Chronic neuropathic facial pain associated with cranial nerves damage: clinical picture, diagnosis, treatment

2020 ◽  
Vol 18 (5) ◽  
pp. 42-45
Author(s):  
T. G. SAKOVETS ◽  
◽  
E. I. BOGDANOV ◽  
Keyword(s):  
Neuropathic Pain ◽  
Herpes Zoster ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Orofacial Pain ◽  
Cranial Nerves ◽  
Ear Canal ◽  
Short Term ◽  
Adequate Treatment ◽  
Hunt Syndrome

The purpose — to study of the features of chronic neuropathic facial pain associated with cranial nerve damage. Material and methods. We studied the modern works on the features of the clinic, diagnosis and treatment of chronic orofacial pain caused the cranial nerves damage. Special attention was paid to the methods of diagnosing neuropathic facial pain of various etiologies, and identifying clinical variants of their course. Results. The best known and most common variant of neuropathic orofacial pain is trigeminal neuralgia. There are classic trigeminal neuralgia that occurs as a result of vaso-neural conflict, secondary trigeminal neuralgia (in multiple sclerosis, voluminous brain neoplasm, etc.), and idiopathic trigeminal neuralgia. Patients have short-term (from fractions of a second to 2 minutes) unilateral paroxysmal facial pain in classic trigeminal neuralgia. In case of secondary trigeminal neuralgia, mainly bilateral neuropathic pain is detected. Painful trigeminal neuropathy (trigeminal neuropathic pain other than trigeminal neuralgia) is caused by trauma and herpes zoster with acute neuropathic pain. After 3 months, painful manifestations after the herpes zoster are qualified as trigeminal postherpetic neuralgia. Post-traumatic neuropathic trigeminal pain is the result of external trauma or iatrogenic damage resulting from dental treatment or neuroablation procedures. Both classical and secondary, idiopathic neuralgia of the glossopharyngeal nerve is characterized by unilateral short-term stabbing pain in the ear, base of the tongue, tonsil region, posterior part of the pharynx; it is less common, in contrast to trigeminal neuralgia. Intermediate nerve neuralgia was first described in 1907 by Hunt; it is rare, manifests itself as unilateral, shooting, paroxysmal pain in the ear canal and temporal areas. Painful neuropathy of the intermediate nerve (Ramsey — Hunt syndrome) with herpes zoster is characterized by dull, persistent pain that occurs inside the ear canal, auricle or mastoid. Rarely, tumors of the face can be the cause of Ramsey — Hunt syndrome. Conclusion. Thus, chronic neuropathic facial pain associated with facial nerves damage has a varied etiology, which requires careful differential diagnosis and selection of adequate treatment tactics.

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 Neuralgias of the Trigeminal Nerve

2000 ◽  
Vol 5 (1) ◽  
pp. 107-113 ◽  
Author(s):  
Allan S Gordon
Keyword(s):  
Neuropathic Pain ◽  
Differential Diagnosis ◽  
Trigeminal Neuralgia ◽  
Clinical Features ◽  
Trigeminal Nerve ◽  
Postherpetic Neuralgia ◽  
Facial Pain ◽  
The Other ◽  
Atypical Facial Pain ◽  
Trigeminal Neuropathic Pain

Practitioners are often presented with patients who complain bitterly of facial pain. The trigeminal nerve is involved in four conditions that are sometimes mixed up. The four conditions - trigeminal neuralgia, trigeminal neuropathic pain, postherpetic neuralgia and atypical facial pain - are discussed under the headings of clinical features, differential diagnosis, cause and treatment. This article should help practitioners to differentiate one from the other and to manage their care.

scholarly journals Orofacial pain: basic mechanisms and implication for successful management

2003 ◽  
Vol 11 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Paulo César Rodrigues Conti ◽  
Richard A. Pertes ◽  
Gary M. Heir ◽  
Cibele Nasri ◽  
Harold V. Cohen ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Temporomandibular Disorders ◽  
Facial Pain ◽  
Orofacial Pain ◽  
Dental Pain ◽  
Medical Problem ◽  
Basic Knowledge ◽  
Successful Management ◽  
Long Period ◽  
The Status

