Cause Of Facial Pain Research Articles

Diffusion tensor imaging in trigeminal neuralgia: beyond the normal morphology

BackgroundTrigeminal neuralgia (TN) is an electric-like recurrent pain of a sudden onset and is localized to the area supplied by the trigeminal nerve, and the patients are usually free in between the attacks. It’s one of the most common causes of facial pain and is commonly induced by mechanical irritation, and there’s strong evidence suggesting an insult at the trigeminal nerve root which is usually caused by a neurovascular compression. The aim of the study was to evaluate the role of diffusion tensor imaging (DTI) in the detection of microstructural changes of normal appearing trigeminal nerve in patients with trigeminal neuralgia and the correlation between DTI parameters and pain severity.ResultsThirty one cases were included in the study (16 patients with TN and 15 healthy controls) underwent MRI with diffusion tensor imaging. The fractional anisotropy (FA) values of the trigeminal nerves were recorded and then comparison between the affected and unaffected sides in TN patients and healthy controls was done, also the degree of FA reduction was correlated with the pain severity in TN groups. The mean FA value of the affected trigeminal nerves was 0.43 ± 0.083, while that of the unaffected sides was 0.56 ± 0.058. The mean FA value of the trigeminal nerves in the healthy controls was 0.54 ± 0.057. A significant statistical differences was found between affected and unaffected sides (P < 0.00001) and between the affected sides and healthy controls (P < 0.0003), while no statistically significant difference was detected between the unaffected side and the healthy controls. A strong negative correlation was found between the pain score and the degree of FA reduction (P < 0.001).ConclusionsDiffusion tensor imaging is a functional MRI technique which can detect the microstructural changes in the normal appearing trigeminal nerves in patients with trigeminal neuralgia with a strong negative correlation between the severity of pain and the degree of FA reduction of the affected trigeminal nerve.

Online dynamic nomogram for predicting pain recurrence after microvascular decompression in trigeminal neuralgia.

Trigeminal neuralgia (TN) is one of the most common causes of facial pain. Microvascular decompression (MVD) is the first-choice surgical treatment. The present study aimed to develop a novel practical assessment system based on preoperative clinical and imaging factors for clinicians to predict the likelihood of pain recurrence following MVD in TN. A total of 56 patients with primary unilateral TN who underwent MVD were retrospectively analyzed. Patients were followed up to observe pain recurrence 1 year after MVD. An online dynamic nomogram was constructed for predicting the probability of pain recurrence after MVD in patients with TN based on multivariate logistic model. The concordance index (C-index) and receiver operating characteristic (ROC) were used to measure model discrimination. Bootstrap resampling was used for internal validation of the model and calibration curve was constructed. Decision curve analysis (DCA) was used to assess clinical applicability. Factors such as numeric rating scale (to score pain degree of patients with TN), response to neuroanalgesic drugs and neurovascular contact on magnetic resonance imaging were independent risk factors affecting the pain recurrence rate (all P<0.05). C-index was 0.973 (95%CI, 0.938-1.000) and the area under the ROC was 0.973 (95%CI, 0.938-1.000). Calibration curve with a 1,000 bootstrap resampling showed a good fit between dynamic nomogram prediction and actual observations. The DCA showed that at a threshold probability between 0 and 100%, this model can achieve a greater net benefit than if all patients had surgery or none had surgery. In conclusion, this online dynamic nomogram reliably predicted risk of pain recurrence in patients with TN following MVD.

A Retrospective Clinical Trial Regarding Oral Rehabilitation Diagnosis Strategies Based on Stomatognathic System Pathology.

