Craniofacial Pain Research Articles

Comparative analysis of myoelectric activity and mandibular movement in healthy and nonpainful articular temporomandibular disorder subjects.

Temporomandibular disorders (TMDs) are one of the leading causes of craniofacial pain, and a high incidence of TMDs in young adults has been reported. Previous studies have used surface electromyography (sEMG) and mandibular kinematic analysis for TMDs diagnosis. This study aimed to provide normal reference values of sEMG and mandibular kinematics in Han Chinese adults, compare the sex differences and assess their diagnosis value on pain-free articular TMDs. This observational study recruited healthy young adults with individual normal occlusion and nonpainful articular TMDs patients with disc displacement. The sEMG signals of the anterior temporalis (TA), masseter (MM), and sternocleidomastoid and digastric were recorded in the mandibular postural positions (MPP) and during maximal voluntary clenching (MVC) with K7 electromyograph. Mandibular kinematics, including maximum opening and opening/closing velocities, were assessed by K7 kinesiograph. The sEMG reference values ranged from 3.0 to 4.3 µV in the MPP (n = 90) in healthy subjects. The sEMG values during MVC, maximum opening, and opening velocity were significantly higher in males than in females. Also, these indices showed good diagnostic efficiency for pain-free articular TMDs (n = 26). Reference values and sex differences in sEMG and mandibular kinematics in healthy subjects were determined. Compared with them, articular TMDs patients showed significantly lower myoelectric activity during maximal biting and restricted mouth opening range and velocity, which may assist in TMDs diagnosis. By analyzing sEMG of masticatory muscle and mandibular kinematics data from healthy Han Chinese young adults and TMDs patients with disc displacement, this study evaluated the sex difference and their diagnosis value on nonpainful TMDs with disc displacement. NCT06372769.

Clinical presentation, management and outcome of maxillofacial fractures in pet rabbits: 27 cases (2008-2022).

To report clinical findings, management strategies and outcomes in pet rabbits with maxillofacial fractures. Medical records of pet rabbits with confirmed maxillofacial fractures from three exotic animal veterinary services between 2008 and 2022 were reviewed. Forty-five fractured maxillofacial bones were reported in 27 rabbits, including mandibular symphyseal separation in 13 rabbits. Median age was 18 months (interquartile range, 7 to 38 months), and median bodyweight was 1.70 kg (interquartile range, 1.36 to 2.33 kg). The most common aetiology was anthropogenic accidents (16/27). Hyporexia/anorexia was the most frequent presenting complaint (17/27). Common clinical findings included dental malocclusion (12/27), craniofacial pain (9/27), crepitus (9/27) and swelling (7/27). Three (3/27) rabbits were euthanised after diagnosis. Mandibular symphyseal separation in 11 of 12 treated rabbits were addressed using circummandibular cerclage wiring. All remaining fractures were conservatively managed. Twenty-three of 27 rabbits survived to hospital discharge. Median time of return to normal or near-normal eating was 1 day (interquartile range, <1 to 3 days). Median survival time was 859 days (interquartile range, 567 to 1092 days). Dental malocclusion was a reported complication in 12 of 16 rabbits with follow-up data. However, only five of 12 rabbits developed associated clinical signs requiring corrective dentistry. Maxillofacial fracture in rabbits may present with similar clinical signs and findings to other conditions such as odontogenic disease. Successful outcomes with infrequent long-term clinical complications are associated with management strategies that emphasise early functional recovery.

