Types Of Facial Pain Research Articles

TRIGEMINAL NEURALGIA AND ITS RECENT ADVANCES

Despite recent advances in understanding and treating trigeminal neuralgia, its management remains a considerable challenge. Better classification of different types of facial pain and the identification of prognostic factors for different treatment options lead the way toward better quality of life for the individual patient. Although the principles of treating trigeminal neuralgia remain basically the same, antiepileptic drugs, muscle relaxants, and neuroleptic agents are widely used medical treatment options. They were not originally developed for treating trigeminal neuralgia. Carbamazepine was studied in adequate placebo-controlled clinical trials in the 1960s and is still considered the most effective drug. Among emerging treatment options currently under clinical investigation are local botulinum neurotoxin type A injections and a novel sodium channel blocker (CNV1014802) that selectively blocks the Nav1.7 sodium channel. Non-pharmacological treatment options are non-invasive electrical stimulation with either transcranial direct-current stimulation or repetitive transcranial magnetic stimulation which both require further evaluation in regard to applicability. Surgical options remain a valid choice for patients not responding to medical treatment and include Gasserian ganglion percutaneous techniques, gamma knife surgery, and microvascular decompression. There is continual effort to improve these techniques and predict the outcome for better patient selection.

Botox: Therapy Beyond Beauty

Botulinum toxin originated from the Latin term ‘botulus’ meaning ‘sausage’. Botulinum toxin is a bacterial extract which acts at the synaptic level and inhibits the neuronal uptake of acetylcholine causing inhibition of muscular contraction. This property of botox proves to be useful in various muscle spastic disorders. Commercially accessible under the brand label of Botox and is universally used in cosmetic field in managing wrinkles and crow lines correspondingly it has multitude of use in treating innumerable maxillofacial complex disorders like Temperomandibular disorders, Hypertonicity of lips, gummy smiles, Bruxism, trigeminal neuralgia and other types of facial pain. Botox is regarded as minimally invasive procedure with promising results in muscular disorders as well as cosmetic purpose. Botulinum when used in therapeutic doses proves to be boon to mankind. The effects are dose dependent as it comes with the black box warning. Overcoming this disadvantage of botox, the newly emerged Frotox ® based on the (Focussed Cold Therapy) is used nowadays and proves to be more efficacious.This article describes in detail about the origin of the toxin, it’s commercially available forms. It also describes the clinical technique, its pros and cons with instructions with patient as well as operator point of view.

Chronic myofascial facial pain

Among a large number of patients with various types of facial pain, the frequency of occurrence of the muscular-tonic and muscular-spastic component is about 70–80 % of cases. As a result, the formation of chronic myofascial facial pain is a common complication of such prosopalgia. The clinical picture of this pathology disguises itself as signs of a primary disease, and often becomes a leading symptom in the pathogenesis of the disease, which complicates the diagnosis and treatment. The review article examines the current diagnostic criteria for myofascial facial pain. It has been shown that recently the clinical and neurophysiological features of various options for chronic facial pain, the functional state of muscle structures in various forms of chronic pain have been intensively studied. The possible ways of the formation of chronic myofascial pathology in the craniomandibular region are analyzed. Modern methods for differential diagnosis of various forms of prosopalgia and pathogenetic mechanisms, determine the course of treatment and prevention are considered.

Recent advances in understanding/managing trigeminal neuralgia.

Despite recent advances in understanding and treating trigeminal neuralgia, its management remains a considerable challenge. Better classification of different types of facial pain and the identification of prognostic factors for different treatment options lead the way toward better quality of life for the individual patient. Although the principles of treating trigeminal neuralgia remain basically the same, antiepileptic drugs, muscle relaxants, and neuroleptic agents are widely used medical treatment options. They were not originally developed for treating trigeminal neuralgia. Carbamazepine was studied in adequate placebo-controlled clinical trials in the 1960s and is still considered the most effective drug. Among emerging treatment options currently under clinical investigation are local botulinum neurotoxin type A injections and a novel sodium channel blocker (CNV1014802) that selectively blocks the Na v1.7 sodium channel. Non-pharmacological treatment options are non-invasive electrical stimulation with either transcranial direct-current stimulation or repetitive transcranial magnetic stimulation which both require further evaluation in regard to applicability. Surgical options remain a valid choice for patients not responding to medical treatment and include Gasserian ganglion percutaneous techniques, gamma knife surgery, and microvascular decompression. There is continual effort to improve these techniques and predict the outcome for better patient selection.