Orofacial pain is a common occurrence in daily dental practice; it is frequently attributed to temporomandibular dysfunction, one of its major causes, followed by pathology of the salivary glands, without avoiding interference at the level of the pain pathways caused by complications of periodontal pathology. The main objective of this study is to identify an important cause of pain in the oral-maxillofacial territory by quantifying the changes at the salivary glandular level using stereological methods. The secondary objective of the present research is to identify the implications of periodontal changes as a consequence of salivary quantitative and qualitative changes, quantified using periodontal indices, on the balance of the temporomandibular joint, dysfunction of it being an important cause of facial pain and having a profound impact on the complex oral rehabilitation algorithm of each clinical case, a condition evaluated with the analysis of the results of the Souleroy questionnaire. In a retrospective study, we evaluated the clinical results obtained after applying complex rehabilitation treatment to 35 subjects, 20 women and 15 men with salivary and TMJ dysfunctions, selected between 2020 and 2021 from the Clinic of Maxillofacial Surgery, Iasi. The most common symptoms of temporomandibular disorders (TMDs) that were identified through the Souleroy questionnaire were pain and different types of damage to the masticatory muscles. The most significant changes in elders are reported in the case of serous cells, which reduced their percentage volume from 46.7% to 37.4%. As regards stereological analysis in conjunction with histological images, there were significant changes in diameters, perimeters, and longitudinal axes in the adult patients as opposed to the elderly patients, which were also influenced by the type of pathology at this level. The scores recorded on the diagnostic Souleroy scale indicated a large number of patients with low efficiency and maximum stress levels: 20.0% in level 1, 25.7% in level 2, and 25.7% in level 3.

Puncture approaches and guidance techniques of radiofrequency thermocoagulation through foramen Ovale for primary trigeminal neuralgia: Systematic review and meta-analysis.

Trigeminal neuralgia (TN) is one of the leading causes of facial pain and seriously affects patients' quality of life. Foramen ovale (FO) radiofrequency thermocoagulation is a classic approach for the treatment of TN that has failed pharmacological therapy. This study summarized the safety and efficacy of transforaminal radiofrequency thermocoagulation for TN by comparing puncture approaches or guidance techniques, thereby providing higher-quality clinical evidence. Databases including PubMed, Embase, Cochrane Library, CNKI, and Wanfang were searched for relevant studies published before May 2022. Relevant data were extracted for analysis to compare methodological variables and clinical outcomes. This meta-analysis included 27 studies with a total of 1,897 patients. In terms of puncture approaches, FO had a significant advantage in reducing VAS at 12 months postoperatively (P = 0.019) and efficacy (P = 0.043). However, FO performed poorly on complications (P < 0.001), operation time (P < 0.001), and the number of needle adjustments (P < 0.001). Regarding the guidance techniques, the adjunctive use of guidance techniques could reduce patients' 6-month VAS (P < 0.001) and 12-month VAS (P < 0.001), improve the efficacy (P = 0.032), reduce recurrence rates (P = 0.001), shorten operation times (P < 0.001), decrease times of intraoperative fluoroscopy (P < 0.001), and improve the success of the first puncture (P < 0.001). FO radiofrequency thermocoagulation has advantages in efficacy it can still better relieve the pain of patients 12 months postoperatively. However, FO has disadvantages in complications, recurrences, and operation time. The adjunctive use of guidance techniques has a positive effect on treatment efficacy and safety during FO radiofrequency thermocoagulation. However, the results still require large samples and high-quality randomized clinical trials to confirm.

Comparative Efficacy of Low-Level Laser Acupuncture and Cupping for Treatment of Patients with Myofascial Pain Dysfunction Syndrome: A Double-blinded, Randomized Clinical Trial: Comparison of the Effects of LLL Acupuncture and Cupping.

Background: Myofascial pain dysfunction syndrome (MPDS) is among the most common causes of facial pain. This study compared the efficacy of low-level laser (LLL) acupuncture and cupping for the treatment of MPDS. Materials and Methods: This double-blind, before-after, randomized clinical trial evaluated 60 MPDS patients that were divided into two groups for LLL acupuncture (808 nm, 0.5 W, 30 J, 4 J/cm2 energy density, 60 seconds; group 1), and cupping (group 2) of masticatory muscle trigger points. Both treatments were performed for maximally eight sessions once every other day. The level of pain at the trigger points was measured upon admission, before and 5 minutes after treatment in each session, at ten days, and two months after treatment completion by a visual analog scale (VAS). The painless maximum mouth opening (MMO) and patient satisfaction with treatment were also assessed at the time as mentioned earlier points. Results: Averagely, 4.5 treatment sessions were required to achieve a 50% reduction in VAS pain score, with no significant difference between the two groups (P=0.9). Both treatments significantly decreased the number of trigger points and pain score, but this reduction occurred significantly sooner in the cupping group (P=0.01). MMO significantly improved in both groups after treatment with no significant difference between them (P=0.2). Patients were significantly more satisfied with LLL acupuncture (P=0.05). Conclusion: Both cupping and LLL acupuncture are equally effective for MPDS; thus, the patient can choose the type of treatment after receiving sufficient information regarding the two modalities.

