Atypical Facial Neuralgia Research Articles

Treatment of trigeminal neuralgia and other facial pains by retrogasserian injection of glycerol.

Håkanson's treatment of trigeminal neuralgia by injecting 0.2 to 0.4 ml of glycerol into the cerebrospinal fluid in Meckel's cave was carried out in 27 patients with trigeminal neuralgia, 3 with atypical facial neuralgia, and 1 with post-traumatic facial neuralgia. Minor modifications of his technique are described based on our finding of a greater pain and sensory loss upon injection than he noted. We present evidence that glycerol is more toxic than its cryoprotectant effect would intimate and that it selectively eliminates those components of the compound action potential in the trigeminal rootlets customarily associated with pain. We conclude that the method is probably going to be an improvement over radiofrequency heating for the treatment of trigeminal neuralgia in many situations.

Relief of chronic facial pain by transcutaneous electrical nerve stimulation

The usefulness of transcutaneous electrical nerve stimulation was compared between 12 cases of trigeminal neuralgia and 12 cases of atypical facial neuralgia. The overall success rate was 58 per cent falling to 42 per cent after six months. There was however a significant difference between the two groups of patients.

The onset of facial pain. A psychological study.

13, mostly male, cases of cluster headache and 15, mostly female, cases of atypical facial neuralgia were submitted to the psychosomatic anamnestic interview of Seguin. A very high proportion of patients in both groups had suffered from early deprivation of physical gratification. Pain itself started initially after a sequence of masked depression followed by dental or facial intervention in most atypical facial neuralgias, and by emotional stress in half of the patients with cluster headaches. Pain afterwards still hid and expressed a current underlying depression in both groups.

Etiology and treatment of idiopathic trigeminal and atypical facial neuralgias

In a series of sixteen patients with idiopathic trigeminal neuralgia and twenty-one patients with atypical facial neuralgia, it was found that the painful phenomena associated with both disorders were, in nearly all instances, closely related to the presence of maxillary or mandibular bone cavities at previous tooth extraction sites. Standard oral surgical procedures for curettage of the cavities, together with administration of antibiotics, were employed in the successful treatment of both the trigeminal and atypical facial neuralgias, with complete pain remissions for periods varying from 2 months (for most recently treated cases) up to 9 years. The observations and results of this study suggest that dental and oral disorders may play a role in the genesis of trigeminal and atypical facial neuralgias.

Jawbone cavities and trigeminal and atypical facial neuralgias

The possible role of dental and oral disease in the etiology of idiopathic trigeminal and atypical facial neuralgias has been examined. Among thirty-eight patients with idiopathic trigeminal neuralgia and twenty-three patients with atypical facial neuralgia, there was in nearly all instances a close relationship between pain experienced and the existence of cavities in alveolar bone and jawbone of the patients. The cavities were at the sites of previous tooth extractions and, although at times more than 1 cm. in a given diameter, were usually not detectable by x-rays. A new method for their detection and localization was developed empirically, based on the observation that peripheral infiltration of local anesthetic into or very close to the bone cavity rapidly abolished trigger and pain perception by patients during persistence of the anesthetic action. Histopathologic examination of bone removed from cavities by curettage revealed, in both idiopathic trigeminal and atypical facial neuralgias, a similar pattern characterized by a highly vascular abnormal healing response of bone. Some lesions presented a mild chronic inflammatory (lymphocytic) infiltration. Preliminary microbiologic studies of material from the walls of the cavities showed the existence within them of a complex, mixed polymicrobial aerobic and anaerobic flora. Treatment consisted of vigorous curettage of the bone cavities, repeated if necessary, plus administration of antibiotics to induce healing and filling-in of the cavities by new bone. Responses of patients to the above treatment consisted of marked to complete pain remissions, the longest of which has been for 9 years. Complete healing leads to complete and persistent pain remissions. It was concluded that in both idiopathic trigeminal and atypical facial neuralgias, dental and oral pathoses may be major etiologic factors.

Controlled thermocoagulation of trigeminal ganglion and rootlets for differential destruction of pain fibers: facial pain other than trigeminal neuralgia.

