Diabetes Mellitus ◽  
Children And Young People ◽  
Narrative Literature ◽  
Diagnosis And Classification ◽  
Narrative Literature Review ◽  
Optimal Approach ◽  
Diagnostic Step

AbstractDiabetes is one of the most prevalent diseases worldwide, whereby type 1 diabetes mellitus (T1DM) alone involves nearly 15 million patients. Although T1DM and type 2 diabetes mellitus (T2DM) are the most common types, there are other forms of diabetes which may remain often under-diagnosed, or that can be misdiagnosed as being T1DM or T2DM. After an initial diagnostic step, the differential diagnosis among T1DM, T2DM, Maturity-Onset Diabetes of the Young (MODY) and others forms has important implication for both therapeutic and behavioral decisions. Although the criteria used for diagnosing diabetes mellitus are well defined by the guidelines of the American Diabetes Association (ADA), no clear indications are provided on the optimal approach to be followed for classifying diabetes, especially in children. In this circumstance, both routine and genetic blood test may play a pivotal role. Therefore, the purpose of this article is to provide, through a narrative literature review, some elements that may aid accurate diagnosis and classification of diabetes in children and young people.

scholarly journals IMPORTANCE OF CLASSICAL MORPHOLOGY IN THE DIAGNOSIS OF MYELODYSPLASTIC SYNDROME

2015 ◽  
Vol 7 ◽  
pp. e2015035 ◽  
Author(s):  
Rosangela Invernizzi ◽  
Federica Quaglia ◽  
Matteo Giovanni Della Porta
Keyword(s):  
Molecular Techniques ◽  
Classification Systems ◽  
World Health ◽  
Hematopoietic Stem ◽  
Morphological Alterations ◽  
Diagnosis And Classification ◽  
The Moment ◽  
Health Organization ◽  
Selection Of

Myelodysplastic syndromes (MDS) are hematopoietic stem cell disorders characterized by dysplastic, ineffective, clonal and neoplastic hematopoiesis. MDS represent a complex hematological problem: differences in disease presentation, progression and outcome  have necessitated the use of classification systems to improve diagnosis, prognostication and treatment selection. However, since a single biological or genetic reliable diagnostic marker has not yet been discovered for MDS, quantitative and qualitative dysplastic morphological alterations of bone marrow precursors and of peripheral blood cells are still fundamental for diagnostic classification. In this paper World Health Organization (WHO) classification refinements and current minimal diagnostic criteria proposed by expert panels are highlighted and related problematic issues are discussed. The recommendations should facilitate diagnostic and prognostic evaluations in MDS and selection of patients for new effective targeted therapies. Although in the future morphology should be supplemented with new molecular techniques, the morphological approach, at least for the moment, is still the cornerstone for the diagnosis and classification of these disorders.

Cranial neuralgias and persistent idiopathic facial pain

2020 ◽  
pp. 237-247
Author(s):  
Aydin Gozalov ◽  
Messoud Ashina ◽  
Joanna M. Zakrzewska
Keyword(s):  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Orofacial Pain ◽  
Treatment Modalities ◽  
Management Approach ◽  
Trigeminal Neuropathy ◽  
Facial Region ◽  
Persistent Idiopathic Facial Pain ◽  
Chronic Orofacial Pain

Orofacial pain is a complex problem and affects up to 7% of the population. Although trigeminal neuralgia has been considered the prime neuralgic condition in the facial region, other forms of neuropathic pain are now being more frequently recognized and require recognition and a different management approach. Many patients with chronic orofacial pain report numerous comorbidities, such as psychiatric or personality disorders, which significantly affect management. Various pain conditions present in the facial region. Some of them rarely present extra-orally (unless as radiating pain) such as atypical odontalgia or persistent dento-alveolar pain disorder and burning mouth syndrome, whereas others will present in both areas such as classical trigeminal neuralgia, post-traumatic trigeminal neuropathy, trigeminal neuropathy attributed to multiple sclerosis, and persistent idiopathic facial pain. Myofascial pain syndrome related to the muscles of mastication is very common and may also be associated with temporomandibular joint problems. Trigeminal neuralgia and the rarer glossopharyngeal neuralgia are similar in quality and characteristics with specific treatment modalities, but differ in pain location. Trigeminal neuropathic pain is caused most frequently by trauma. If no other diagnostic criteria are fulfilled, a diagnosis of persistent idiopathic facial pain is made. It is crucial for these patients to be managed by multidisciplinary teams.