Evaluation of somatosensory bedside testing and neurodynamics of the trigeminal nerve in craniofacial pain: A matched case–control study

ABSTRACT Objective The objective of this study was to investigate whether trigeminal somatosensory function and mechanosensitivity differ between groups with craniofacial neuropathic pain (CNP), non-neuropathic craniofacial pain (NNP), and healthy controls (HC). Methods Thirty-three participants were categorized into these groups, matched for age and sex. The study evaluated pain intensity, the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS), and various trigeminal somatosensory tests, including vibration, pressure pain, thermal detection, cold pain, and neurodynamic tests of the trigeminal nerve. Results Cold pain thresholds differed significantly among the three groups CNP, NNP, and HC (p = .047). No difference was found in vibration detection, pressure pain threshold, and thermal detection. Trigeminal nerve mechanosensitivity was significantly different among the three groups (p = .03), particularly between groups CNP and HC (p = .01). Conclusion Differences in aspects of trigeminal somatosensory function, including cold pain and trigeminal mechanosensitivity, exist between subjects with chronic craniofacial pain and HC. This implies that a clinical classification system for neuromusculoskeletal rehabilitation could be valuable in evaluating patients.

Effectiveness of a cervical treatment in wind-instrument musicians with temporomandibular dysfunction: A randomized clinical trial

AimsTo compare the effectiveness of a combined treatment involving manual therapy and postural exercises in wind musicians with temporomandibular dysfunction (TMD). Methods: A randomized controlled clinical trial was conducted among a sample of TMD-affected wind-instrument musician students (NCT05893251), who were assigned to an experimental group (EG) or a control group (CG). Both groups underwent an active cervical postural treatment for 4 weeks, with the experimental group (EG) additionally receiving a cervical therapy protocol. Participants were assessed through the craniofacial pain and disability inventory (CF-PDI) test and maximum mouth opening (MMO). ResultsThe treatment administered to the experimental group (EG) demonstrated higher efficacy compared to the control group (CG) in terms of MMO and CF-PDI scores (p < 0.05). ConclusionA therapeutic program including manual therapy at a cervical level and a program of active postural exercises results to be more effective than solely performing postural exercises on wind musicians with DTM.

Comparative evaluation of surgical procedures for trigeminal neuralgia: a literature review

Trigeminal Neuralgia (TN) has been described in the literature as one of the commonest types of craniofacial pain disorders. TN refers to recurrent lancinating pain that occurs in the distribution of one or more branches of the fifth cranial nerve. The pain perception is typically unilateral, abrupt in onset, brief in duration, and usually starts after trivial stimuli. The overall prevalence of TN was reported around 0.7/1000 persons, but it tends to be higher in more advanced age groups since the initial onset of the symptoms most frequently starts at the age of 50–60 years. Although TN is more commonly seen in adults, pediatric TN represents &lt;1.5% of all cases. Pediatric TN differs from adult TN primarily being bilateral in nature (42%) and associated with compression of multiple cranial nerves (46%). This review will evaluate the current surgical procedures used for the treatment of TN. Operative interventions for TN include microvascular decompression (MVD), balloon compression (BC), radiofrequency thermocoagulation (RF TC), glycerol rhizotomy (GR), and stereotactic radiosurgery (SRS). We review the historical development, advantages, and limitations of these operations. Additionally, we compare specific parameters for all current surgical procedures. We evaluated the short- and long-term outcomes, risk factors, complications and side effects in patients with TN who underwent operations. Arguments for and against the use of surgery for TN are presented. Next, surgical decision-making algorithm for refractory classical or idiopathic TN is proposed for patients who require surgery. This algorithm may be used by neurosurgeons in selecting the best surgical treatment. Lastly, we show the data on current clinical trials, the role of genetics to search for genes predisposing to TN. This project begins with the presumption that the risk for developing classical TN is in large part determined genetically. If so, given the power of modern genetic analysis, it should be possible to identify the underlying gene(s). At present, there is no ideal surgical procedure for trigeminal neuralgia—one that is minimally invasive, uniformly effective, lacking complications, and without failures or recurrences. MVD still remains the standard by which all other contemporary procedures are measured. MVD provides the longest pain-free interval, yet it is not free of morbidity and mortality. Stereotactic radiosurgery provides a reasonable noninvasive option, but it has delayed onset and a recurrence interval (a few years).

Biological markers of brain network connectivity and pain sensitivity distinguish low coping from high coping Veterans with persistent post-traumatic headache.

