Orofacial Pain Flashcards
What are the 4 major causes of orofacial pain?
- Dentoalveolar
- Musculoskeletal
- Neuropathic
- Neurovascular
What are the subtypes of dentoalveolar causes of orofacial pain?
- Dental pain
- Periodontal pain
- Abscess
- CTS
- Maxillary sinusitis
- Salivary gland diseases
- Oral mucosal diseases
- Neoplasias
What are the types of MSK orofacial pain?
TMD
What are the types of neuropathic pain?
- Trigeminal neuralgia
- Glossopharyngeal neuralgia
- BMS
- Postherpetic neuralgia
What are the types of neurovascular pain?
- Migraines (with or without aura)
- Headaches (e.g.: cluster)
- Temporal arteritis
- Paroxysmal hemicranias
What are the clinical features of trigeminal neuralgia?
- Sharp, stabbing, electric shock-like pain
- Unilateral
- Lasts from a few seconds to two minutes
- Pain is set off by innocuous stimuli
- After initial episode, the same stimulus pay not cause pain for a while
- Rarely wakes patient up at night (unless you’re maybe sleeping on the affected side)
What are the investigations you’d undertake for trigeminal neuralgia and why?
MRI or CT scan to exclude:
- neurovascular compression
- MS
- tumour
What is the first-line treatment for trigeminal neuralgia?
- Carbemazepine (or Oxcarbazepine for 2nd line), gabapentin, pregabalin, Na valproate
What are the invasive, surgical treatment options for TN?
- Microvascular decompression
- Percutaneous rhizotomy (destroys part of the nerve that’s causing pain)
- Stereotactic radiotherapy
What are the positives and negatives of microvascular decompression?
- MVD is the only non-ablative (tissue-destroying) procedure
- Has demonstrated the greatest improvement in life quality (60-70% of patients remaining pain free at 10-20 years)
- However, it is the most invasive treatment
- Mortality rates b/w 0.2-0.5%
- 5% of cases have permanent ipsilateral hearing loss
What are the subtypes of trigeminal neuralgia?
- Classical (attributed to nerve compression)
- Secondary (attributed to underlying disease - MS)
- Idiopathic (no known cause)
What do you have to remember to do after prescribing carbamazepine to TN patients?
Perform a baseline haematological, renal and hepatic testing.
What are the clinical features of glossopharyngeal neuralgia?
- Pain on swallowing (giveaway to separate from TN)
- Sharp pain in ear and tonsils
- Aggravating stimuli may be - coughing, yawning, swallowing
What tests should you perform to diagnose GN?
- OPG and CBCT (to check for Eagle’s syndrome)
What is the aetiology of postherpectic neuralgia?
- Activation of latent varicella zoster (shingles)
