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Dr Curtin > Week 12- Dysaesthesia & Atypical Facial Pain > Flashcards

Week 12- Dysaesthesia & Atypical Facial Pain Flashcards

1
Q

What is dysaesthesia?

A

Descriptive term
Abnormal unpleasant sensation (when touched) due to damage to peripheral nerves.

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2
Q

What are the differences between dysesthesia and atypical facial pain?

A

Dysesthesia: descriptive term, myriad of aetiologies, tx depends on cause, outcome depends on aetiology.

Atypical facial pain: a clinical entity, aetiology is hypothetical, tx is difficult and outcome is speculative

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3
Q

What is a syndrome?

A

Group of several things that occur together that don’t appear to be related

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4
Q

Where is fluid located in oedema?

A

Fluid is interstitial

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5
Q

What are the most frequent causes of iatrogenic neuropathies in dental practice?

A
  • 3rd molar surgery: IAN, lingual, long buccal nerve
  • Md nerve blocks: IAN, lingual nerve
  • Implant insertion
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6
Q

How can you avoid iatrogenic neuropathies in dental practive?

A
  • Pre-op assessment (IOPA, OPG, CBCT, CT)
  • Operative technique
  • Darkening of root of 8’s and narrowing of IAN canal in OPG indicates superimposition of root and IAN canal.
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7
Q

Does CBCT reduce risk of iatrogenic neuropathy in 3rd molar exo’s compared to using just OPG?

A

No. It allows us to risk stratify but it does not change what happens to the patient.

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8
Q

What are LA-associated neurosensory disorders associated with?

A

IAN blocks (>90%)

4% solution LA

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9
Q

What are the disturbances of dysesthesia following IAN block?

A
  • Funcitonal difficulties
    • eating
    • drinking
    • speaking
  • Sensory issues
    • paraesthesia/anaesthesia
    • allodynia (extreme sensitivity)
    • pain (spontaneous or provoked)
    • tingling
    • burning
    • formication (ants crawling)
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10
Q

What are the methods for evaluating patients with dysesthesia?

A
  • Area affected (dermatomes)
  • Subjective function
  • Light touch
  • Sharp-blunt discrimination
  • 2 point discrimination
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11
Q

What is dysaesthesia caused by?

A

Occurs due to abnormality in neuronal function (either peripherally or centrally). Pathophysiology varies according to cause.

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12
Q

What is the definition for neurology, neurogenic and neuropathy?

A
  • Neurogenic: arising from nerves
  • Neuropathic: disease affecting nerves
  • Neurological: associated with nerves
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13
Q

What are non-iatrogenic causes of dysaesthesia?

A

More common in general population

  • Diabetes
  • Excess alcohol
  • Nutritional
  • Drugs
  • MS
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14
Q

What can happen when nerves are injured?

A

Depends on type and degree of injury

  • Wallerian degeneration: nerve cut completely and distal part degenerates
  • Inside-out progression: when nerve is stretched there is physiological disturbance (Na and K channels) and then structural disturbance (axons and sheath degenerate)
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15
Q

What does the degree of injury indicate?

A

Can be indicative of extent to which return to normal can be expected and can also guide management

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16
Q

What happens when the tiny blood vessels running along nerves are damaged?

A

Doesn’t take much stretch to cause damage and needles can pierce the vessels leading to intra-neuronal hematoma and increase in internal pressure and thrombosis. Normal conduction doesn’t happen and that area of nerve can become ischaemic. Pt will go numb. No way of imaging this.

17
Q

What is neuropraxia?

A

Injury to peripheral nerves causes burning, stinging and pain. Typically heal on their own

18
Q

What is axonotmesis?

A

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

19
Q

What is neurotmesis?

A

Complete transection of a peripheral nerve

20
Q

What are the types of facial pain?

A
  • Headaches
    • tension headaches
    • myofascial pain/headaches
  • Neuralgias
    • trigeminal neuralgia
    • post-herpetic neuralgia
    • atypical facial pain
21
Q

What is the new term for atypical facial pain?

A

Persistent idiopathic facial pain?

22
Q

When does atypical facial pain often arise?

A

After minor operation or injury to face

23
Q

What is the definition of atypical facial pain?

A

Persistent facial and/or oral pain with varying presentations but recurring daily for >2 hours/day or >3 months in the absence of clinical neurological deficit.

24
Q

What are the most frequent features of a pt diagnosed with AFP?

A
  • Female
  • 40’s
  • Not hormonally related
  • Sleep not disturbed (no pain when they wake up unlike myofacial pain)
  • Pain free interval after waking
  • Very rare
25
Q

How should you manage patient who present with facial pain?

A
  • First exclude dental pain!
  • Then consider what else it could be
  • Care in labelling- diagnosis
26
Q

What are the links of atypical facial pain to other facial pain conditions?

A

Suggested shared pathophysiology with other painful neuropathies

  • Myofascial pain
  • headaches
  • Referred pain
  • Trigeminal neuralgia
27
Q

Outline pathophysiology of nerve injury

A
  • Iatrogenic- IAN block, implant
  • Non-iatrogenic: metabolic disturbances- diabetes, MS

Causes: stretching, damage to nerve structure

28
Q

Outline an appropriate course of management for patients reporting dysaesthesia

A
  • Reverse tx if you can- take implant out.
  • Medications
  • Supportive management
29
Q

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

A
  • Rule out dental cause
  • Look for other cause of headache
  • Don’t pull out teeth or do endo that you don’t need to do
30
Q

What are differences between trigeminal neuralgia and atypical facial pain

A
  • TN: region of trigeminal nerve with anatomical correlation, “like an electric shock” – short, severe, intermittent and triggered by touching. Often caused when blood vessel presses against the trigeminal nerve.
  • AFP: region of trigeminal nerve, but may have poor anatomical correlation, “crushing”, burning, aching. Vague compared to TGN, often deep, poorly localised, continuous/persistent.
31
Q

What are signs of the proximity of third molar roots to the mandibular canal

A
  • Darkening of roots
  • Narrowing of roots and canal
  • Interruption in the white line of the canal
  • Deflection of root

Dr Curtin (4 decks)

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