Headache is the most common type of pain following mild traumatic brain injury. Roughly half of those with persistent post-traumatic headache (PPTH) also report neck pain which is associated with greater severity and functional impact of headache. This observational cohort study aimed to identify biological phenotypes to help inform mechanism-based approaches in the management of PPTH with and without concomitant neck pain. Thirty-three military Veterans (mean (SD) = 37±16 years, 29 males) with PPTH completed a clinical assessment, quantitative sensory testing, and magnetic resonance imaging of the brain and cervical spine. Multidimensional phenotyping was performed using a Random Forest analysis and Partitioning Around Medoids (PAM) clustering of input features from three biologic domains: 1) resting state functional connectivity (rsFC) of the periaqueductal gray (PAG), 2) quality and size of cervical muscles, and 3) mechanical pain sensitivity and central modulation of pain. Two subgroups were distinguished by biological features that included forehead pressure pain threshold and rsFC between the PAG and selected nodes within the default mode, salience, and sensorimotor networks. Compared to the High Pain Coping group, the Low Pain Coping group exhibited higher pain-related anxiety (p=0.009), higher pain catastrophizing (p=0.004), lower pain self-efficacy (p=0.010), and greater headache-related disability (p=0.012). Findings suggest that greater functional connectivity of pain modulation networks involving the PAG combined with impairments in craniofacial pain sensitivity, but not cervical muscle health, distinguish a clinically important subgroup of individuals with PPTH who are less able to cope with pain and more severely impacted by headache.

Intrathecal Drug Delivery System in Prepontine Cistern for Patients with Intractable Craniofacial Cancer Pain: A Multicenter Retrospective Study.

Patients with craniofacial cancer frequently suffer from severe pain. The traditional intrathecal, oral, or intravenous analgesics could only provide insufficient pain relief with many side effects. Thus, a more effective analgesia approach is required. This study aimed to investigate the safety and efficacy of placing the catheter of an intrathecal morphine pump in the prepontine cistern for the treatment of craniofacial cancer pain. We performed a retrospective study of patients with primary or metastatic craniofacial cancer pain who received the catheter placement of an intrathecal morphine pump into the prepontine cistern in eleven medical centers from September 2019 to December 2023. Friedman test and pairwise signed-rank test were used to evaluate the difference in numeric rating scale (NRS) scores, the number of breakthrough pain episodes, dose of intrathecal morphine, and dose of systemic morphine equivalents (oral, patch, intravenous) from preoperative period to postoperative days 1, 7, and 30. P values were corrected for multiple comparisons using Bonferroni test. The study included 33 patients. The median (interquartile range [IQR]) of NRS scores at days 1, 7, and 30 postimplant were 2.0 (1.0-3.5), 2.0 (1.0-2.0), and 1.0 (1.0-2.0), respectively, which was significantly lower than that before surgery (median, 8.0; IQR, 7.0-10.0; all P < .001). Compared to baseline number/d of breakthrough pain episodes (median, 6.0; IQR, 4.5-10.0), there was a progressive decrease in the number/d of breakthrough pain episodes at day 1, day 7, and day 30 postimplant, and the median (IQR) were 1.0 (0.0-3.0), 2.0 (0.0-3.0), and 0.0 (0.0-1.2), respectively (all P < .001). Approximately 78.8% and 96.7% of patients reported pain relief >50% at days 1 and 30 postimplant, respectively. Compared with that at day 1 postimplant, the proportion of patients with a pain relief rate >75% at day 30 postimplant also increased with continued intrathecal treatment. Compared to the dose of baseline systemic morphine equivalents (median, 228 mg.d-1; IQR, 120-408 mg.d-1), the dose of systemic morphine equivalents reduced significantly from 0(0-120) mg.d-1 at day 1 postimplant (P = .001), to 0 (0-0) mg.d-1 at days 7 and 30 postimplant (both P < .001). Few patients reported perioperative adverse events, including nausea, constipation, hypotension, urinary retention, dry mouth, headache, and sedation. No severe adverse events occurred. Placing the catheter tip of an intrathecal morphine pump into the prepontine cistern could effectively relieve refractory craniofacial cancer pain with an extremely low total morphine dose requirement and few adverse events. This procedure could be considered in patients with severe refractory craniofacial cancer pain.

