Painful Trigeminal Neuropathy Attributed to a Space-occupying Lesion Presenting as a Toothache: A Report of 4 Cases

Abstract

Painful trigeminal neuropathy attributed to a space-occupying lesion (code 13.1.2.5 in the International Classification of Headache Disorders, 3rd edition [beta version]) is an orofacial pain condition that has characteristics of classical trigeminal neuralgia but is caused by a space-occupying lesion. We present 4 cases of intracranial lesions mimicking odontogenic pain as follows: case 1, a 61-year-old woman presented with a chief complaint of aching soreness in the right mandibular molar area for 1 year; case 2, a 59-year-old man presented with severe pain in the left maxillary and mandibular molars; case 3, a 72-year-old man presented with a chief complaint of facial shock–like pain on the left side; and case 4, a 75-year-old man presented with a chief complaint of paroxysmal pain and numbness in the buccal gingiva of the right mandibular molar region. Cases 1 and 2 had trigeminal neuralgia, which had previously been incorrectly attributed to osteoma and maxillary sinus retention cyst, respectively, and resulted in inappropriate dental surgical procedures. All patients subsequently underwent magnetic resonance imaging, and the results were consistent with intracranial disease. Magnetic resonance images revealed acoustic neuromas in the cerebellopontine angle in cases 1, 2, and 4 and a small meningioma near the entry to the left Meckel cave in case 3. Cases 1, 3, and 4 had these lesions removed; after which, their pain resolved. Before dental treatment, dental practitioners should focus not only on dental imaging but also on the patient's medical history and pain characteristics.