SURGICAL TREATMENT FOR FACIAL PAIN

Introduction. Different types of facial pain (FP) are the chronic, intractable diseases of the nervous system. To improve the effectiveness of surgery in patients with FP, to reduce the number of unnecessary invasive procedures and to increase the number of favorable outcomes, it is needed to use algorithms for choosing the most preferable interventions. Objective is to evaluate the effectiveness of the proposed algorithm in the treatment of the FP in the practice of a neurosurgical hospital on a large number of patients, the development of algorithms for differentiated treatment of patients with the different etiologies of FP syndrome and to review the literature in light of the effectiveness of different types of interventions. Materials and methods. The proposed algorithm was tested in 382 patients (128 men and 254 women) with different types of FP. Patients were treated in 4 hospitals from 2000 to 2016. Results. The pain relief more than 25 % of the initial intensity of pain was detected in 78.2 % of patients in the follow-up period in all types of surgical interventions when using the algorithm. Conclusion. The choice of the type of surgical intervention is based primarily on clarifying the etiopathogenetic mechanisms of the development of pain syndrome. This requires a comprehensive examination of patients using methods such as magnetic resonance imaging, the use of the T2 3D-CISS, the tractography of the trigeminal nerve root, the use of a contrast to diagnose the cause of FP. To select the optimal type of treatment, it is proposed to use algorithms, which reflect the most preferred methods.

Neuronavigated percutaneous approach to the sphenopalatine ganglion.

The sphenopalatine ganglion (SPG) has been assumed to be involved in the genesis of several types of facial pain, including Sluder's neuralgia, trigeminal neuralgia, persistent idiopathic facial pain, cluster headache, and atypical facial pain. The gold standard treatments for SPG-related pain are percutaneous procedures performed with the aid of fluoroscopy or CT. In this technical note the authors present, for the first time, an SPG approach using the aid of a neuronavigator.

Gamma knife radiosurgery for trigeminal neuralgia secondary to benign lesions.

Investigate the clinical outcomes of gamma knife radiosurgery (GKS) in patients with benign intracranial lesions and accompanying trigeminal neuralgia (TN). From February 2002 to November 2011, 50 patients (11 males, 39 females) underwent GKS for intracranial lesions accompanied by TN. Pathological diagnoses included meningioma in 30 patients, vestibular schwannoma in 11, trigeminal schwannoma in 7, epidermoid cyst in 1, and arteriovenous malformation in 1. Twenty-two (44%) had a lesion dominantly located in the middle fossa and 26 patients (52%) in the posterior fossa. Twenty-five (50%) patients complained of type I pain, and 18 patients (36%) suffered from type II pain. The other 7 patients (14%) presented with facial pain that could not be determined. Pain was assessed retrospectively by subjective descriptions and with the Barrow Neurological Institute pain intensity score before and after GKS. Tumor control was evaluated with magnetic resonance imaging in 44 (95.7%) of 46 patients over a median follow-up period of 54.8 months (range, 13-142 months). Initial improvement in pain after GKS was observed in 46 (92%) patients. The percentage of patients with improved Barrow Neurological Institute score was 73.5% at 1 year, 70.7% at 2 years, and 76.5% at 3 years. Complete pain relief at the final follow-up was achieved in 18 patients (36%). Pain recurred in 13 patients (28.3%) after initial improvement. Pathological diagnosis, location of the lesion, and type of facial pain did not influence the initial pain response after GKS. Pain recurred more frequently in patients with meningioma than in those with schwannoma (P = .045). Type II pain showed better response to the treatment (P = .006). The majority of patients with facial pain secondary to a benign intracranial lesion showed improvement after GKS. However, a substantial proportion of the patients experienced incomplete pain relief and recurrence. GKS needs to be combined with an additional modality or the technique must be modified to achieve complete and durable pain control.

Prospective three-year follow up of a cohort study of 240 patients with chronic facial pain.

Patients often present with facial pain ascribed to sinusitis, despite normal nasal endoscopy and sinus computed tomography. Facial pain is increasingly recognised to be of neurological origin. A cohort of 240 patients with chronic facial pain was followed up for 36 months at an otolaryngological practice in Malta. The types of facial pain were classified according to International Headache Classification criteria. The body mass index, occupation and educational level of patients were compared with the general population. Tension-type mid-facial pain and facial migraine without aura were the most common types of chronic facial pain. The sites of pain, symptoms, treatment and outcomes for these principal pain types are discussed. Patients with mid-facial pain were treated with low-dose amitriptyline for eight weeks. After three years, nearly half of the patients were symptom free, and in a third the pain changed from being chronic to being episodic. The treatment of patients with facial migraine was more varied but the length of time until recurrence of pain was similar. The most effective long-term treatments for tension-type mid-facial pain and facial migraine were low-dose amitriptyline and low-dose amitriptyline and triptans, respectively.