Nutritional Strategies for Chronic Craniofacial Pain and Temporomandibular Disorders: Current Clinical and Preclinical Insights.

This narrative review provides an overview of current knowledge on the impact of nutritional strategies on chronic craniofacial pain associated with temporomandibular disorders (TMDs). Individuals experiencing painful TMDs alter their dietary habits, avoiding certain foods, possibly due to chewing difficulties, which might lead to nutrient deficiencies. Our literature investigation revealed that the causal links between nutritional changes and craniofacial pain remain unclear. However, clinical and preclinical studies suggest that nutraceuticals, including vitamins, minerals, polyphenols, omega-3 fatty acids, isoprenoids, carotenoids, lectins, polysaccharides, glucosamines, and palmitoylethanolamides, could have beneficial effects on managing TMDs. This is described in 12 clinical and 38 preclinical articles since 2000. Clinical articles discussed the roles of vitamins, minerals, glucosamine, and palmitoylethanolamides. The other nutraceuticals were assessed solely in preclinical studies, using TMD models, mostly craniofacial inflammatory rodents, with 36 of the 38 articles published since 2013. Our investigation indicates that current evidence is insufficient to assess the efficacy of these nutraceuticals. However, the existing data suggest potential for therapeutic intervention in TMDs. Further support from longitudinal and randomized controlled studies and well-designed preclinical investigations is necessary to evaluate the efficacy of each nutraceutical intervention and understand their underlying mechanisms in TMDs.

Clinical profile of Brazilian patients with temporomandibular joint disorder and orofacial pain: A 20-year retrospective study

ObjectiveTemporomandibular joint disorder (TMD) comprises several musculoskeletal conditions in the orofacial region, with chronic pain and/or dysfunction involving the temporomandibular joint (TMJ) and masticatory muscles. This study assessed the clinical characteristics of patients with TMD treated at a public tertiary care facility in Brazil. MethodsIn this retrospective study, we assessed data from adult patients attending the Center for Occlusion, TMD, and Orofacial Pain at a Brazilian school of dentistry, from 2000 to 2020. Data from eligible charts were collected: demographic variables, clinical complaints, location of pain, pain intensity (10-point VAS), duration of treatment, and therapeutic procedures. Data were analyzed using descriptive and inferential statistics at the 0.05 significance level. ResultsThe sample consisted of 2324 patients (79.4 % females) with a median age of 38 years and median duration of treatment of 35 days. Major clinical complaints were craniofacial pain (including in the TMJ region) (82.9 %), self-reported bruxism (clenching/grinding) (44.6 %), and clicking/crepitation (39.1 %). Craniofacial pain was associated with female gender and age of 39 years and older, but not with bruxism. The most frequent procedures were counseling (96.5 %), exercises (47.5 %), occlusal splints (18.5 %), and physiotherapy (13.8 %). Reduction in pain intensity was moderately associated with multiple (3 or more) therapies and longer duration of treatment. ConclusionIt can be concluded that the patients presented a diversity of clinical characteristics requiring individualized treatment. A multimodal, interdisciplinary therapeutic approach, including counseling, appears to benefit most patients with TMD-related pain.