I describe the results of retrogasserian differential lidocaine block to aid in the selection of patients for a differential thermal lesion in the trigeminal ganglion and rootlets. This procedure temporarily duplicates the state of analgesia without anesthesia one seeks to make permanent with the radiofrequency heating. The results of this heating procedure are described in the treatment of 71 patients with facial pain of cancer, postherpetic, periodic migrainous neuralgia, acromegaly, trigeminal neuropathy, central pain, post-traumatic facial neuralgia, and atypical facial neuralgia.

Disturbance of facial sensation

The anatomic and clinical pathologic aspects of disturbed facial sensation have been discussed, with references to published examples. Eleven cases of facial anesthesia have been described. Four of these were diagnosed as benign trigeminal neuropathy, a condition presumed to be a viral infection. The others were diagnosed as disseminated sclerosis, an acoustic neurofibroma, disseminated lupus erythematosis, hysteria, an unusual case of trauma, atypical facial neuralgia, and anesthesia dolorosa following section of the left trigeminal and glossopharyngeal roots.

Nerve Route Hypothesis Revived

A voice from the past encouraged formulation of a hypothesis concerning taste, lacrimation, and facial pain, a New England physician told the Congress of Neurological Surgeons. Ernest Sachs, Jr, MD, assistant professor of neurosurgery, Dartmouth Medical School and Hitchcock Clinic, Hanover, NH, said that in sectioning the nervus intermedius between the VII and VIII cranial nerves of a woman with atypical facial neuralgia, the patient (under local anesthesia) inadvertently jumped, and the VII (facial) nerve was torn. "In the course of ascertaining that hemostasis was complete," he continued, "when the remaining VIII cranial nerve was touched, she again had ear and face pain." After careful checking to make sure that stimulation of blood vessels, or dura, or some other factor was not involved, he said, "with the patient's acquiescence, the VIII nerve was sectioned also, after which the pain could not be reproduced." <h3>Clinical Evidence</h3> On the basis of this

Carbamazepine and other drugs for facial pain

Trigeminal neuralgia (tic douloureux) is one of the severest types of facial pain. Carbamazepine (Tegretol - Geigy) is a new drug that helps many patients with trigeminal neuralgia, but not those with other facial pain. Precise diagnosis is therefore particularly important and trigeminal neuralgia should be distinguished from migrainous, post-herpetic and atypical facial neuralgia.

“Atypical facial neuralgia” due to pulpitis: Report of a case

“Atypical facial neuralgia” due to pulpitis: Report of a case

A So-called “Atypical Facial Neuralgia”

Typical among so-called “atypical facial neuralgias” is a syndrome of severe unilateral pain limited to the orbit and the territory supplied by branches of the external carotid artery, with irritation of the lacrimal and nasal mucosal glands. The pain strikes once or several times in 24 hours, is limited in duration—30 to 180 minutes—and occurs in series or “clusters” lasting several weeks. The series are separated from each other by intervals of months or years. A limited vasodilatation is the presumptive mechanism, their histaminic character is disputed, their etiology doubtful. The syndrome occurs mostly in men. It is considered to be a limited migraine variant. Effective treatment is prophylactic and consists of large doses of ergotamine tartrate once or twice daily during a cycle.

The surgical treatment of headache and atypical facial neuralgia.

The surgical treatment of headache and atypical facial neuralgia.

Atypical facial neuralgia resulting from fractured styloid process of the temporal bone

Atypical facial neuralgia resulting from fractured styloid process of the temporal bone

Cephalgic mechanisms with special reference to the atypical facial neuralgias.

The LaryngoscopeVolume 62, Issue 3 p. 284-298 Article Cephalgic mechanisms with special reference to the atypical facial neuralgias.† Edwin N. Kime M.D., Edwin N. Kime M.D. (By Invitation) Indianapolis, IndSearch for more papers by this author Edwin N. Kime M.D., Edwin N. Kime M.D. (By Invitation) Indianapolis, IndSearch for more papers by this author First published: March 1952 https://doi.org/10.1288/00005537-195203000-00006 † Read by invitation at the meeting of the Middle Section, American Laryngological, Rhinological and Otological Society, Inc., Indianapolis, Ind., Jan. 28, 1952. AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume62, Issue3March 1952Pages 284-298 RelatedInformation

Primary atypical facial neuralgia; an hysterical conversion symptom.