436 Colored Pain Drawing in Patients With Trigeminal Neuralgia and Its Impact on Gamma Knife Radiosurgery Outcomes

INTRODUCTION: Trigeminal neuralgia (TN) is one of the most common causes of facial pain and Gamma Knife radiosurgery (GKRS) has been used for a long time with high pain relief rates. However, psychological processes can influence the pain perception and adversely affect treatment outcome. Colored pain drawing (CPD) is a simple,powerful tool for capturing essential aspects of the subjective pain. METHODS: Fifty consecutive patients with medically intractable, ICHD-3 beta-confirmed TN were included. A numerical pain rate scale (NPRS) was used to assess usual level of pain experienced by the patient. Patients were asked to draw the distribution of usual pain pattern with a colored pen of their choice on two standardized face charts. The patients then underwent GKRS. Follow-up data were obtained by clinical examination and/or telephone questionnaire postoperatively at 1, 3 and 6 months. Outcome results were categorized based on the Barrow Neurological Institute (BNI) pain scale (BNI I–III:good outcomes and BNI IV–V:treatment failure). BNI facial numbness score was used to assess complications. All CPDs were classified as “expected” or “unexpected” based on the patient’s description of pain. RESULTS: The median age was 64 years (range, 27-88) years and the male/female ratio was 3:2. 86% of the patients experienced immediate pain relief within the first 3 months. Of those patients, 39 (90.7%) did not have any pain recurrence (BNI I). At last follow-up, 39 (78%) patients had good treatment outcome and 11 patients (22%) had treatment failure. 96% of the patients did not experience any facial numbness. There were 35 patients with “expected” and 15 patients with “unexpected” CPDs. NPRS scores were not significantly different between groups (p = 0.985). The preference of association of pain with black or red color was distinct and did not differ between two groups (p = 0.08). Patients with “expected” CPDs reported significantly better freedom from pain compared with those with “unexpected” CPDs (p &lt; 0.0001). CONCLUSION: CPDs could serve as clinical acumen for outcomes of GKRS treatment for TN.

Лицеві болі в стоматології

У лекції описані найчастіші варіанти лицевих болів у клінічній практиці лікаря-стоматолога. Наведені особливості клінічної картини, що дозволяє диференціювати їх між собою і зі стоматологічними больовими синдромами. Розкрити основні причини розвитку лицевих болів і показане місце серед них стоматологічних проблем і захворювань. Подані основні напрямки лікування прозопалгій. Наведено клінічний випадок розвитку лицевого болю у хворого на ускладнений карієс.

Analysis of the prevalence of headaches subtypes in a specialized outpatient clinic in a municipality in medium-sized Minas Gerais

Objective To evaluate the prevalence of different subtypes of headaches in a tertiary referral clinic for headache care in the city of Barbacena. Methods A retrospective and descriptive cross-sectional cohort study that evaluated the medical records of 130 patients previously seen by a neurologist in January 2020 to March 2021 in the headache clinic. Results The mean age of patients was 42.5 years, most of them female (83.07%). Primary headaches were the most common, with migraine found in 73% of cases and tension-type headache (TTH) in 17%. Among secondary headaches, the most common subtype was headache attributed to a substance or its suppression (11%), followed by cases such as headache due to cranial neuralgia and central causes of facial pain (3%) and headache attributed to trauma or head and/or cervical injury (3%). All cases in which there was an association of diagnoses of headache subtypes were found in patients with migraine (100%). Conclusion This study defines the prevalence of headaches in a specialized outpatient clinic, confirming literature data that show migraine as the most common headache.

Imaging of Trigeminal Neuralgia and Other Facial Pain.

We review and illustrate the radiology of facial pain, emphasizing trigeminal neuralgia, relevant anatomy, current classification, concepts about etiology, and the role of imaging and its influence on the choice of treatment. We discuss glossopharyngeal neuralgia, other neuropathic causes of facial pain, postinflammatory and neoplastic causes, and nociceptive (end-organ) causes of facial pain, as well as referred otalgia. Other conditions that may present with facial pain, including trigeminal autonomic cephalgias and giant cell arteritis, are reviewed briefly. We discuss the elements of a comprehensive MR imaging protocol to enable detection of these diverse causes of facial pain.