Trigeminal neuralgia: Revisited

Trigeminal neuralgia (TN) is an extremely painful condition characterized by recurrent attacks of sharp, intermittent, pricking type pain in the trigeminal nerve distribution, primarily affecting the elderly woman. The pain is nearly always unilateral, and it may occur repeatedly throughout the day. The diagnosis is typically determined by thorough clinical examination, history taking, and should be discriminated from other type of facial pain. This article highlights the general features, historical perspectives, etiological characteristics, pathophysiology, differential diagnosis, therapeutic options, and responsibilities of the oral healthcare professionals in diagnosing and managing patients with TN

Does dose rate affect efficacy? The outcomes of 256 Gamma Knife surgery procedures for trigeminal neuralgia and other types of facial pain as they relate to the half-life of cobalt

Gamma Knife surgery (GKS) is a treatment option for patients with refractory typical trigeminal neuralgia (TN), TN with atypical features, and atypical types of facial pain. The Gamma Knife's 201 60Co sources decay with a half-life of 5.26 years. The authors examined whether the decrease in dose rate over 4.6 years between Co source replacements affected the control rates of facial pain in patients undergoing GKS. The authors collected complete follow-up data on 239 of 326 GKS procedures performed in patients with facial pain. Patients were classified by their type of pain. The isocenter of a 4-mm collimator helmet was targeted at the proximal trigeminal nerve root, and the dose (80-90 Gy) was prescribed at the 100% isodose line. Patients reported the amount of pain control following radiosurgery by answering a standardized questionnaire. Eighty percent of patients experienced greater than 50% pain relief, and 56% of patients experienced complete pain relief after GKS. Neither dose rate nor treatment time was significantly associated with either the control rate or degree of pain relief. A significant association between the type of facial pain and the pain control rate after GKS was observed (p < 0.001; Pearson chi-square test). In their statistical analysis, the authors accounted for changes in prescription dose over time to prevent the dose rate from being a confounding variable. There was no observable effect of the dose rate or of the treatment duration within the typical period to source replacement. Patients with facial pain appear to receive consistent treatment with GKS at any time during the first half-life of the Co sources.

The Outcome of Gamma Knife Radiosurgery for Facial Pain Varies by Pre-treatment Burchiel Classification Pain Type: Results From 256 Gamma Knife Radiosurgery Procedures for Facial Pain

Purpose/Objective: Facial pain is a spectrum of conditions of varying clinical behavior. Burchiel suggested a pain classification scheme (BPC) for different types of facial pain. We analyzed the outcomes of 256 gamma knife radiosurgery procedures for facial pain based on pretreatment BPC.

Facial pain in a Neurological Tertiary Care Centre — Evaluation of the International Classification of Headache Disorders

The aim of this study was to examine the diagnostic spectrum of facial pain and to evaluate the clinical features relevant to the differential diagnosis in a neurological tertiary care centre. This is the first investigation comparing the first with the second edition of the International Classification of Headache Disorders (ICHD-I, ICHD-II) in consecutively referred patients comprising a broad spectrum of disorders without restricting the inclusion to certain diagnoses. Studying 97 consecutive patients referred for facial pain, we found trigeminal neuralgia or other types of cranial neuralgia in 38% and 39% according to ICHD-I and ICHD-II, respectively; persistent idiopathic facial pain was diagnosed in 27% and 21%, respectively. The proportion of patients who could not be classified was 24% in ICHD-I and 29% in ICHD-II. Six per cent of the patients had cluster headache or chronic paroxysmal hemicrania, the remaining 5% had various other disorders. The agreement between ICHD-I and ICHD-II was very good to perfect. In ICHD-II, sensitivity and specificity were similar to ICHD-I, the specificity and negative predictive value were imrpoved in single features of trigeminal neuralgia, but were widely unchanged in persistent idiopathic facial pain. The number of patients who could not be classified was larger in ICHD-II than in ICHD-I. Modifying the diagnostic criteria for different types of facial pain, in particular changes in the criteria of persistent idiopathic facial pain, might be helpful in reducing the number of patients with unclassifiable facial pain.

