J Orofac Pain
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Comparative Study Clinical Trial Controlled Clinical Trial
Thermographic assessment of neuropathic facial pain.
Ongoing pain, intermittent sharp pain, or intermittent dull aching pain around the teeth can evoke the suspicion of tooth pathology. However, when no dental cause can be found clinically or radiographically, the differential diagnosis involving neuropathic pain and pulpal pathology is still a challenge. Neuropathic facial pains are still too often misdiagnosed as tooth pain of dental origin, resulting in unnecessary dental extraction or endodontic therapy. ⋯ The other half of the patients with sympathetically independent traumatic trigeminal neuralgia displayed "cold" thermograms in the area of their pain complaints. Electronic thermography was the least selective test for the group showing "cold" thermogram patterns (80% agreement with the thermographic characterization criteria). These data suggest that electronic thermography may be helpful in differentiating neuropathic pains from pulpal pathology.
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Pain-pressure thresholds (PPTs) and stimulus-response (S-R) curves in masseter muscles and index fingers of 11 female patients with chronic jaw-muscle pain were compared with that of 11 matched control subjects. Experimental hyperalgesic and hypoalgesic conditions in the masseter muscles of control subjects were induced by intramuscular injection of 5% saline and of local anesthetic, respectively. The PPTs were found to be significantly lower in the masseter muscles of pain patients than in those of control subjects. ⋯ The PPTs in masseter muscles of control subjects were not significantly affected by injection of 5% saline; however, the slopes of the S-R curves for the masseter muscles were significantly steeper for saline-injection values compared to baseline values (21.7% +/- 29.6%, P < .037). Injection of local anesthetic into masseter muscles of control subjects increased the PPTs significantly and reduced the slopes of the S-R curves significantly as compared to baseline values (-22.9% +/- 34.6%, P < .0155). The present results suggest that PPTs and S-R curves are valuable tools for quantitative description of chronic and experimental jaw muscle pain.
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Case Reports
Fibrous ankylosis of the temporomandibular joint: report of a case with atypical presentation.
A case of chronic unilateral mandibular dislocation with development of fibrous ankylosis is presented. This was an unusual presentation of intracapsular tissue ankylosis to the eminentia, as well as retrocondylar cicatrix combined with contralateral mandibular osseous compensations and remodeling with resulting ramus impingements upon relocation of the condyle. Various diagnostic and therapeutic considerations are reviewed and discussed.
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Case Reports
Benign indomethacin-responsive headaches presenting in the orofacial region: eight case reports.
Indomethacin-responsive headaches can present in the orofacial region. According to the classification of headache by the International Headache Society, indomethacin-responsive headaches include chronic paroxysmal hemicrania, hemicrania continue, benign cough headache, benign exertional headache, and sharp, short-lived headache pain syndrome. ⋯ Because these headache disorders are rare but may present as facial pain, they should be considered in the differential diagnosis of orofacial pain. A comprehensive evaluation prior to performing irreversible treatments is essential when an idiopathic facial pain presents to the dental clinician.
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Case Reports
Temporomandibular joint derangement with multiple surgical interventions: a case report.
This case report describes the experience of a 26-year-old woman who underwent multiple jaw surgeries. An initial 22 months of unsuccessful nonsurgical therapy was followed by a 7-year period during which the following were performed: 12 surgeries of her right temporomandibular joint; one surgery of her left temporomandibular joint; bilateral coronoidectomies; one surgery of her right mandible; and three surgeries of her left mandible. This case is important because although the existence of multiple jaw surgery cases are widely noted throughout the literature, this is the first case report that presents in-depth prospective documentation.