Orofacial Pain is the field of dentistry devoted to the diagnosis and management of chronic, complex, facial pain and oromotor disorders. This specialty in dentistry has developed over a number of years out of the need for better understanding of a group of patients who somehow were not clearly suffering from dental pain disorders, but still did not seem to have a clearly defined medical problem. After a long period of treating patients based on the mechanicist aspect of the disease, our profession has realized the importance of basic knowledge and differencial diagnosis in order to proper manage these patients. This modification in the approach has caused severe changes in education as well as in clinical activities. Historically considered as a problem of occlusion, Orofacial Pain, including Temporomandibular Disorders (TMD) has recently reached the status of "Specialty" in Brazil. Therefore, this paper aims to discuss the main differences between musculoskeletal and neuropathic pain and the importance of basic knowledge to perform successful management.

scholarly journals A Minimally Invasive Surgical Technique for the Treatment of Posttraumatic Trigeminal Neuropathic Pain with Peripheral Nerve Stimulation

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. E725-E732
Author(s):  
Jackson Cohen
Keyword(s):  
Neuropathic Pain ◽  
Surgical Technique ◽  
Trigeminal Neuralgia ◽  
Minimally Invasive ◽  
Peripheral Nerve ◽  
Nerve Stimulation ◽  
Facial Pain ◽  
Peripheral Nerve Stimulation ◽  
Invasive Technique ◽  
Trigeminal Neuropathic Pain

Background: Facial pain occurring after traumatic injury of the facial branches of the trigeminal nerve is a medical condition that is often very difficult to treat. Patients are quite disabled by their symptoms and most therapies are ineffective in relieving this pain. Peripheral nerve stimulation has been used as a treatment to provide pain relief for this type of intractable atypical facial pain. Objective: To describe a minimally invasive peripheral nerve stimulation surgical technique for treating posttraumatic trigeminal neuralgia. Study Design: Case report based on a patient seen in a university setting with posttraumatic trigeminal neuropathic pain who underwent a minimally invasive technique for the placement of a peripheral nerve stimulator. Setting: University-based outpatient clinic. Methods: A patient with a clinical picture suggestive of trigeminal neuropathic pain secondary to trauma involving the V1 and V2 branches of the trigeminal nerve was selected. Conservative management was attempted with no improvement before peripheral nerve stimulation was tried with a minimally invasive surgical technique. We recorded the patient’s subjective assessment of pain and daily function before and after the procedure. Results: Following the procedure, the patient’s pain score decreased approximately 50% and the patient reported a better quality of life with improvement in daily function as well as a more positive outlook on her condition. There were no complications after the procedure and the patient reported no complaints with the device. Limitations: Case report. Conclusions: This surgical technique for placing peripheral nerve stimulators allows for a minimally invasive approach for the treatment of intractable posttraumatic trigeminal neuralgia with potentially less risk of facial nerve damage. This case confirms the need for further studies to be done in the future to prove the safety and effectiveness of this technique. Key Words: Peripheral nerve stimulation, posttraumatic trigeminal neuralgia, neuropathic pain, minimally invasive technique, facial pain.

Trigeminal Neuralgia

2018 ◽  
pp. 257-266
Author(s):  
Radhika Grandhe ◽  
Eli Johnson Harris ◽  
Eugene Koshkin
Keyword(s):  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Clinical Diagnosis ◽  
Facial Pain ◽  
Pharmacological Therapy ◽  
Surgical Decompression ◽  
Facial Movements ◽  
Classical Trigeminal Neuralgia ◽  
Neuropathic Pain Condition ◽  
Secondary Causes

Trigeminal neuralgia is a rare neuropathic pain condition but can be very disabling. The hallmark is brief episodes of intense, radiating pain within the territory of trigeminal nerve distribution. It is typically unilateral, often accompanied by facial spasms and can be triggered by facial movements in a majority of patients. Microvascular compression of trigeminal ganglion is the etiology for most patients with classical trigeminal neuralgia. Some patients can have continuous facial pain in addition to paroxysms of pain. Trigeminal neuralgia is a clinical diagnosis, but MRI is done to rule out secondary causes or to detect microvascular compression. Pharmacological therapy with first-line agents—carbamazepine or oxcarbazepine—is the preferred treatment. Patients with failed pharmacological therapy are considered for surgical decompression, ablation procedures, or Gamma Knife surgery.