Effects and safety of high-frequency repetitive transcranial magnetic stimulation in trigeminal neuralgia

Background. Trigeminal neuralgia is the most common cause of facial pain. Insufficient effectiveness and frequent side effects of pharmacological therapy, as well as the risk of complications of invasive neurosurgical manipulations, determine the relevance of the development of new treatment approaches, one of which is repetitive transcranial magnetic stimulation (rTMS).The aim of the study is to determine the effectiveness of high‑frequency rTMS of the primary motor cortex in terms of pain intensity and quality of life in patients with trigeminal neuralgia, as well as to assess the safety of the stimulation course.Materials and methods. This open‑label non‑randomized single arm study included 20 patients with classic trigeminal neuralgia according to the ICHD‑3 classification. All patients received 10 sessions of navigated high‑frequency rTMS of the primary motor cortex (hand area) of the hemisphere, contralateral to pain syndrome localization. The maximum and average pain intensity was assessed before and after 10 rTMS sessions according to a Numeric Pain Rating Scale (NPRS), as well as quality of life was measured according to the SF‑36 questionnaire, and the severity of affective disorders according was measured to the Beck Depression Inventory (BDI). Safety and tolerability of rTMS were assessed using self‑developed questionnaires for adverse events that occurred during stimulation and within 24 hours after the previous session.Results. A significant decrease in the maximum (p = 0.01) and average (p &lt;0.01) pain intensity was shown after 10 sessions of rTMS. In 50 % of patients, the maximum pain intensity decreased by more than 30 % vs baseline. Significant changes were detected in the physical health measure of SF‑36 quality of life questionnaire, particularly, in the “bodily pain” domain, as well as in such aspects of the mental health measure as “vitality” and “social functioning”. The severity of affective disorders did not change significantly. A favorable profile of rTMS tolerability has been demonstrated.Conclusion. An open‑label study showed the possible effectiveness of 10 sessions of high‑frequency rTMS to reduceт the pain intensity in patients with trigeminal neuralgia. For the first time, the spectrum of adverse events both during stimulation and within a day after its completion was systematically analyzed.

Percutaneous Radiofrequency Thermocoagulation in Trigeminal Neuralgia : Analysis of Early and Late Outcomes of 156 Cases and 209 Interventions.

ObjectiveTrigeminal neuralgia is one of the most common causes of facial pain. Our aim is to investigate the efficacy and borders of percutaneous radiofrequency thermocoagulation in the treatment of trigeminal neuralgia. MethodsBetween May 2007 and April 2017, 156 patients with trigeminal neuralgia were treated with radiofrequency thermocoagulation. These 156 patients underwent 209 procedures. In our study, we investigated the early and late results of percutaneous radiofrequency thermocoagulation under guiding fluoroscopic imaging in the treatment of trigeminal neuralgia. Barrow Neurological Institute (BNI) pain scale was used for grading the early results. In addition, Kaplan-Meier survival analysis was used to assess long-term outcomes. Of the 156 patients who underwent radiofrequency thermocoagulation for trigeminal neuralgia, 45 had additional disease. Patients with this condition were evaluated with their comorbidities. Early and late results were compared with those without comorbidity. ResultsIn 193 of 209 interventions BNI pain scale I to III results were obtained. Out of the 193 successful operation 136 patients (65.07%) were discharged as BNI I, 14 (6.70%) as BNI II, 43 (20.58%) as BNI III. Sixteen patients (7.65%) remained uncontrolled (BNI IV and V). While the treatment results of trigeminal neuralgia patients with comorbidity seem more successful in the early period, this difference was not observed in follow-up examinations. ConclusionFinally, we concluded that percutaneous radiofrequency thermocoagulation of the Gasserian ganglion is a safe and effective method in the treatment of trigeminal neuralgia. However, over time, the effectiveness of the treatment decreases. Neverthless, the reapprability of this intervention gives it a distinct advantage.

