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Neville and Damm > Ch 18 - Orofacial Pain > Flashcards

Ch 18 - Orofacial Pain Flashcards

1
Q

What are the 2 alternate names for Bell palsy?

A
  1. Idiopathic Seventh Nerve Paralysis

2. Idiopathic facial paralysis

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2
Q

What are the main two theories for the etiology of Bell palsy?

A

herpes infection (HSV or VZV)

or

cell-mediated autoimmune reaction

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3
Q

Bell palsy can develop at any age, but whats the most common?

A

young and middle-aged adults

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4
Q

How long does Bell palsy take to completely set in?

A

Hours - pts usually wake up in full paralysis, can have prodromal symptoms

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5
Q

It is infrequent for Bell palsy to be bilateral, what are 4 other conditions that present with this bilateral, rapid onset?

A
  1. Guillain-Barre syndrome
  2. uveoparotid fever (AKA acute sarcoidosis aka Heerfordt syndrome)
  3. if other CN deficits consider a CNS infectious disease or a basilar skull tumor
  4. +vertigo, +tinnitus = Ramsay Hunt syndrome (VZV)
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6
Q

What is the treatment for Bell palsy?

A

self limiting, should resolve in 3-4 months..if no recovery systemic corticosteroids (see other flashcard)

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7
Q

What % of Bell palsy patients may not have a complete recovery?

A

20-30%

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8
Q

So assuming that Bell palsy was not self limiting and did not recover after 3-4 months, what treatment is given? Be specific with the regimen… What is NOT recommended?

A

10 day taper of prednisone starting at 60mg/day + antiviral (acyclovir, famciclovir, or valacyclovir)…NOT recommended: antiviral therapy alone

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9
Q

Eye protection for Bell palsy patients is critical so what can we do?

A

topical ocular antibiotics and artificial tears may be required to prevent corneal ulcer

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10
Q

What are the 2 alternate terms for Frey syndrome?

A
  1. Auriculotemporal syndrome

2. Gustatory sweating and flushing

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11
Q

What are the characteristics of Frey syndrome?

A
  1. Facial flushing and sweating along the auriculotemporal nerve
  2. in response to gustatory stimulus
  3. caused by injury to the nerve
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12
Q

What % range of patients with a history of a parotidectomy will develop Frey syndrome?

A

40-70%

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13
Q

What is the objective test for Frey syndrome?

A

Minor starch-iodine test

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14
Q

What systemic condition can cause bilateral gustatory sweating, thus mimicing Frey syndrome?

A

1/3 of diabetics WITH neuropathy esp severe kidney damage

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15
Q

What are two “related” phenomena to Frey syndrome that accompany an operation or injury to the submandibular gland or the facial nerve proximal to the geniculate ganglion?

A
  1. submandibular gland = chorda tympani syndrome

2. facial nerve proximal to the geniculate ganglion = gustatory lacrimation syndrome aka “crocodile tears”

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16
Q

How long does it take for the effects of Frey syndrome to present following the nerve injury?

A

2 months to 2 years

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17
Q

What color will present in a positive Minor iodine-starch test for a Frey syndrome patient?

A

blue

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18
Q

What % of adult patients and infants with Frey syndrome can have complete resolution without intervention?

A

5% of adults, almost all infants

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19
Q

What treatment can be effective long term for Frey syndrome?

A

botox injectons

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20
Q

What anatomical structure makes it difficult for patients to localize the source of their head and neck pain?

A

the trigeminal convergence (pain fibers from the head and neck travel to the spinal nucleus caudalis of the trigemnial nerve)

21
Q

What is the alternate name for trigeminal neuralgia?

A

Tic Douloreux (or just Tic) (translated means “painful jerking”)

22
Q

What is the definition of neuralgia?

A

pain extending along a nerve

23
Q

What is the most common facial neuralgia? Which branches of the nerve are most commonly affected?

A

trigeminal neuralgia…V2 or V3

24
Q

Which disease has one of the highest suicide rates?

