chpt 18- facial pain and neuromusc diseases - ppt Flashcards
unilateral paralysis of CN7
Bell’s Palsy
Bell’s Palsy is assoc w/what other neuromuscular disease
1/5 of pts w/Multiple Sclerosis also have Bell’s Palsy
Trigger events
- occur 75% of cases and include:
- VIRAL INFECTION (herpes)
- EXPOSURE TO COLD
- local/systemic infections
- ischemia
- acute otitis media
- pregnancy
gender/age demographics for Bell’s Palsy
- middle aged women (71%) > men
- in kids: secondary to viral infection, lyme disease, earache
Tx and prognosis for Bells Palsy
- 82% recover slowly over 6mo
- histamine, steroids, HBO, surgical decompression, ocular Abs and artificial tears
- SELF LIMITING
what do neuralgias and headaches share in common
- both may mimic pain of dental origin
- need to r/o dental inflammatory diseases
another name for trigeminal neuralgia
tic doulourex
age of onset for trigeminal neuralgia
avg age 50
what other neuromuscular disease is trigeminal neuralgia assoc with
4% have MS
name two disorders of facial pain that are associated with MS
- Bell’s Palsy
- Trigeminal Neuralgia
Trigger points for trigeminal neuralgia
- nasolabial fold
- vermillion border
- periorbital skin
- alveolus
main branches affected by trigeminal neuralgia
CN V: mostly max/mand but opthalmic can also be affected
Criteria for Trigeminal Neuralgia Dx
- abrupt attack initiated by a light touch and a specific, CONSTANT, trigger point
- extreme paroxysmal lancinating pain
- duration of single spasm < 2min but may repeat
- pain is limited to 1 or more branches of CNV; NO MOTOR DEFICIT
- trigger point refractory to additional attacks for several minutes
what is trigeminal neuralgia often misdiagnosed as
dental pain
What disorder is characterized by paroxysmal facial pain that is accompanied by excess lacrimation, conjunctival injection, and intense headache?
SUNCT syndrome
what does SUNCT syndrome stand for? –> EXAM
- Short Lasting
- Unilateral
- Neuralgiform headache
- Conjunctival injection
- Tearing
What CN does Glossopharyngeal Neuralgia affect
CN IX
chronic pain associated w/VZV (shingles)
Postherpetic Neuralgia
constant burning sensation over nerve distribution w/episodic stabbing pains
Postherpetic Neuralgia
Facial paralysis seen in association with herpes zoster of the face or external auditory canal.
Ramsay Hunt Syndrome
tx and prognosis for Ramsay Hunt
- 82% recover completely in 6mo
- antiviral
- antihistamines/vasodilators
- systemic corticosteroids
- ocular Abs and artificial tears
Persistent maxillofacial pain that doesn’t fit any of the more specific pain patterns that is diagnosed by exclusion of other disorders and is hard to localize and may extend to extra-oral area or may be confined to a specific area
Atypical Facial Pain
gender/age demographics for Atypical Facial Pain
women > men
4-6th decade
3 drugs used to tx atypical facial pain
- gabapentin
- opioid analgesic
- TCA
headache whose pain is behind brow-bone and/or cheekbones
sinus headache
headache whose pain is in and around one eye
cluster headache
headache whose pain is like a band squeezing the head
tension headache
headache described by pain, nausea, and visual changes in the classic form
migraine
demographics for cluster headache (gender, race, age)
-male > female
-3-4th decade
-blacks
familial (50x increase risk)
unilateral pain of mid and upper face near eye, assoc w/opthalmic division of trigeminal nerve, abrupt onset, no trigger zone, recurs at same time, lasts for weeks then long remission
cluster headache