Temporomandibular joint disorder among Peruvian music students of different instrumental specialties

Background Music, a profound human expression, can have physical implications for its practitioners. Musicians face various physical challenges that can impact their well-being, with craniofacial and temporomandibular pain being prevalent yet understudied. Temporomandibular joint disorder (TMJD) affects up to one-third of the population, though prevalence varies by study. While musculoskeletal issues like carpal tunnel syndrome are well-documented in musicians, craniofacial and temporomandibular pain is less explored. This study aims to determine the differences in TMJD frequency among music students of different instrumental specialties. Methods The sample was composed of students between 12 and 25 years of age from the National University of Music of Peru. A stratified random probability sample was chosen. Data were collected using a structured instrument covering general data, academic information, dental malocclusion, the Fonseca Simplified Anamnestic Index, and the Global Stress Perception Scale. Statistical analysis included Pearson's Chi-square test and a generalized linear model regression. Results The sample included 71.4% males with a median age of 23 years. Class II dental occlusion was most common (51.4%). TMJD prevalence was: 14.3% no TMJD, 60.0% mild TMJD, 22.9% moderate TMJD, and 2.9% severe TMJD. Metal wind (PR=0.04, 95%CI [0.00; 50.04], p=0.002) and woodwind players (PR=0.03, 95%CI [0.00; 0.56], p=0.018) had lower TMJD prevalence compared to plucked string and percussion players. Post-regression analysis indicated significant differences between metal wind and percussion students (p=0.030) and between percussion and woodwind students (p=0.025). These results are supported by the adjusted ratio of proportions analysis, which maintains statistical significance. Conclusion We found significant differences in TMJD prevalence among music students based on their instrumental specialty, with lower rates in metal wind and woodwind players compared to plucked string and percussion players.

Dupilumab Improves Facial Pain and Reduces Rescue Treatments in Patients with CRSwNP and Recalcitrant Frontal Sinusitis.

Recalcitrant frontal sinusitis in patients with chronic rhinosinusitis and nasal polyps (CRSwNP) has a negative impact on their quality of life due to frontal pain and a high risk of sinus occlusion, thus necessitating antibiotics, systemic corticosteroids, and multiple surgeries. The aim of this study was to assess the efficacy of dupilumab in reducing frontal pain and the need for rescue treatments for recalcitrant frontal sinusitis in patients with CRSwNP. We enrolled a cohort of 10 patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis associated with severe facial pain measured by MIDAS score who were treated with dupilumab 300 mg every 2 weeks and followed for at least 12 months. The mean MIDAS score decreased from 45.6 ± 10.7 at baseline to 1.3 ± 2.3 at 6 months (p < 0.05). VAS craniofacial pain decreased from 7.3 ± 1.6 at baseline to 1.2 ± 1.5 at 6 months (p < 0.05). No patient needed oral corticosteroids during treatment with dupilumab (p < 0.05), and the use of analgesics decreased from 9.6 ± 3.1 NSAID pills/week in the last 2 months at baseline to 0.6 ± 1.3 at 1 year of follow-up (p < 0.05). Our results demonstrated that use of subcutaneous dupilumab can improve symptom control, including recurrent severe cranio-facial pain, and reduce the need for rescue medical treatments (systemic steroids and NSAID) in patients with severe uncontrolled CRSwNP and concomitant recurrent frontal sinusitis.

Role of HDAC5 Epigenetics in Chronic Craniofacial Neuropathic Pain.

The information provided from the papers reviewed here about the role of epigenetics in chronic craniofacial neuropathic pain is critically important because epigenetic dysregulation during the development and maintenance of chronic neuropathic pain is not yet well characterized, particularly for craniofacial pain. We have noted that gene expression changes reported vary depending on the nerve injury model and the reported sample collection time point. At a truly chronic timepoint of 10 weeks in our model of chronic neuropathic pain, functional groupings of genes examined include those potentially contributing to anti-inflammation, nerve repair/regeneration, and nociception. Genes altered after treatment with the epigenetic modulator LMK235 are discussed. All of these differentials are key in working toward the development of diagnosis-targeted therapeutics and likely for the timing of when the treatment is provided. The emphasis on the relevance of time post-injury is reiterated here.

Oxytocin Receptors on Calvarial Periosteal Innervation: Therapeutic Target for Post-Traumatic Headache?