A

trigeminal neuralgia

25
Q

What is the theory for the etiology of classical trigeminal neuralgia?

A

compresion of the nerve by aging blood vessels leading to demyelination

26
Q

What are three etiologies for secondary trigeminal neuralgia?

A
  1. Multiple sclerosis
  2. tumor pushing nerve
  3. AV malformation
27
Q

Whats the incidence of trigeminal neuralgia in the US?

A

4-5 cases / 100,000

28
Q

What % range of patients with multiple sclerosis develop trigeminal nerualgia?

A

2-4%

29
Q

Although trigemnial neuralgia can occur at any age, what is the characteristic range? Gender?

A

50 and older… Women 1.5:1

30
Q

Bilateral trigeminal neuralgia is unusual, what should be suspected?

A

multiple sclerosis

31
Q

What are two common “trigger zones” for trigeminal neuralgia?

A

nasolabial fold or oral cavity

32
Q

How long does a trigeminal neuralgia episode typically last?

A

no longer than 2 minutes - with a refractory period of no pain - can be helpful to distinguish from odontogenic pain

33
Q

What are some terms (total of 3) that can be used when a patient presents with some, but not all of the diagnostic criteria for trigeminal neuralgia?

A
  1. atypical trigeminal neuralgia
  2. persistent idiopathic facial pain
  3. atypical facial nerualgia
34
Q

If a patient has suspected trigeminal neuralgia, but presents with objective sensory loss, what should be considered for the diagnosis?

A

a CNS tumor

35
Q

What is the initial treatment for trigeminal neuralgia? What % of patients respond to this treatment?

A

carBAMazepine (anticonvulsant)…80%

36
Q

What is the term for distorted sensations of the facial skin?

A

facial dysesthesia

37
Q

What is the term for a combination of anesthesia and spontaneous pain?

A

anesthesia dolorosa

38
Q

What is the alternate term for glossopharyngeal neuralgia?

A

Vagoglossopharyngeal neuralgia

39
Q

Where is the pain felt in glossopharyngeal neuralgia?

A

the tonsil and ear (often radiating from the throat to the ear because of typmanic branch of the glossopharyngal nerve)

40
Q

What is the etiology of Classical glossopharyngeal neuralgia?

A

unassociated with any underlying disorder and often is attributed to ARTERIAL COMPRESSION of the nerve as it courses through the subarachnoid space to the jugular foramen

41
Q

What are 3 etiologies for secondary/symptomatic glossopharyngeal neuralgia?

A

Compression of the nerve by a specific lesion:

  1. intracranial or cranial base tumors / oropharyngeal tumors
  2. pagetic bone
  3. calcified stylohyoid ligament
42
Q

Unlike trigeminal neuralgia, it is uncommon for glossopharyngeal neuralgia to be associated with what systemic disease?

A

multiple sclerosis

43
Q

Age and gender for glossopharyngeal neuralgia?

A

middle aged and older adults, no gender predilection

44
Q

What is the term for paroxysmal pain felt in the ear?

A

tympanic plexus nerualgia

45
Q

Is glossopharyngeal neuralgia bilateral or unilateral?

A

unilateral - bilateral is RARE

46
Q

What general region does the patient feel pain in with glossopharyngeal neuralgia?

A

pain radiates upward from the oropharynx to the ipselateral ear

47
Q

While trigger points for glossopharyngeal neuralgia are not usually found on the skin, where is an “external” trigger point?

A

within the ear canal

48
Q

What % of glossopharyngeal neuralgia patients will also experience vagoglossopharyngeal neuralgia? What are some of the symptoms? (5 total)

A

10%

  1. syncope
  2. hypotension
  3. seizures
  4. bradycardia
  5. cardiac arrest
49
Q

What is the typical med given to the 10% of glossopharyngeal neuralgia patients with vagoglossopharyngeal neuralgia and have an increased risk for cardiac complications?

A

atropine

Neville and Damm (72 decks)

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