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DS4101 > W12 - Dyasthesia / Atypical Facial Pain - Curtin > Flashcards

W12 - Dyasthesia / Atypical Facial Pain - Curtin Flashcards

1
Q

Define dysaesthesia

A

descriptive term - NOT a clinical entity

an abnormal unpleasant sensation due to damage to peripheral nerves

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2
Q

Difference betwen neurogenic, neuropathic and neurological

A

Neurogenic - arising from nerves

Neuropathic - pathlogy associated with nerves

Neurologic - associated with nerves

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3
Q

What is a syndrome?

A

A group of symptoms that appear together that do not appear to be directly related to one another

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4
Q

Common dental procedures that can cause iatrogenic neuropathies (3)

A

wisdom teeth removal

IAN block

Implant insertion

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5
Q

How to prevent iatrogenic neuropathy to the IAN (2)

A
  • Pre op assessment (PA, OPG, CBCT, CT)
  • Operative technique
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6
Q

What does it mean when there is darkening of root on md third molars on opg

A

risk indicator of superpositioning of the third molar root on the IAN canal

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7
Q

Why doesnt CBCT reduce neurosensory disturbances after wizzy removal compared to OPG

A

Doesnt change what you need to do

  • Allows you to risk stratify
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8
Q

Features of LA associated neurosensory disturbances (3)

A
  1. >90% of LA associated NSDs are assoc with IAN blocks
  2. Majority of LA-assoc NSDs are assoc with 4% solutions
    1. Strong epidemiological association
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9
Q

Features of IAN dysasthesia

A

Function Difficulties (eating, drinking, speaking)

Sensory issues (paraesthesia, allodynia, burning, tingles)

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10
Q

Features of IAN dysasthesia

A

Function Difficulties (eating, drinking, speaking)

Sensory issues (paraesthesia, allodynia, burning, tingles)

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11
Q

Features of IAN dysasthesia

A

Function Difficulties (eating, drinking, speaking)

Sensory issues (paraesthesia, allodynia, burning, tingles)

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12
Q

Is formication a good thing for wizzy exo?

A

Yes - means nerve is intact

pt will say “bugs crawling on me”

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13
Q

Describe the methods of evaluating patients with dysaesthesia (5)

A
  1. Test area affected (correct dermatome)
  2. Subjective funciton
  3. Light touch
  4. Sharp-blunt discrimination
  5. 2-point discrimination
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14
Q

What should be added for further description of dysathesia?

A

Dermatome affected and characteristics

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15
Q

Pathophysiology of dysaesthesia in general terms

A

Due to abnormality in neuronal funciton- either peripherally or centrally,

  • varies on the cause
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16
Q

Causes of non iatrogenic dysaesthesia (5)

A

More common in the general population

  • Diabetes
  • Excessive alcohol
  • Nutritional
  • Drugs
  • MS
17
Q

Why should you beware of pts with exicsion SCC on lip

A

Distal spread

18
Q

What does the extent of nerve injury depend on? (3)

A

Depends on type of injury

degree of injury

Neural anatomy

19
Q

What is wallerian degeneration

A

active process of retrograde degeneration of the distal end of an axon that is a result of a nerve lesion

20
Q

What is neurotenesis

A

Complete transection (cut) of a peripheral nerve

Most severe

Neuropraxia

21
Q

Neuropraxia (def)

A

Injury to peripheral nerves that causes burning, stinging and pain

  • Heal on their own
22
Q

axonotmesis

A

More severe type of peripheral nerve injury and is usually cased by crush, stretch or percussion

23
Q

Dental procedures which are associated with dyasthesia (3)

A

Extraction

Endo

Apicectomy

24
Q
A

Atypical facial pain can sleep at night

25
Q

Iatrogenic neuropathy associated with wizzy removal

A

IAN (0.5-8%)

Lingual nerve (0.5-10%)

Long buccal nerve

26
Q

Why is articaine 4% controversial with IAN blocks

A

Some studies report higher incidences of neuro sensory disturbances

27
Q

3 common neuralgias/neuropathies associated with dental procedures

A
  • Atypical Facial Pain / PIFP (83%)
  • Trigeminal neuralgia
  • misc. Neurop
28
Q

Outline the pathophysiology of nerve injury

A

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)

29
Q

Describe the course of management for patients with iatrogenic dysaesthesia

A

reverse action

Medications

supportive management

  • Ex. take implant out
30
Q

Outline an appropriate course of management for patients reporting atypical facial pain (2)

A

Rule out dental cause

Look for other cause of headache

Be conservative in treatment plan (dont take out teeth you dont have to)

31
Q

2 Types of Facial Pain + examples

A
  1. Headaches
    1. Temporal / tension
    2. Myofascial pain headaches
  2. Neuralgias
    1. AFP
    2. Trigeminal neuralgia
    3. Post herpetic neuralgia
32
Q

What is AFP / PIFP (definition)

A

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

33
Q

AFP / PIFP features (5) (who, age, effect)

A
  • Female (76%)
  • 40’s
  • Not hormonal
  • Sleep is not disturbed
  • Pain free interval on waking

DS4101 (43 decks)

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