Involvement of dental occlusion and trigeminal neuralgia : A clinical report

1. Involvement of dental occlusion and trigeminal neuralgia: A clinical report Takami Hirono Hotta, JPD 1997;Vol(77);Num.4 Tic douloureux 길병원 보철과 김 세 웅 http://dent.ghil.com

2. What is Trigeminal Neuralgia? • Tic douloureux or Fothergill’s disease(1773) • Disorder of the fifth cranial(trigeminal) nerve • Episodes of intermittent, intense, stabbing, shooting, electric shock-like pain • In the areas of the face where the branches of the nerve are distributed Kim se woung

3. Neuropathic Pain Disorders(신경병성 동통 장애) • Paroxysmal(발작성) • Trigeminal neuralgia • Glossopharyngeal neuralgia • Geniculate neuralgia • Superior laryngeal neuralgia • Continuous(지속형) • Deafferentation pain syndrome • Postherpetic neuralgia • Posttraumatic and postsurgical neuralgia • Sympathetically maintained pain • Causalgia • Reflex sympathetic dystrophy • Unclassifiable • Atypical odontalgia • Vascular orofacial pain, atypical facial pain • Burning mouth syndrome • Phantom pain syndrome Kim se woung

4. History taking • History takingis the most important factor in the diagnosis of trigeminal neuralgia(TN). • Nature of pain • Pain is brief and paroxysmal, but it may occur in volleys of multiple attacks. • Pain is stabbing or shock-like and typically quite severe. • Distribution of pain • One or more branches of the trigeminal nerve(usually maxillary or mandibular) are involved. • Lips, eyes, nose, scalp, forehead, upper jaw, and lower jaw • Less frequently in the mucosal area of the mouth • Pain is unilateral(rarely bilateral), esp. right side Kim se woung

5. Paroxysmal pain의 증상 위치 Kim se woung

6. History taking • Duration of pain is typically from a few seconds to 1-2 minutes. • Pain may occur several times a day; patients typically experience no pain between episodes. • Onset of symptoms • Occurs most often after age 50(50~70), but cases are known in children and even infants. • Female > male (3:2) • Trigger points • Various triggers may commonly precipitate a pain attack. • Light touch or vibration is the most provocative. • Activities such hair-combing, shaving, face washing, tooth-brushing, yawning, putting on makeup, chewing or swallowing often trigger an episode. • Pain provokes brief muscle spasm of the facial muscles, thus producing the tic. Kim se woung

7. Physical examination • Physical examination findings are normal; • In fact, a normal neurologic examination is part of the definition of idiopathic TN. • Perform a careful examination of the cranial nerves, including the corneal reflex. • Be alert to the presence of any abnormality on physical examination. • Abnormality suggests that the pain syndromeis secondary to another process. • Remember that patients report pain following stimulation of a trigger point; thus, some patients may limit their examination for fear of stimulating these points. Kim se woung

8. Causes • Most patients’ conditions are idiopathic, but compression of the trigeminal roots by tumors or vascular anomalies may cause similar pain. • Multiple sclerosis • Temporomandibular Joint Syndrome • Other Problems to be Considered: • Atypical facial pain • Glossopharyngeal neuralgia • Temporomandibular joint pain • Compression of trigeminal roots from tumors, aberrant vessels or abnormal bony structure 삼차신경(*)이동맥(@)에 의해서 압박되어 있는 소견 Kim se woung

9. Continue………… Kim se woung