Difficult diagnosis of facial pain: A case report and mini-review

2010 ◽  
Vol 1 (4) ◽  
pp. 179-183 ◽  
Author(s):  
Satu K. Jääskeläinen ◽  
Heli Forssell ◽  
Olli Tenovuo ◽  
Riitta Parkkola
Keyword(s):  
Neuropathic Pain ◽  
Case Report ◽  
Facial Pain ◽  
Orofacial Pain ◽  
Brain Mri ◽  
Correct Diagnosis ◽  
Mouth Opening ◽  
Nerve Fibers ◽  
Sampling Errors ◽  
Myelinated Nerve

AbstractThis case report elucidates pitfalls of clinical and radiologic investigations of neuropathic pain due to trigeminal pathology, and utility of neurophysiologic examination when diagnosing facial pain. Our patient was a 63-year-old woman who developed acute, severe facial pain, first located behind the left eye. Neuralgic exacerbations, paresthesia within lower face on the left and restricted mouth opening occurred during the course of the disease with gradual progression. Brain MRI and CT scans were interpreted as normal at 4 and 10 months after symptom onset. At 9 months, detailed neurophysiologic examination showed severe chronic mandibular neuropathy at the left oval foramen with more prominent disturbance of the thick myelinated nerve fibers than the small fibers suggesting compressive etiology. Guided by the neurophysiologic findings, 11 months after the onset of the symptoms, a new brain MRI with contrast enhancement revealed metastatic adenocarcinoma of the left temporal bone along the mandibular nerve, exactly matching the site indicated by the neurophysiologic examination. Neurophysiologic tests offer cost-effective, sensitive tools for screening and accurate level diagnostics of neuropathy and neuropathic pain, which can be utilized also in the diagnosis of facial pain. In addition, whenever there are progressing neurologic deficits or neurophysiologic signs indicating expansive lesion, despite initially normal findings in the brain imaging studies, repeated MRI examinations are warranted, preferably focusing to the ‘neurophysiologic region of interest’ to avoid radiologic sampling errors. As no isolated technique achieves 100% diagnostic accuracy, only rational combinations of different methods will result in correct diagnosis of facial pain without unnecessary delays. Treatment of neuropathic pain is often delayed because of difficulties in reaching the correct diagnosis. During the work-up, many differential diagnostic alternatives have to be considered, also in patients with chronic orofacial pain. Table 1 shows the most important differential diagnoses of orofacial pain.

Repeat posterior fossa exploration for patients with persistent or recurrent idiopathic trigeminal neuralgia

2008 ◽  
Vol 108 (5) ◽  
pp. 916-920 ◽  
Author(s):  
Nelly Amador ◽  
Bruce E. Pollock
Keyword(s):  
Trigeminal Neuralgia ◽  
Posterior Fossa ◽  
Facial Pain ◽  
Cranial Nerves ◽  
Less Invasive ◽  
Idiopathic Trigeminal Neuralgia ◽  
Pain Outcomes ◽  
Pain Outcome ◽  
Facial Numbness ◽  
The Mean

Object Patients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression (MVD) typically undergo less invasive procedures in the hope of providing pain relief. The outcomes and risks of repeat posterior fossa exploration (PFE) for these patients are not clearly understood. Methods From September 2000 to November 2006, 29 patients (14 men, 15 women) underwent repeat PFE. The mean number of surgeries per patient at the time of repeat PFE was 3.2 (range 1–6). The mean follow-up duration after surgery was 33.7 months. Results Compression of the trigeminal nerve was noted in 24 patients (83%) by an artery (13 patients, 45%), vein (4 patients, 14%), or Teflon (7 patients, 24%). Four patients (14%) who underwent operations elsewhere had incorrect cranial nerves decompressed at their first surgery. Only MVD was performed in 18 patients (62%) and a partial nerve section (PNS) was performed in 11 patients (38%). An excellent facial pain outcome (no pain, no medications required) was achieved and maintained for 80% and 75% of patients at 1 and 3 years after surgery, respectively. Patients with Burchiel Type 1 TN were pain free without medications (91% at 1 year and 85% at 3 years) more frequently than patients with Burchiel Type 2 TN (27% at both 1 and 3 years; hazard ratio = 5.4, 95% confidence interval 1.4–21.1, p = 0.02). Fifteen patients (52%) had new or increased facial numbness. Two patients (7%) developed anesthesia dolorosa; both had undergone PNS. Two patients (7%) had hearing loss after surgery. Conclusions Repeat PFE for patients with idiopathic TN has facial pain outcomes that are comparable with both percutaneous needle-based techniques and stereotactic radiosurgery. Patients with persistent or recurrent TN should be considered for repeat PFE, especially if other less invasive surgeries have not relieved their facial pain.