Following a mild traumatic brain injury (mTBI), the most prevalent and profoundly debilitating occurrence is the emergence of an acute and persistent post-traumatic headache (PTH), for which there are presently no approved treatments. A crucial gap in knowledge exists regarding the consequences of an mTBI, which could serve as a foundation for the development of therapeutic approaches. The activation of trigeminal sensory nerve terminals that innervate the calvarial periosteum (CP)-a densely innervated tissue layer covering the calvarial skull-has been implicated in both migraines and PTHs. We have previously shown that trigeminal oxytocin receptors (OTRs) may provide a therapeutic target for PTHs. This study examined the expression of oxytocin receptors on trigeminal nerves innervating the periosteum and whether these receptors might serve as a therapeutic target for PTHs using a direct application of oxytocin to the periosteum in a rodent model of PTH. We used retrograde tracing and immunohistochemistry to determine if trigeminal ganglion (TG) neurons innervating the periosteum expressed OTRs and/or CGRPs. To model the impact of local inflammation that occurs following an mTBI, we applied chemical inflammatory mediators directly to the CP and assessed for changes in immediate-early gene expression as an indication of neuronal activation. We also determined whether mTBI would lead to expression changes to OTR levels. To determine whether these OTRs could be a viable therapeutic target, we assessed the impact of oxytocin injections into the CP in a mouse model of PTH-induced periorbital allodynia. The results of these experiments demonstrate the following: (1) the cell bodies of CP afferents reside in the TG and express both OTRs and CGRPs; (2) inflammatory chemical stimulation of the periosteum leads to rapid activation of TG neurons (phospho-ERK (p-ERK) expression), (3) mTBI-induced inflammation increased OTR expression compared to the sham group; and (4) administration of oxytocin into the periosteum on day 2 and day 40 blocked cutaneous allodynia for up to one hour post-administration for both acute and persistence phases in the PTH model-an effect that was preventable by the administration of an OTR antagonist. Taken together, our observations suggest that periosteal trigeminal afferents contribute to post-TBI craniofacial pain, and that periosteum tissue can be used as a potential local target for therapeutics such as oxytocin.

Computed tomography-guided trigeminal tractotomy-nucleotomy for refractory chronic craniofacial pain: a case report

BackgroundRefractory chronic craniofacial pain is a debilitating condition with limited treatment options. This case report presents the use of percutaneous computed tomography-guided trigeminal tractotomy-nucleotomy under general anesthesia in a patient with refractory trigeminal neuralgia and post-treatment anesthesia dolorosa. This case report expands the use of TR-NC to include treatment-resistant post-treatment anesthesia dolorosa and introduces real-time verification under anesthesia, potentially broadening access and improving precision, while highlighting the need for further research on long-term efficacy and patient selection for this promising technique.Case presentationA 50-year-old woman with 12 years of chronic facial pain in the opthalmic and maxillary trigeminal branches despite multiple surgical and medical interventions underwent computed tomography-guided trigeminal tractotomy-nucleotomy under general anesthesia. Initial pain relief was significant, but symptoms gradually returned within 12 months. Transient mild ataxia was the only complication.ConclusionThis case suggests trigeminal tractotomy-nucleotomy under general anesthesia with real-time verification may be a valuable option for patients with refractory post-treatment anesthesia dolorosa. However, the transient nature of pain relief necessitates further investigation of long-term outcomes and optimal patient selection.

Quality of life, craniomandibular function, and psychosocial factors related to pain and movement in patients with head and neck cancer.