Primary atypical facial neuralgia; an hysterical conversion symptom.

ATYPICAL FACE PAIN; A STATISTICAL CONSIDERATION OF 66 CASES

Article1 November 1947ATYPICAL FACE PAIN; A STATISTICAL CONSIDERATION OF 66 CASESTHOMAS W. MCELIN, M.D., BAYARD T. HORTON, M.D., F.A.C.P.THOMAS W. MCELIN, M.D.Search for more papers by this author, BAYARD T. HORTON, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-27-5-749 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptHeadache and pain in the face are two difficult problems with which the practitioner of medicine must reckon. Unusual and irregular facial pain seems almost more of a therapeutic chore than the more familiar distress of headache.REVIEW OF THE LITERATURE AND CONSIDERATION OF TERMINOLOGYGlaser1, 2, 3reviewed the problem with painstaking care in 1928, in 1938 and again in 1940. In 1928, 143 case histories from the Hospital of the University of Pennsylvania were studied critically and the complete syndrome of atypical face pain was presented for the first time and was called "atypical facial neuralgia." The records...Bibliography1. GLASER MA: Atypical neuralgia, so called: a critical analysis of 143 cases, Arch. Neurol. and Psychiat., 1928, xx, 537-558. CrossrefGoogle Scholar2. GLASERBEERMAN MAHM: Atypical facial neuralgia: an analysis of 200 cases, Arch. Int. Med., 1938, lxi, 172-183. CrossrefGoogle Scholar3. GLASER MA: Atypical facial neuralgia: diagnosis, cause and treatment, Arch. Int. Med., 1940, lxv, 340-367. CrossrefGoogle Scholar4. SLUDER G: Concerning some headaches and eye disorders of nasal origin, 1918, C. V. Mosby Company, St. Louis, 272 pp. Google Scholar5. CUSHING H: The major trigeminal neuralgias and their surgical treatment based on experiences with 332 gasserian operations; the varieties of facial neuralgia, Am. Jr. Med. Sci., 1920, clx, 157-184. CrossrefGoogle Scholar6. FAY T: Atypical neuralgia, Arch. Neurol. and Psychiat., 1927, xviii, 309-313. Google Scholar7. FAY T: Atypical facial neuralgia, a syndrome of vascular pain, Ann. Otol., Rhin. and Laryn., 1932, xli, 1030-1062. CrossrefGoogle Scholar8. DAVISPOLLOCK LLJ: The rôle of the sympathetic nervous system in the production of pain in the head, Arch. Neurol. and Psychiat., 1932, xxvii, 282-293. CrossrefGoogle Scholar9. WILSON DC: Atypical facial neuralgia, Jr. Am. Med. Assoc., 1932, xcix, 813-816. CrossrefGoogle Scholar10. FRAZIERRUSSELL CHEC: Neuralgia of the face: an analysis of 754 cases with relation to pain and other sensory phenomena before and after operation, Arch. Neurol. and Psychiat., 1924, xi, 557-563. CrossrefGoogle Scholar11. BRICKNERRILEY RMHA: Autonomic facio-cephalalgia, Bull. Neurol. Inst. New York., 1935, iv, 422-431. Google Scholar12. VALLERY-RADOTBLAMOUTIER PP: Syndrome de vasodilatation hémicéphalique d'origine sympathique (hémicranie, hémihydrorrhée nasale, hémilarmoiement); (présentation de la malade), Bull, et mém. Soc. méd. d. hôp. de Paris, 1925, ii, 1488-1493. Google Scholar13. FAY T: Neuralgias of the face and head; their diagnosis and treatment, Pennsylvania Med. Jr., 1941, xliv, 861-865. Google Scholar14. SCHREIER H: Trigeminal neuralgia-like syndrome; case report and treatment, Med. Rec., 1940, cli, 359-360. Google Scholar15. REICHERT FL: Buccal neuralgia; a form of atypical facial neuralgia of sympathetic origin, Arch. Surg., 1940, xli, 473-486. CrossrefGoogle Scholar16. HYSLOP GH: Atypical facial neuralgia, Laryngoscope, 1941, li, 719-724. Google Scholar17. MARTIN RC: Atypical facial neuralgia, Arch. Otolaryng., 1942, xxxv, 735-739. CrossrefGoogle Scholar18. HORTON BT: Symposium: head and face pain, Trans. Am. Acad. Ophth., 1944, xlix, 23-33. Google Scholar19. GITTINS TR: Headache and facial neuralgia (classification and differential diagnosis), Trans. Am. Laryng., Rhin. and Otol. Soc., 1942, 191-201. Google Scholar20. WALKER AE: The relief of facial pain, Med. Clin. North Am., 1945, xxix, 73-97. CrossrefGoogle Scholar21. MCELINHORTON TWBT: Clinical observations on the use of benadryl: a new antihistamine substance, Proc. Staff Meet., Mayo Clin., 1945, xx, 417-429. Google Scholar22. HORTON BT: The use of histamine in the treatment of specific types of headaches, Jr. Am. Med. Assoc., 1941, cxvi, 377-383. CrossrefGoogle Scholar23. HORTONMACY BTD: Treatment of headache, Med. Clin. North Am., 1946, xxx, 811-831. CrossrefGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Rochester, Minnesota*Received for publication January 28, 1947.†Fellow in Medicine, Mayo Foundation.‡Division of Medicine, Mayo Clinic. 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SURGICAL ANATOMY OF THE EXTERNAL CAROTID PLEXUS