Brain activity assessment by functional MRI before and after radiofrequency of gasserian ganglia in patients with trigeminal neuralgia

Background and Objectives: Trigeminal neuralgia (TN) is one of the common causes of facial pain. However, its treatment is a challenge. Radiofrequency (RF) is an effective and safe option that is available. In our study, we used functional Magnetic resonance imaging (fMRI) to assess levels of brain activity in patients with TN, before and after receiving radiofrequency.&#x0D; Methodology: This study is a randomized prospective clinical study. It included 30 patients with TN who were scheduled for thermal (i.e. conventional) radiofrequency (CRF) and pulsed radiofrequency (PRF). 15 patients were randomly assigned to each group. All patients were contacted before the intervention and then 1 week, 1 month, 3 months, and 6 months after the intervention. They were assessed using the Visual Analogue Scale (VAS) score, and their complaints of facial numbness, muscles of mastication dysfunction and carbamazepine dose. fMRI was done before and one month after the intervention.&#x0D; Results: The study group comprised of 13 men and 17 women; a total of 30 patients. The mean age of patients was 50.60 ±12.06 years in the thermal radiofrequency group and 47.93 ±9.90 years in the pulsed radiofrequency group. The median VAS score before the procedure was 8 in both groups, (7-9) in CRF and (7-8) in PRF. Our study demonstrated a statistically significant difference in VAS score at different stages of follow-up after thermal radiofrequency and pulsed radiofrequency when compared with the pretreatment stage. PRF patients continued on medications. Mild complications as facial numbness and masticatory muscle weakness were reported in the CRF group. In some brain regions, fMRI revealed reduced BOLD signal activation after radiofrequency ablation compared to that before the radiofrequency therapy but it was not significant.&#x0D; Conclusion: In our study, post-intervention fMRI revealed a reduction in signal activations of some brain regions but we could not correlate these changes with the clinical improvement. Radiofrequency is an effective treatment for trigeminal neuralgia. CRF is preferable as it had less complications.&#x0D; Key words: fMRI; Trigeminal neuralgia; Pulsed Radiofrequency; Thermal radiofrequency&#x0D; Citation: Abdallah M, Khalil S, Hamed A, Soliman RK, Mohamed A. Brain activity assessment by functional MRI before and after radiofrequency of gasserian ganglia in patients with trigeminal neuralgia. Anaesth. pain intensive care 2020;24(6):---&#x0D; Received: 30 July 2020, Reviewed: 6 October 2020, Revised: 29 October 2020, Accepted: 30 October 2020&#x0D; Abbreviations: fMRI – functional Magnetic Resonance Imaging, RF – Radiofrequency, CRF – Conventional Radiofrequency, PRF – Pulsed Radiofrequency, TN – Trigeminal Neuralgia, BMI – Body mass index, VAS – Visual Analogue Scale, BOLD – Blood Oxygen Level-Dependent, ReHo – Regional Homogeneity, ALFF – Amplitude of Low Frequency fluctuations.

Recurrent Painful Ophthalmoplegic Neuropathy: Migraine, Neuralgia, or Something Else?

Recurrent painful ophthalmoplegic neuropathy (RPON) is a very rare disease characterized by recurrent attacks (at least two) of unilateral headache associated with ipsilateral ophthalmoplegia due to paresis of one or more cranial motor nerves, not due to any orbital, parasellar, or posterior fossa lesions. The differential diagnoses for this condition are broad. In addition to disability during an acute attack, this disease could also cause a permanent neurologic deficit. The understanding of RPON pathogenesis has changed over time, leading to a change in the classification of this disorder between editions of the International Classification of Headache Disorders, in which the condition was moved from the chapter on migraine to the chapter on cranial neuralgias and central causes of facial pain. There is no consensus on the pathogenesis of RPON. It is possible that multiple pathogenic mechanisms underlie various clinical forms of the disease. A depiction of pathologic analyses of patients with radiologically confirmed changes in the affected nerves during and outside of attacks would significantly contribute to knowledge of its pathogenesis. Brain imaging should be performed in each patient during an acute RPON attack and at a regular schedule between attacks. Further case reports and case series are required before further conclusions can be made regarding RPON pathogenesis and proposals for treatment options.

Trigeminal Neuralgia Crisis - Intravenous Phenytoin as Acute Rescue Treatment.

