Facial Pain Flashcards
What is the sensory innervation of the face and dentition?
Provided by trigeminal nerve
What is the trigeminal nerve and its branches?
5th cranial nerve
Opthalmic
Maxillary
Mandibular
Is mandibular branch of trigeminal just sensory?
No has motor branch to supply MoM
What is the facial nerve?
Motor nerve w/ 5 branches - TZBMC
What does facial nerve supply?
MoM
What are symptoms of reversible pulpits?
Short lasting, triggered by cold/ hot stimulus, poorly localisedW
What are symptoms of irreversible pulpits?
Severe, long lasting, spontaneous
What are symptoms of apical periodontitis?
Tenderness on percussion, abscess formation
Causes of dental pain other than caries?
Cracked cusp
Dentine hypersensitivity
What is cracked cusp syndrome?
fracture has propagated through tooth but no loss of tooth structure
Characteristics of cracked tooth?
Pain which is worse on release of the bite
Who does TN commonly occur in?
More common in females > 50 years
What is important to exclude in younger pts?
MS
What is TN?
Neuropathic pain associated w/ nerve injury or lesion
What nerve does TN affect?
Trigeminal nerve, any branch can be affected
Which branch of trigeminal is most commonly involved in TN?
Maxillary or mandibular
Common presentation of TN?
Unilateral pain (less common to be bilateral)
Stabbing/ electric shock type painW
What are two presentations of TN?
Type 1 = classic
Type II = atypical - often w/ burning in widespread areas
What are differentials of TN?
Cluster headaches
Temporal arthritis
What are cluster headaches?
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
What is TA?
Temporal arthritis - giant cell arteritis
Severe headaches w/ pain over temporal region, jaw claudication and alteration of vision
What is mx of TA?
Steroids
How confirm dx of TA?
Biopsy of superficial temporal arthritis
Mx of TN?
Analgesia
Anticonvulsants
Microvascular decompression
What analgesia should be used in TN?
Manage w/ WHO analgesia ladder
Start w/ NSAIDs/ paracetamol before progressing to mild opioids like codeine
What anticonvulsant drugs can be used?
First line is carbamazepine - used to both control symptoms and gain dx
What is important when carbamazepine is prescribed?
Check liver function
What is microvascular decompression?
Surrounding blood vessels are received away from trigeminal nerve
Long-lasting relief but IS MAJOR SURGICAL INTERVENTION
What are triggers for TN?
Touching face, cold wind, shaving, kissing
If pain affects mandibular devision, what can be used for short-term relief?
IAN block