To describe the characteristics of and the associations between health-related quality of life, pain, craniomandibular function, and psychosocial factors related to pain and fear of movement in patients with head and neck cancer. Seventy-eight patients diagnosed with HNC were recruited. Measurements of the maximum mouth opening range and pressure pain thresholds on the masseter muscle and the distal phalanx of the thumb were conducted, as well as a battery of self-report questionnaires were administrated, including the QoL Questionnaire (EORT QLQ-H&N35), Numeric Rating Scale (NRS), Pain Catastrophizing Scale (PCS), the Spanish translation of the Tampa Scale for Kinesiophobia for Temporomandibular Disorders (TSK-TMD), and the short version of the Craniofacial Pain and Disability Inventory (CF-PDI-11). The study sample (66.7% men, mean age 60.12 [11.95] years) experienced a moderate impact on their QoL levels (57.68 [18.25] EORT QLQ-H&N35) and high kinesiophobia values (20.49 [9.11] TSK-TMD). Pain was present in 41% of the patients, but only 3.8% reported severe pain. 26.4% had a restricted mouth opening range, and 34.62% showed significant catastrophism levels. There were strong positive correlations between EORT QLQ-H&N35 and CF-PDI-11 (r = 0.81), between NRS and CF-PDI-11 (r = 0.74), and between PCS and CF-PDI-11 (r = 0.66). Patients with HNC experience negative effects in their QoL, related to their impairment in craniomandibular function. Fear of movement, pain intensity, and catastrophism are associated with poorer functionality; relationships that should be considered when attempting to improve health care.

Participatory action ultrasound imaging in increasing clinician confidence with new approaches to trigger point dry needling of the lateral pterygoid

Upon self-reflection, some clinicians privately confess a lack of confidence in being able to safely perform trigger point dry needling (TrPDN) or trigger point injection (TrPI) on craniofacial muscles. Procedural performance anxiety seems to be more pronounced relative to those muscles that cannot be palpated and/or have an increased risk of iatrogenic injury to neurovascular structures. Participatory action ultrasound imaging (PAUI) can be a useful tool in enhancing clinician confidence. A clinician-subject with a left lateral pterygoid trigger point was dry-needled under ultrasound guidance by a clinician-needler with extensive training and experience relative to evaluation and treatment of patients with craniofacial pain. Prior to PAUI, both the clinician-needler and clinician-observer describe low-to-moderate anxiety in the performance of TrPDN of the lateral pterygoid, using a lateral-to-medial approach. By contrast, both the clinician-needler and clinician-observer expressed high anxiety, objectively confirmed by the state-trait anxiety inventory (STAI) form Y-1 (STAI Y-1), in the performance of a newly learned cephalo-caudal approach. Following an initial round of clinical training without PAUI, subjective anxiety remained high despite a lower theoretical risk to the maxillary artery using the cepalo-caudal approach. A second round of training was performed with the addition of PAUI; the clinician-needler was able to reach the target tissue within 2 min in each of 3 attempts. Upon visual inspection and interpretation of the images and cine, the clinician-needler and clinician-observer both expressed a “significant” decrease in self-reported anxiety in performing the cephalo-caudal approach, objectively verified by improvements in the STAI Y-1 score of both clinicians. This case report presents PAUI as a means for future research and clinician education regarding risk assessment of TrPDN or TrPI of muscles with risk of iatrogenic injury.

Technical guideline for intra-prepontine cisternal drug delivery via spinal puncture through subarachnoid catheterization.

The distribution characteristics of intrathecal drugs and the limitation of current catheterization techniques make traditional intrathecal analgesic treatment nearly useless for refractory craniofacial pain, such as trigemina neuralgia. This technical guideline aims to promote the widespread and standardize the application of intra-prepontine cisternal drug delivery via spinal puncture and catheterization. A modified Delphi approach was used to work for this guideline. On the issues related to the intra-prepontine cisternal targeted drug delivery technique, the working group consulted 10 experts from the field with 3 rounds of email feedback and 3 rounds of conference discussion. For the efficacy and safety of the intra-prepontine cisternal targeted drug delivery technique, a consensus was formed on 7 topics (with an agreement rate of more than 80%), including the principles of the technique, indications and contraindications, patient preparation, surgical specifications for intra-prepontine cisternal catheter placement, analgesic dosage coordination, analgesic management, and prevention and treatment of complications. Utilizing the intra-prepontine cisternal drug infusion system to manage refractory craniofacial pain could provide advantages in terms of minimally invasive, secure, and effective treatment. This application can not only alleviate the suffering of individuals experiencing the prolonged pain but also support the maintenance of quality of life and dignity in their final moments, justifiing its widespread dissemination and standardized adoption in domestic and international professional fields.