scholarly journals Prevalence of orofacial Pain among working adults - A Retrospective Study

2020 ◽  
Vol 11 (SPL4) ◽  
pp. 496-502
Author(s):  
Kalyani P ◽  
Manjari Chaudhary ◽  
Santhosh Kumar M. P.
Keyword(s):  
Retrospective Study ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Orofacial Pain ◽  
Time Frame ◽  
P Value ◽  
Atypical Facial Pain ◽  
Chi Square ◽  
Female Ratio ◽  
Working Adults

Orofacial pain can be defined as a discipline of dentistry that deals with the diagnosis and management of different types of pain pertaining to the orofacial region such as the trigeminal neuralgia, atypical facial pain, postherpetic neuralgia, etc. The aim of the current study is to determine the prevalence of Orofacial Pain among working adults. The retrospective study involved the analysis of the case sheets of the patients with orofacial pain in the stipulated time frame and assessment based on the following parameters: age, gender, the type of orofacial pain, working status—statistical analysis calculated by chi-square test. A p-value <0.05 was considered significant. The prevalence of orofacial pain was 0.08% with a female - to - the male ratio of 1.06: 1 and working adults to non-working adults ratio of 1.36: 1. Trigeminal neuralgia shows a male-female ratio of 1.18: 1 and higher prevalence of Atypical facial pain in females (15.15%). According to our study, it can be concluded that orofacial pain was more prevalent in females. The prevalence of Trigeminal Neuralgia was higher in males and Atypical facial pain was the most prevalent type in females.

Trigeminal Neuropathic Pain

2019 ◽  
pp. 31-40
Author(s):  
Mandana A. Behbahani ◽  
Nauman S. Chaudhry ◽  
Konstantin V. Slavin
Keyword(s):  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Facial Pain ◽  
Pulse Generator ◽  
Unintentional Injury ◽  
Pain Syndrome ◽  
Management Process ◽  
Trigeminal Neuropathic Pain ◽  
Pain Syndromes ◽  
Internal Pulse Generator

Trigeminal neuropathic pain (TNP) involves pain isolated to the distribution of one or more branches of the trigeminal nerve following unintentional injury to that nerve. It is important to distinguish this facial pain syndrome from trigeminal neuralgia, as the treatment is quite different. The diagnosis is typically clinical, although local anesthetic blocks may aid in the diagnosis. Psychological testing is often performed preoperatively. Like other neuropathic pain syndromes, TNP may be treated with peripheral nerve stimulation. This chapter discusses a typical presentation of TNP, as well as the evaluation and management process, including placement of subcutaneous electrodes and connection to an internal pulse generator.

scholarly journals Peripheral neuromodulation for the treatment of refractory trigeminal neuralgia

2015 ◽  
Vol 20 (2) ◽  
pp. 63-66 ◽  
Author(s):  
Naum Shaparin ◽  
Karina Gritsenko ◽  
Diego Fernandez Garcia-Roves ◽  
Ushma Shah ◽  
Todd Schultz ◽  
...  
Keyword(s):  
United States ◽  
Neuropathic Pain ◽  
Trigeminal Neuralgia ◽  
Chronic Headache ◽  
Orofacial Pain ◽  
The United States ◽  
Headache Disorders ◽  
Affected Patient ◽  
Present Case Report ◽  
The Face

Trigeminal neuralgia is a type of orofacial pain that is diagnosed in 150,000 individuals each year, with an incidence of 12.6 per 100,000 person-years and a prevalence of 155 cases per 1,000,000 in the United States. Trigeminal neuralgia pain is characterized by sudden, severe, brief, stabbing or lancinating, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve, which can cause significant suffering for the affected patient population.In many patients, a combination of medication and interventional treatments can be therapeutic, but is not always successful. Peripheral nerve stimulation has gained popularity as a simple and effective neuromodulation technique for the treatment of many pain conditions, including chronic headache disorders. Specifically in trigeminal neuralgia, neurostimulation of the supraorbital and infraorbital nerves may serve to provide relief of neuropathic pain by targeting the distal nerves that supply sensation to the areas of the face where the pain attacks occur, producing a field of paresthesia within the peripheral distribution of pain through the creation of an electric field in the vicinity of the leads.The purpose of the present case report is to introduce a new, less-invasive interventional technique, and to describe the authors’ first experience with supraorbital and infraorbital neurostimulation therapy for the treatment of trigeminal neuralgia in a patient who had failed previous conservative management.

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