The aim of this retrospective cohort study was to analyze responses to intravenous (IV) phenytoin (PHT) for trigeminal neuralgia (TN) crisis in a group of patients treated at our institution. TN is one of the most common causes of facial pain. Its treatment relies on preventive therapy with either carbamazepine or oxcarbazepine. During severe pain episodes, patients may be unable to eat, drink, or even swallow oral medication, requiring in-hospital treatment. There is scarce evidence to support IV medication use for TN, making management of this condition difficult. We reviewed clinical records of patients with TN crisis consulting the emergency department at a tertiary neurological referral center in Buenos Aires, Argentina, treated with IV PHT as analgesic strategy, and with at least 1-month posttreatment follow-up. Demographic features, magnetic resonance imaging findings, and therapeutic management were analyzed. Thirty-nine patients with TN were included, 18 (46.2%) receiving IV PHT more than once (total number of infusions administered, 65). Immediate pain relief was observed in 89.2% (58/65) and 15.4% (10/65) presented side effects. We recommend IV PHT as acute rescue treatment in TN crisis.

The simple treatment of chronic facial pain due to trigeminal neuralgia with dental occlusal equilibration

BackgroundTrigeminal neuralgia (TN) is the most common cranial neuralgia in adults, with a slightly higher incidence in women than in man. This chronic pain condition affects the trigeminal nerve, also known as the 5th cranial nerve. Antiseizure drugs are the main biomedical treatment of TN. However, TN is not the only source of chronic facial pain (CFP). Background persistent idiopathic facial pain (PIFP) is also a chronic disorder. The underlying pathophysiologies of TN and PIFP are still unknown. Occlusal equilibration appliance (OEA) will stop bruxism by relaxing all mastication muscle especially, The Lateral Pterygoid muscle. The posterior trunk of the mandibular division of the trigeminal nerve normally descends deep to the lateral pterygoid muscle. In three of 52 dissections the three branches of the posterior trunk were observed to pass through the medial fiber of the lower belly of the lateral pterygoid muscle. Case descriptionA 70 year-old Thai female with left facial pain was diagnosed by a neurologist with TN 4 years prior to seeking occlusal equilibration. The cause of facial pain was treated with occlusal equilibration appliance. ConclusionA complete dissipation of pain was achieved after using occlusal equilibration appliance for 2 weeks and 3 days. The present article is the one of the first to demonstrate the efficacy of occlusal equilibration appliance treatment for chronic facial pain. As the present article shows, OEA treatment affects TN and CFP successfully. However, additional large-scale studies are necessary to validate the efficacy of OEA in TN and CFP treatment.

The Effectiveness and Safety of 42°C Pulsed Radiofrequency Combined with 60°C Continuous Radiofrequency for Refractory Infraorbital Neuralgia: A Prospective Study

Background: Infraorbital neuralgia, one of the rare causes of facial pain, lacks systematic treatment guidelines because few studies on the topic have been published. We previously found that 42°C percutaneous nondestructive pulsed radiofrequency (PRF) treatment could achieve satisfactory pain relief for infraorbital neuralgia patients. However, patients who responded poorly to PRF had no other ideal treatment options until now. Recently, standard PRF combined with 60°C continuous radiofrequency (CRF) was successfully performed on trigeminal neuralgia patients and achieved a promising effective rate with mild complications. However, the efficacy of the combined therapy in the treatment of infraorbital neuralgia has not yet been reported. Objectives: To evaluate the effectiveness and safety of 42°C PRF combined with 60°C CRF in infraorbital neuralgia patients who responded poorly to 42°C PRF and were reluctant to receive destructive therapies or nerve decompression surgery. Study Design: Prospective, single-center, observational clinical trial. Setting: The interventional pain management center in Beijing Tiantan Hospital. Methods: We prospectively investigated the effects of 10 minutes of 3-dimensional computer tomography-guided 42°C PRF combined with 270 seconds of 60°C CRF in the treatment of 28 patients with refractory infraorbital neuralgia. The response criterion was a postoperative verbal pain numeric rating scale score reduction of &gt; 50%. The response rates at different time points during a 2-year follow-up were calculated. Results: The effective rates of combined PRF and CRF treatment were 95.5%, 86.4%, 81.8%, 72.7%, 72.7%, and 72.7% postoperative at 1 month, 3 months, 6 months, 1 year, 18 months, and 2 years, respectively. Except for 16 patients (72.7%) experiencing mild numbness that gradually disappeared within 1 week to 2 months after the operation, no obvious complications were observed. Limitations: This study examined the therapeutic effectiveness over a period of only 2 years; no further follow-up was conducted. In addition, this study is a single-center observational clinical study with small sample sizes. Conclusions: For patients with intractable infraorbital neuralgia, 42°C PRF combined with 60°C CRF is an effective and safe treatment. Prospective, double-blind randomized controlled trials with longer follow-up periods are needed to evaluate whether the combined treatment could become an alternative option for those who do not respond to conservative treatment, sparing those patients from destructive therapies or more invasive nerve decompression surgery. Key words: Infraorbital neuralgia, effectiveness, safety, pulsed radiofrequency, continuous radiofrequency, combined therapy

Comparative Analysis of Balloon Compression and Radiofrequency Ablation in Idiopathic Trigeminal Neuralgia: A Retrospective Study with a 24-Month Follow-up.