Fully endoscopic far-lateral supracerebellar infratentorial approach for trigeminal neuralgia: illustrative case reports

BackgroundTrigeminal neuralgia (TN) is a common cause of craniofacial pain. The retrosigmoid approach is usually used to treat TN, but no cases of endoscopic far-lateral supracerebellar infratentorial approach (EF-SCITA) were used to undergo operation for TN.Case presentationTwo patients were presented with severe facial pain and preliminary diagnosis was TN. Preoperative magnetic resonance imaging revealed that a superior cerebellar artery (SCA) compressed the trigeminal nerve in case 1, and a tumor located in the petrous apex extending into the Meckel’s cave compressed the trigeminal nerve in case 2. Operations were achieved through the EF-SCITA. The pain was totally relieved with no postsurgical complications in both cases.ConclusionsWe present the first two case reports of EF-SCITA to relieve classical and secondary TN successfully. The EF-SCITA can be a promising approach for treating TN.

Modulatory Processes in Craniofacial Pain States.

Pain is a common symptom associated with many disorders affecting the craniofacial tissues that include the teeth and their supporting structures, the jaw, face and tongue muscles, and the temporomandibular joint. Most acute craniofacial pain states are easily recognized and readily treated, but chronic craniofacial pain states (e.g., temporomandibular disorders [TMD], trigeminal neuropathies, and some headaches) may be especially challenging to manage successfully. This chapter provides an overview of the processes that underlie craniofacial pain, with a focus on the pain-modulatory mechanisms operating in craniofacial tissues and in the central nervous system (CNS), including the role of endogenous chemical processes such as those involving opioids. The chapter outlines in particular findings from preclinical studies that have provided substantial information about the neural as well as nonneural (e.g., glial) processes involved in the initiation, transmission, and modulation of nociceptive signals in the trigeminal system, and also draws attention to their clinical correlates. The increased understanding gained from these preclinical studies of how nociceptive signals can be modulated will contribute to improvements in presently available therapeutic approaches to manage craniofacial pain as well as to the development of novel analgesic approaches.

Personalized 3D Printed Tooth-Supported Template as a Novel Strategy for Radiofrequency Thermocoagulation for Trigeminal Neuralgia After the Failure of CT-Guided Puncture.

Trigeminal neuralgia (TN) is a common form of craniofacial pain, and Radiofrequency thermocoagulation (RFT) has become a commonly utilized treatment modality for TN. However, the complex anatomical configuration of the maxillofacial region and the difficulties inherent in positioning the neck in a hyperextended manner can present challenges for CT-guided punctures. The objective of this study is to assess the effectiveness and safety of 3D printed tooth-supported template(3D-PTST) guided RFT in patients who have previously undergone unsuccessful CT-guided puncture. Patients with TN undergoing RFT at the Department of Pain Medicine, PLA General Hospital, from January 2018 to January 2023, were assessed. 3D-PTST guided RFT was employed as an alternative when percutaneous puncture failed. Clinical, demographic, and follow-up data were collected. The duration of the procedure was determined by subtracting the time of anesthesia administration from the time of surgical drape removal. Pain intensity was assessed using the Numerical Rating Scale-11 scale. Treatment effects were evaluated utilizing the Barrow Neurological Institute scale. Incidences of complications related to RFA were documented. Six TN patients underwent 3D-PTST guided RFT. With tooth-supported template guidance, five patients achieved therapeutic target puncture in one attempt with one CT scan. One patient required two attempts with two CT scans. Operation duration ranged from 18 to 46 mins (mean 30 mins). All completed 3D-PTST-guided RFT without difficulty, significantly improving pain symptoms. Four patients had no pain recurrence at 12, 18, 36 and 37 months follow-up, respectively. Recurrence occurred in two patients (at 1 and 13 months). No serious treatment-related complications were observed. 3D-PTST guided RFT is an effective, repeatable, safe, and minimally invasive treatment method for patients with TN who have failed due to difficulty in puncture.