W12 - Dyasthesia / Atypical Facial Pain - Curtin Flashcards
Define dysaesthesia
descriptive term - NOT a clinical entity
an abnormal unpleasant sensation due to damage to peripheral nerves
Difference betwen neurogenic, neuropathic and neurological
Neurogenic - arising from nerves
Neuropathic - pathlogy associated with nerves
Neurologic - associated with nerves
What is a syndrome?
A group of symptoms that appear together that do not appear to be directly related to one another
Common dental procedures that can cause iatrogenic neuropathies (3)
wisdom teeth removal
IAN block
Implant insertion
How to prevent iatrogenic neuropathy to the IAN (2)
- Pre op assessment (PA, OPG, CBCT, CT)
- Operative technique
What does it mean when there is darkening of root on md third molars on opg
risk indicator of superpositioning of the third molar root on the IAN canal
Why doesnt CBCT reduce neurosensory disturbances after wizzy removal compared to OPG
Doesnt change what you need to do
- Allows you to risk stratify
Features of LA associated neurosensory disturbances (3)
- >90% of LA associated NSDs are assoc with IAN blocks
- Majority of LA-assoc NSDs are assoc with 4% solutions
- Strong epidemiological association
Features of IAN dysasthesia
Function Difficulties (eating, drinking, speaking)
Sensory issues (paraesthesia, allodynia, burning, tingles)
Features of IAN dysasthesia
Function Difficulties (eating, drinking, speaking)
Sensory issues (paraesthesia, allodynia, burning, tingles)
Features of IAN dysasthesia
Function Difficulties (eating, drinking, speaking)
Sensory issues (paraesthesia, allodynia, burning, tingles)
Is formication a good thing for wizzy exo?
Yes - means nerve is intact
pt will say “bugs crawling on me”
Describe the methods of evaluating patients with dysaesthesia (5)
- Test area affected (correct dermatome)
- Subjective funciton
- Light touch
- Sharp-blunt discrimination
- 2-point discrimination
What should be added for further description of dysathesia?
Dermatome affected and characteristics
Pathophysiology of dysaesthesia in general terms
Due to abnormality in neuronal funciton- either peripherally or centrally,
- varies on the cause
Causes of non iatrogenic dysaesthesia (5)
More common in the general population
- Diabetes
- Excessive alcohol
- Nutritional
- Drugs
- MS
Why should you beware of pts with exicsion SCC on lip
Distal spread
What does the extent of nerve injury depend on? (3)
Depends on type of injury
degree of injury
Neural anatomy
What is wallerian degeneration
active process of retrograde degeneration of the distal end of an axon that is a result of a nerve lesion
What is neurotenesis
Complete transection (cut) of a peripheral nerve
Most severe
Neuropraxia
Neuropraxia (def)
Injury to peripheral nerves that causes burning, stinging and pain
- Heal on their own
axonotmesis
More severe type of peripheral nerve injury and is usually cased by crush, stretch or percussion
Dental procedures which are associated with dyasthesia (3)
Extraction
Endo
Apicectomy
Atypical facial pain can sleep at night
Iatrogenic neuropathy associated with wizzy removal
IAN (0.5-8%)
Lingual nerve (0.5-10%)
Long buccal nerve
Why is articaine 4% controversial with IAN blocks
Some studies report higher incidences of neuro sensory disturbances
3 common neuralgias/neuropathies associated with dental procedures
- Atypical Facial Pain / PIFP (83%)
- Trigeminal neuralgia
- misc. Neurop
Outline the pathophysiology of nerve injury
Iatrogenic or non iatrogenic
Iatrogenic - ex ian block, implant
Non iatrogenic - conditions ex metabolic disturbance, diabetes, ms
causing:
Stretching, damage to structure (axons, myelin sheath)
Describe the course of management for patients with iatrogenic dysaesthesia
reverse action
Medications
supportive management
- Ex. take implant out
Outline an appropriate course of management for patients reporting atypical facial pain (2)
Rule out dental cause
Look for other cause of headache
Be conservative in treatment plan (dont take out teeth you dont have to)
2 Types of Facial Pain + examples
- Headaches
- Temporal / tension
- Myofascial pain headaches
- Neuralgias
- AFP
- Trigeminal neuralgia
- Post herpetic neuralgia
What is AFP / PIFP (definition)
Atypical Facial Pain
Persistent Idiopathic Facial Pain
Persistent facial pain with varying presentations recuring daily for >2 hours/day for >3 months with nil clinical pathology
AFP / PIFP features (5) (who, age, effect)
- Female (76%)
- 40’s
- Not hormonal
- Sleep is not disturbed
- Pain free interval on waking