scholarly journals Classification: The key to understanding facial pain

Cephalalgia ◽  
2017 ◽  
Vol 37 (7) ◽  
pp. 609-612 ◽  
Author(s):  
Peter Svensson ◽  
Arne May
Keyword(s):  
Facial Pain ◽  
Conceptual Models ◽  
Temporomandibular Disorder ◽  
Classification Systems ◽  
Pain Condition ◽  
Good Classification ◽  
Rater Variability ◽  
Future Work ◽  
Homogenous Population

It is indisputable that the global scientific advances in headache research, be it bench or bedside, have benefited enormously from the operational diagnostic criteria published in 1988. Today, this classification system is indispensable. The reason for this success is a low inter-rater variability. In general, orofacial pain conditions are less well characterised – with the noticeable exemption of temporomandibular disorder pain. Tremendous work has been put into changing this, and significant progress has been achieved – in particular, in terms of the clinical implications and overriding conceptual models for oro-facial pain. Scientific classifications have only one goal: To provide a scientific agreement about the main features of an object of research and a scientific consensus regarding the name. The main significance is not the fact that a good classification offers a detailed and accurate image of the reality. If we want to overcome the obstacles of different competing classification systems, we need to overcome specialisation borders. The key to success is to understand that such a definition does not mirror all possible clinical facets of a given pain condition but is simply a convention – that is, a consensus on a word used for a pain condition. Simply speaking, a classification creates a common language to be used by more than one profession. It will be crucial to define any given pain condition as precisely and rigid as possible, in order to ensure a homogenous population. Only this ensures a low inter-rater variability, which consequently allows combining and comparing research on a population across different professional settings. This is not easy for chronic facial pain without verifiable morphological cause or structural lesions, as these syndromes are often rather featureless. The new IASP classification of chronic pain is a big step forward to a better characterisation of such conditions, and will trigger future work on a new and operationalised classification of oro-facial pain.

VARIANT INTRANEURAL VEIN-TRIGEMINAL NERVE RELATIONSHIPS

Neurosurgery ◽  
2009 ◽  
Vol 65 (5) ◽  
pp. 958-961 ◽  
Author(s):  
Gregory M. Helbig ◽  
James D. Callahan ◽  
Aaron A. Cohen-Gadol
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Complication Rates ◽  
Entry Zone ◽  
Root Entry Zone ◽  
Detailed Classification ◽  
Trigeminal Nerve Root

Abstract OBJECTIVE Trigeminal neuralgia is often caused by compression, demyelination, and injury of the trigeminal nerve root entry zone by an adjacent artery and/or vein. Previously described variations of the nerve-vessel relationship note external nerve compression. We offer a detailed classification of intraneural vessels that travel through the trigeminal nerve and safe, effective surgical management. CLINICAL PRESENTATION We report 3 microvascular decompression operations for medically refractory trigeminal neuralgia during which the surgeon encountered a vein crossing through the trigeminal nerve. Two types of intraneural veins are described: type 1, in which the vein travels between the motor and sensory branches of the trigeminal nerve (1 patient), and type 2, in which the vein bisects the sensory branch (portio major) (2 patients). INTERVENTION We recommend sacrificing the intraneural vein between the motor and sensory branches if the vein is small (most likely type 1). If the intraneural vein is large and bisects the sensory branch (most likely type 2), vein mobilization can be achieved, but often requires extensive dissection through the nerve. Because this maneuver may lead to trigeminal nerve injury and result in uncomfortable neuropathy and numbness (including corneal hypoesthesia), we recommend against mobilization of the vein through the nerve, suggesting instead, consideration of a selective trigeminal nerve rhizotomy. CONCLUSION Because aggressive dissection of intraneural vessels can lead to higher than normal complication rates, preoperative knowledge of vein-trigeminal nerve variants is crucial for intraoperative success.

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