Staged bilateral nucleus caudalis drez lesioning for persistent idiopathic facial pain: exceptional case report

IntroductionBorderline personality disorder may be associated with persistent facial pain since its relationship with different pain syndromes has been reported. Persistent idiopathic facial pain is commonly unilateral, pulsating, burning, or profound and challenging for clinicians. Therefore, excluding underlying organic causes by appropriate clinical investigation and complementary tests is essential to diagnose this disease.Objective This case report aimed to provide evidence of the relationship between idiopathic persistent facial pain and borderline personality disorder.Case report A 24-year-old woman reported severe pain in the left hemiface for ten months, three to six hours per day, five days per week. No abnormalities were found in dental and neurological assessments. A psychiatric evaluation was performed, and the patient met the criteria for borderline personality disorder. Pharmacological treatment consisted of daily lithium carbonate (900 mg) and venlafaxine (150 mg). Weekly sessions of cognitive-behavioral therapy with emotional regulation and tolerance to stress were performed. The patient was evaluated every 30 days and showed improved pain intensity and frequency over six months. Conclusion Proper management of borderline personality disorder can modify the evolution of persistent idiopathic facial pain when both pathologies are comorbidities.

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Sphenopalatine Ganglion Electrical Nerve Stimulation Implant for Intractable Facial Pain

January 2018 - Pain Physician ◽

10.36076/ppj.2015/18/e403 ◽

2015 ◽

Vol 3;18 (3;5) ◽

pp. E403-E409

Author(s):

Foad Elahi

Keyword(s):

Case Report ◽

Pain Relief ◽

Local Anesthetic ◽

Nerve Stimulation ◽

Facial Pain ◽

Pain Clinic ◽

Sphenopalatine Ganglion ◽

Electrical Nerve Stimulation ◽

Persistent Idiopathic Facial Pain ◽

Electrical Neuromodulation

Persistent idiopathic facial pain can be extremely difficult and significantly challenging to manage for the patient and the clinician. Pharmacological treatment of these painful conditions is not always successful. It has been suggested that the autonomic reflex plays an important role in the pathophysiology of headaches and facial neuralgia. The key structure in the expression of cranial autonomic symptoms is the sphenopalatine ganglion (SPG), also known as the pterygopalatine ganglion. The role of the SPG in the pathophysiology of headaches and facial pain has become clearer in the past decade. In this case report, we describe a 30-year-old woman with insidious onset of right facial pain. She was suffering from daily pain for more than 9 years prior to her visit at the pain clinic. Her pain was constant with episodic aggravation without a predisposing trigger factor. The patient was evaluated by multiple specialties and tried multimodal therapy, which included antiepileptic medications, with minimal pain relief. A SPG block using short-acting local anesthetic provided significant temporary pain relief. The second and third attempt of SPG block using different local anesthetic medications demonstrated the same responses. After a thorough psychological assessment and ruling out the presence of a correctable cause for the pain, we decided to proceed with SPG electrical neuromodulation. The patient reported significant pain relief during the electrical nerve stimulation trial. The patient underwent a permanent implant of the neurostimulation electrode in the SPG region. The patient was successfully taken off opioid medication and her pain was dramatically responsive during a 6-month follow-up visit. In this article we describe the SPG nerve stimulation and the technical aspect of pterygopalatine fossa electrode placement. The pterygoplatine fossa is an easily accessible location. This case report will be encouraging for physicians treating intractable facial pain by demonstrating a novel therapeutic option. This report shows a minimally invasive approach to the SPG. Key words: Sphenopalatine ganglion, persistent idiopathic facial pain, electrical neuromodulation

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A novel method to treat recurrent facial pain: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02888-1 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Jintakorn Kuvatanasuchati ◽

Karoon Leowsrisook

Keyword(s):

Case Report ◽

Trigeminal Neuralgia ◽

Facial Pain ◽

Case Presentation ◽

Facial Movements ◽

Novel Treatment ◽

Effective Cost ◽

Novel Method

Abstract Background Chronic facial pain is a serious condition affecting millions of people worldwide. The reasons for chronic facial pain vary, and currently, the methods of treating chronic facial pain are expensive, invasive, and, based on current findings, ineffective. The purpose of this study is to develop and test an effective, cost-friendly method to treat patients with chronic facial pain. This study will examine the effectiveness of a novel treatment of a patient suffering from trigeminal neuralgia. Case presentation A 70-year-old Thai female visited the advanced general dentistry clinic at the Faculty of Dentistry, Mahidol University, Bangkok, Thailand. She was suffering from facial pain on her left side and was diagnosed by a physician as having trigeminal neuralgia. She experienced a sharp shooting pain that was triggered by facial movements such as chewing, speaking, or brushing teeth, and touching certain areas of her face. Bouts of pain lasted from a few seconds to several minutes, and episodes of several attacks lasted days, weeks, months, or longer prior to her visit to the advanced general dentistry clinic at Mahidol University. Physician designed an occlusal equilibration appliance for treating the patient by inserting the appliance in the mouth for dental occlusal equilibration (deprogram). The patient used this appliance by placing it in the mouth continuously (day and night) and removed it only when eating. After using the appliance for 2 weeks, the patient appeared to feel and look better prior to taking medication and was able to eat normally. The patient was pain free after treatment for a duration of 9 months. However, after 9 months, the pain reoccurred and manifested itself. Conclusion This novel treatment of recurrent facial pain showed an improvement of the patient’s chronic facial pain and serves as evidence to being a novel method for treating those suffering from trigeminal neuralgia.