Trigeminal neuralgia (TN) is a common cause of facial pain, with a prevalence of 40 per million. This paper is a retrospective 24-month follow-up study of 20 patients with idiopathic drug-resistant TN who underwent balloon compression (BC) or radiofrequency ablation (RFA). When neuralgia affected more than one divisions or it involved ophthalmic division, BC was performed. RFA was performed in neuralgia involving isolated mandibular or maxillary division. At all the time points, numerical rating score (NRS) was lower in the BC group, but the difference was not significant. The proportion of patients developing recurrence of pain was lower in the BC group, but the difference was not significant (p-value 0.63). The proportion of patients requiring a repeat procedure was lower in the BC group, but the difference was not significant. There was no significant correlation among recurrence of pain, age of the patient and number of divisions in which neuralgia was present. In BC, a pear shape of the balloon is desirable, but this shape is not always achievable. Recurrence of pain in the BC group was comparable to that in the available literature, but the recurrence rate in the RFA group was comparatively higher. The complications in BC were higher, but they were transient and improved with time. BC and RFA are effective modalities of treatment for idiopathic TN with comparable results. In TN involving multiple divisions, BC may be more convenient.

Temporomandibular Joint Dysfunction as a Cause of Facial Pain- A Case Report

Temporomandibular joint dysfunction (TMJD) is one of the rare causes of facial pain. Its’ onset is often insidious. It can be a difficult condition to manage as most sufferers tend to have a chronic clinical course. This case report will look at a young man with TMJD and what options are available for its’ management.

Facial pain: sinus or not?

SUMMARYFacial pain remains a diagnostic and therapeutic challenge for both clinicians and patients. In clinical practice, patients suffering from facial pain generally undergo multiple repeated consultations with different specialists and receive various treatments, including surgery. Many patients, as well as their primary care physicians, mistakenly attribute their pain as being due to rhinosinusitis when this is not the case. It is important to exclude non-sinus-related causes of facial pain before considering sinus surgery to avoid inappropriate treatment. Unfortunately, a significant proportion of patients have persistent facial pain after endoscopic sinus surgery (ESS) due to erroneous considerations on aetiology of facial pain by physicians. It should be taken into account that neurological and sinus diseases may share overlapping symptoms, but they frequently co-exist as comorbidities. The aim of this review was to clarify the diagnostic criteria of facial pain in order to improve discrimination between sinogenic and non-sinogenic facial pain and provide some clinical and diagnostic criteria that may help clinicians in addressing differential diagnosis.

Maxillary sinus pain with radiolucent sinuses due to agenesis of the membranous ostium

IntroductionThe absence of opacities on CT scan usually eliminates paranasal sinus disease as a cause of facial pain. The authors report a case, which constitutes an exception to this general rule, corresponding to a new aetiology of sinus pain. Case reportA 16-year-old boy presented with very painful “recurrent acute sinusitis” triggered by pressure changes (altitude, diving, surfing), with no sinus opacity on CT scan. Surgical exploration demonstrated absence of a primary or accessory maxillary ostium. Middle meatus antrostomy relieved the patient's pain. DiscussionThe pathophysiology of this case of recurrent acute pseudo-sinusitis and the efficacy of antrostomy can be explained by the evo-devo theory of the origin and function of the paranasal sinuses. This case illustrates the absence of communication in the ethmoid of the membranous sac lining the maxillary sinus, formed by degeneration of the maxillary erythropoietic bone marrow. Under stable environmental conditions, the continuous production of nitric oxide by the sinus epithelium is eliminated by simple transmembrane diffusion, but is insufficiently eliminated in the case of rapid pressure changes, inducing sometimes very severe sinus pain, mimicking sinusitis. This case report paves the way for more detailed studies on the role of the paranasal sinuses in facial disease and respiratory physiology.