Both neurologists and surgeons have given steadily increasing consideration to the pain which accompanies vascular disease. Among the varieties is atypical facial neuralgia, in which the pain is felt in the areas supplied by the external carotid artery. Section of the sensory root of the trigeminal nerve has usually failed to relieve such pain. Other attempts to relieve it have included resection of the cervicothoracic sympathetic chain at various levels and periarterial stripping of the common carotid artery near its bifurcation. It is generally believed that the autonomic nervous system is involved in the production of atypical facial neuralgia, and on this basis attempts have been made to relieve it by severing (either preganglionically or postganglionically) the motor outflow reaching the affected sites. After the operative treatment of atypical facial neuralgia, results are not predictable, and in some cases no relief at all is obtained. Furthermore, a Horner's syndrome results

ATYPICAL FACIAL NEURALGIA

A large group of patients have atypical facial neuralgia characterized by severe boring, at times burning, pain, not limited to the distribution of a cranial nerve but occurring back of the eye, over the zygoma, cheek or nose and occasionally over the mastoid region and down the neck. It cannot be brought on by touching or moving the area and is not lancinating as is trigeminal neuralgia. This syndrome is often temporarily relieved by cocainizing the sphenopalatine ganglion, and Sluder, who first described the condition, thought that permanent relief was sometimes obtained by the injection of alcohol into that ganglion. I have seen patients relieved after cocainization but not after injection of alcohol. Hypotheses as to the production of this pain are many. Davis and Pollock¹stated the belief that they had disproved experimentally the existence of afferent sympathetic fibers. It was their opinion that stimulation of the efferent sympathetic

Atypical facial neuralgia

Atypical facial neuralgia

BUCCAL NEURALGIA

My reason for reporting on buccal is that I have segregated a group of cases of a condition that falls into the general classification of atypical facial neuralgia but in which pain was limited to the cheek, upper jaw, malar region and nose. Moreover, a simple surgical procedure has been found that gave relief in a majority of these cases. So-called atypical facial neuralgia is believed to originate in the sympathetic nervous system. Occasionally it is associated with trigeminal tic douloureux, but it is not relieved by section of the sensory root of the fifth nerve. Atypical facial neuralgia is described as a deepseated, dully aching, burning, throbbing, boring pain in the nasal, maxillary, zygomatic and temporal regions, in the jaw, in or behind the eye, in the nostril, in the cheek, in the gum and at times behind the ear, extending to the occipital region and occasionally down