Sinus maxillaris mycetoma of odontogenic origin: case report

Fungal infections are on the increase and those of the jaw cavities with Aspergillus species may be connected with the root apices of teeth in the upper jaw. Diagnostic changes in the sinus maxillaris and certain types of facial pain may be indicative of fungal infection. The authors report a case of aspergillosis sinusitis and describe the diagnostic methods and treatment of this infection that may be associated with endodontic treatment.

Atypical Facial Pain: A Survey of Treatment in the Manchester Area (UK)

Introduction A review of the scientific literature found no unified opinion on the approach to the diagnosis and treatment of atypical facial pain (AFP). Aim To investigate the approaches to AFP, among the units of oral and maxillofacial surgery, oral medicine, anaesthetics, Ear, Nose and Throat (ENT), psychiatry and neurology in the Greater Manchester area (UK). Method Analysis of the clinical notes of 250 patients from a three-year period using a data collection sheet. Statistical analysis Chi-square and Kruskal-Wallis tests. Results AFP cases had a female preponderance and a long history of a persistent pain affecting no dominant location. Pain was of moderate to severe intensity, throbbing in quality and could disrupt sleep. Over half the cases had signs and symptoms related to other recognised types of facial pain. Effective treatments involved antidepressants and acupuncture. There was no unified pattern of referral between units. The short and long- term outcomes were influenced by treatment rather than the approach to diagnosis. Anaesthetic and neurology units had better outcomes than the oral and maxillofacial surgery and oral medicine units ( p&lt;0.001). Conclusions Different specialities receive referrals diagnosed as AFP but there is no uniform approach to treatment and this results in different outcomes. A more uniform approach to care is required.

Tic douloureux.

Tic douloureux is an excruciatingly painful condition that primarily affects elderly people. It consists of unilateral electric shock-like facial pains triggered by non-noxious stimulation with clear-cut pain-free intervals. It should be discriminated from all other types of facial pain by the history and physical examination. Primary treatment includes anticonvulsant drugs; if these fail or side effects prevent their use, a surgical procedure is warranted. Almost every patient with tic douloureux can be relieved of his or her pain with anticonvulsant medications or surgery. Stereotactic radiosurgery, percutaneous gangliolysis and suboccipital craniectomy with microvascular decompression are the primary surgical options. The common aspects of tic douloureux and some of the rarer variations are reviewed, and treatment options are presented.

Tension Headache and Bruxism in the Sleep Disordered Patient

An association exists between bruxism, tension headache, and sleep disorders, particularly sleep apnea, in the craniomandibular dysfunction patient. Understanding the relationship of these three entities provides the clinician with valuable information that enhances one's ability to make a differential diagnosis. A review of sleep disorders is presented so that a clearer understanding of them can be gained, with emphasis on obstructive sleep apnea. Current theories regarding bruxism, morning headache, and sleep disorders relate closely to altered muscle activity, altered breathing and fluctuation in oxygen saturation levels, which in turn can contribute to a patient's complaints of various types of facial pain.

Masticatory muscle activity as a function of parafunctional, active and passive oral behavioural patterns.

Oral behavioural patterns have received limited empirical support for their causal role in the development of head and facial pain. The present study was designed to assess electromyographic (EMG) variations in six muscle groups (i.e., bilateral masseter, temporalis and orbicularis oris) as a function of various oral behavioural patterns. A second purpose was to determine whether mandibular movement patterns and specific oral behaviours could be predicted by EMG patterns. Eleven non-pain subjects followed each of twenty oral behavioural patterns while EMG was recorded. Electromyographic change scores were computed for each behaviour relative to baseline measures. Initial analyses were performed using factorial repeated measures ANOVAS. Using post hoc analyses as general guides, specific EMG criteria were developed for classifying mandibular movements. For most subjects, EMG patterns accurately classified teeth clenching, protrusive/retrusive movements, right movements, left movements and lip movement patterns. Wide individual variations were found among muscle groups for identical behaviours. The association between particular oral behaviours and EMG patterns may explain 'sinus' headaches and certain types of facial pain.

A method for bulbospinal trigeminal nucleotomy in the treatment of facial deafferentation pain.

Many types of facial pain are difficult to treat, such as postherpetic, posttraumatic, or pain following denervation procedures used in the treatment of trigeminal neuralgia (anesthesia dolorosa), all of which involve deafferentation of the spinal trigeminal nucleus.

各種顔面痛に対する鍼灸療法の適応と効果

各種顔面痛に対する鍼灸療法の適応と効果

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.