Facial Pain

Question 1

What is the sensory innervation of the face and dentition?

Answer 1

Provided by trigeminal nerve

Question 2

What is the trigeminal nerve and its branches?

Answer 2

5th cranial nerve
Opthalmic
Maxillary
Mandibular

Question 3

Is mandibular branch of trigeminal just sensory?

Answer 3

No has motor branch to supply MoM

Question 4

What is the facial nerve?

Answer 4

Motor nerve w/ 5 branches - TZBMC

Question 5

What does facial nerve supply?

Answer 5

MoM

Question 6

What are symptoms of reversible pulpits?

Answer 6

Short lasting, triggered by cold/ hot stimulus, poorly localisedW

Question 7

What are symptoms of irreversible pulpits?

Answer 7

Severe, long lasting, spontaneous

Question 8

What are symptoms of apical periodontitis?

Answer 8

Tenderness on percussion, abscess formation

Question 9

Causes of dental pain other than caries?

Answer 9

Cracked cusp
Dentine hypersensitivity

Question 10

What is cracked cusp syndrome?

Answer 10

fracture has propagated through tooth but no loss of tooth structure

Question 11

Characteristics of cracked tooth?

Answer 11

Pain which is worse on release of the bite

Question 12

Who does TN commonly occur in?

Answer 12

More common in females > 50 years

Question 13

What is important to exclude in younger pts?

Answer 13

MS

Question 14

What is TN?

Answer 14

Neuropathic pain associated w/ nerve injury or lesion

Question 15

What nerve does TN affect?

Answer 15

Trigeminal nerve, any branch can be affected

Question 16

Which branch of trigeminal is most commonly involved in TN?

Answer 16

Maxillary or mandibular

Question 17

Common presentation of TN?

Answer 17

Unilateral pain (less common to be bilateral)
Stabbing/ electric shock type painW

Question 18

What are two presentations of TN?

Answer 18

Type 1 = classic
Type II = atypical - often w/ burning in widespread areas

Question 19

What are differentials of TN?

Answer 19

Cluster headaches
Temporal arthritis

Question 20

What are cluster headaches?

Answer 20

excruciating pain on single side of face and around eye
Headaches begin without warning w/ piercing sensation
Watering of eye/ drooping of eyelid
Long lasting and can occur multiple times a day

Question 21

What is TA?

Answer 21

Temporal arthritis - giant cell arteritis
Severe headaches w/ pain over temporal region, jaw claudication and alteration of vision

Question 22

What is mx of TA?

Answer 22

Steroids

Question 23

How confirm dx of TA?

Answer 23

Biopsy of superficial temporal arthritis

Question 24

Mx of TN?

Answer 24

Analgesia
Anticonvulsants
Microvascular decompression

Question 25

What analgesia should be used in TN?

Answer 25

Manage w/ WHO analgesia ladder
Start w/ NSAIDs/ paracetamol before progressing to mild opioids like codeine

Question 26

What anticonvulsant drugs can be used?

Answer 26

First line is carbamazepine - used to both control symptoms and gain dx

Question 27

What is important when carbamazepine is prescribed?

Answer 27

Check liver function

Question 28

What is microvascular decompression?

Answer 28

Surrounding blood vessels are received away from trigeminal nerve
Long-lasting relief but IS MAJOR SURGICAL INTERVENTION

Question 29

What are triggers for TN?

Answer 29

Touching face, cold wind, shaving, kissing

Question 30

If pain affects mandibular devision, what can be used for short-term relief?

Answer 30

IAN block