ORAL MED - orofacial pain Flashcards
what are the 2 main systems of classifying orofacial pain?
international classification of headache disorders
international classification of orofacial pain
what category of orofacial pain does trigeminal neuralgia fall under?
pain attributed to lesion or disease of the trigeminal nerve
give a description of trigeminal neuralgia?
recurrent unilateral brief electric shock-like pains
abrupt in onset and termination
what is the diagnostic criteria for trigeminal neuralgia?
a. recurrent, unilateral facial pain of 1/more divisions of the trigeminal nerve
b. pain lasts from 1 second-2mins, severe intensity, electric shock like
c. precipitated by innocuous stimuli
d. not better accounted for by another diagnosis
what are provoking factors of trigeminal neuralgia?
chewing
talking
touching
cold
what are the 3 types of trigeminal neuralgia?
classical
secondary
idiopathic
describe classical trigeminal neuralgia?
develops without apparent cause other than neurovascular compression
how is classical trigeminal neuralgia diagnosed?
MRI/ surgery - morphological changes in the trigeminal root
how secondary trigeminal neuralgia caused?
caused by an underlying disease:
- multiple sclerosis
- space occupying lesion
- other
investigations for trigeminal neuralgia?
high resolution magnetic resonance imaging
what is first line pharmacological treatment for trigeminal neuralgia?
carbamazepine
what are the properties of carbamazepine?
anti-convulsant
metabolised in the liver
excreted in urine
list some contraindications and cautions for carbamazepine?
pregnancy
hepatic and renal impairment
herbal - st johns wort, alcohol, grapefruit
what are some second line treatments for trigeminal neuralgia?
pregablin
gabapentin
what additional management can be prescribed by GDPs for trigeminal neuralgia?
lidocaine nasal spray (maxillary pain)
lidocaine ointment (trigger point)
lidocaine as infil/block
what are the different surgical managements of trigeminal neuralgia?
palliative destructive at the level of the grasserion ganglion
posterior cranial fossa surgery
role of the GDP in regards to trigeminal neuralgia?
diagnosis
exclusion of dentoalveolar pathology
initiate medical management in conjunction with GMP
refer
describe glossopharyngeal neuralgia?
unilateral brief stabbing pain
abrupt in onset and termination
pain in the ear, base of tongue, tonsillar area and beneath angle of the mandible
what commonly provokes glossopharyngeal neuralgia?
swallowing
talking
coughing
diagnostic criteria for glossopharyngeal neuralgia?
a. recurring unilateral pain
b. lasts from 1second - 2 mins, severe intensity, electric shock-like, precipitated by swallowing, coughing, talking/ yawning
c. not diagnosed otherwise
what investigations are used for glossopharyngeal neuralgia?
high resolution MRI or head and neck
systemic management for glossopharyngeal neuralgia?
carbamazepine
list 3 types of painful trigeminal neuropathies?
painful trigeminal neuropathy attributed to HZV
trigeminal post-herpetic neuralgia
painful post-traumatic trigeminal neuropathy
what is allodynia?
pain in response to a stimulus which would not normally cause pain
what is hyperalgesia?
increased response to a stimulus which would normally cause pain
what is hypoalgesia?
reduction in response to a stimulus which would normally cause pain
what is hyperaesthesia?
increased cutaneous/ mucosal sensitivity to a stimulus
what is dysaesthesia?
an unpleasant sensation affecting the skin/ mucosa
describe painful trigeminal neuropathies?
indicative of neural damage
primary pain usually continuous
mechanical allodynia and cold hyperalgesia common
describe painful trigeminal neuropathy attributed to herpes zoster virus?
unilateral facial pain
less than 3 months duration
in trigeminal region
other symptoms of acute herpes zoster
describe trigeminal post-herpetic neuralgia?
unilateral facial pain
lasting at least 3 months
in the trigeminal region
caused by herpes zoster
how is shingles prevented?
immunisation against herpes zoster for 65-69 yr olds
how is trigeminal post-herpetic neuralgia prevented?
antivirals up to 72 hours following appearance of lesions of shingles
topical management of trigeminal neuropathy associated with herpes zoster?
lidocaine patches
systemic management of trigeminal neuropathy associated with herpes zoster?
amitriptyline
describe painful post-traumatic trigeminal neuropathy?
unilateral/ bilateral facial/ oral pain
caused by trauma to trigeminal nerve
other symptoms of trigeminal nerve dysfunction
diagnostic criteria for post traumatic trigeminal neuropathy?
a. history of trauma to trigeminal nerve with signs of nerve dysfunction
b. pain localised to trigeminal nerve affected by trauma, developing less than 6 months after event
c. no other diagnosis