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Isolated intramaxillry sinus cell causing long-standing facial pain: A case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.106188 ◽

2021 ◽

pp. 106188

Author(s):

Saud Alromaih ◽

Nouf Aloraini ◽

Saleh Alqaryan ◽

Ibrahim Sumaily

Keyword(s):

Case Report ◽

Facial Pain

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Evaluation of patients suffered from burning mouth syndrome and persistent idiopathic facial pain using Japanese version PainDETECT questionnaire and depression scales

Journal of Dental Sciences ◽

10.1016/j.jds.2020.06.008 ◽

2021 ◽

Vol 16 (1) ◽

pp. 131-136

Author(s):

Aiji Sato (Boku) ◽

Hiroyuki Kimura ◽

Tatsuya Tokura ◽

Eri Umemura ◽

Tomoya Miyauchi ◽

...

Keyword(s):

Facial Pain ◽

Japanese Version ◽

Burning Mouth Syndrome ◽

Persistent Idiopathic Facial Pain ◽

Paindetect Questionnaire ◽

Burning Mouth ◽

Depression Scales

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Multifactorial Facial Pain—Differential Diagnosis: A Case Report

The Journal of the American Dental Association ◽

10.14219/jada.archive.1990.0052 ◽

1990 ◽

Vol 120 (3) ◽

pp. 315-320

Author(s):

William C. Donlon ◽

Herman Kaplan ◽

Bahram Javid ◽

Michael Harness ◽

Peggy Shultz ◽

...

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Facial Pain

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Surgical treatment of Eagle’s Syndrome through intraoral access: a case report and literature review

Brazilian Journal of Case Reports ◽

10.52600/2763-583x.bjcr.2021.1.1.15-21 ◽

2021 ◽

Vol 1 (1) ◽

pp. 15-21

Author(s):

Rodrigo Cristhian Avelino Bezerra ◽

Jonas Nogueira Ferreira Maciel Gusmão ◽

Bruno Frota Amora Silva ◽

Rodrigo Lemos Alves ◽

Eliardo Silveira Santos ◽

...

Keyword(s):

Case Report ◽

Surgical Treatment ◽

Literature Review ◽

Facial Pain ◽

Clinical Case ◽

Styloid Process ◽

Eagle’S Syndrome ◽

Intraoral Approach ◽

Eagle Syndrome ◽

Review Study

The styloid process is a bone projection that originates in the tympanic portion of the temporal bone. The enlongation of the styloid process, or the ossification of the styloid process, can originate a series of symptoms such as dysphagia, odynophagia, facial pain, otalgia, headache, tinnitus and trismus, establishing the clinical picture of Eagle Syndrome. In this report, we present an important clinical case of adult patient diagnosed with Eagle’s Syndrome who underwent surgery for reduction of the enlongated styloid process, by intraoral approach, added to a literature review study.

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Comparison of Clinical Symptoms and Magnetic Resonance Angiographic (MRA) Results in Patients with Trigeminal Neuralgia and Persistent Idiopathic Facial Pain. Medium-Term Outcome after Microvascular Decompression of Cases with Positive MRA Findings

Cephalalgia ◽

10.1111/j.1468-2982.2005.01030.x ◽

2006 ◽

Vol 26 (3) ◽

pp. 266-276 ◽

Cited By ~ 41

Author(s):

A Kuncz ◽

E Vörös ◽

P Barzó ◽

J Tajti ◽

P Milassin ◽

...

Keyword(s):

Magnetic Resonance ◽

Trigeminal Neuralgia ◽

Microvascular Decompression ◽

Facial Pain ◽

Clinical Symptoms ◽

Vascular Compression ◽

Term Outcome ◽

Persistent Idiopathic Facial Pain ◽

Venous Compression ◽

Imaging Results

To evaluate whether NC could be demonstrated preoperatively, high-resolution magnetic resonance angiography (MRA) was performed in 287 consecutive patients with TN and persistent idiopathic facial pain (PIFP) on a 0.5-T and a 1-T MR unit. Depending on the clinical symptoms, the TN cases were divided into typical TN and trigeminal neuralgia with non-neuralgic interparoxysmal pain (TNWIP) groups. Microvascular decompression (MVD) was performed in 103 of the MRA-positive cases. The patients were followed up postoperatively for from 1 to 10 years. The clinical symptoms were compared with the imaging results. The value of MRA was assessed on the basis of the clinical symptoms and surgical findings. The outcome of MVD was graded as excellent, good or poor. The clinical symptoms were compared with the type of vascular compression and the outcome of MVD. The MRA image was positive in 161 (56%) of the 287 cases. There were significant differences between the clinical groups: 66.5% of the typical TN group, 47.5% of the TNWIP group and 3.4% of the PIFP group were positive. The quality of the MR unit significantly determined the ratio of positive/negative MRA results. The surgical findings corresponded with the MRA images. Six patients from the MRA-negative group were operated on for selective rhizotomy and no NC was found. Venous compression of the trigeminal nerve was observed in a significantly higher proportion in the background of TNWIP than in that of typical TN on MRA imaging (24.1% and 0.8%, respectively) and also during MVD (31.2% and 1.2%, respectively). Four years following the MVD, 69% of the patients gave an excellent, 23% a good and 8% a poor result. The rate of some kind of recurrence of pain was 20% in the typical TN and 44% in TNWIP group. The rate of recurrence was 57% when pure venous compression was present. The only patient who was operated on from the PIFP group did not react to the MVD. The clinical symptoms and preoperative MRA performed by at least a 1-T MR unit furnish considerable information, which can play a role in the planning of the treatment of TN.

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