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Atypical Facial Pain

Rafael Benoliel, Charly Gaul
Background Persistent idiopathic facial pain (PIFP) is a chronic disorder recurring daily for more than two hours per day over more than three months, in the absence of clinical neurological deficit. PIFP is the current terminology for Atypical Facial Pain and is characterized by daily or near daily pain that is initially confined but may subsequently spread. Pain cannot be attributed to any pathological process, although traumatic neuropathic mechanisms are suspected. When present intraorally, PIFP has been termed 'Atypical Odontalgia', and this entity is discussed in a separate article in this special issue...
January 1, 2017: Cephalalgia: An International Journal of Headache
Yair Sharav, Zaza Katsarava, Andrew Charles
Background Many patients with mid-face or lower face craniofacial pain are diagnosed, based on accompanying signs and symptoms and features other than location, as either atypical migraines or atypical TACs. Distinguishing features of headache disorders as a cause of facial pain include the temporal pattern of pain, associated symptoms including light and sound sensitivity and nausea, cranial autonomic symptoms, and the lack of local triggering among others. Results An intraoral neurovascular pain has been observed, and was termed neurovascular orofacial pain (NVOP)...
January 1, 2017: Cephalalgia: An International Journal of Headache
Austin L Weiss, Ken P Ehrhardt, Reda Tolba
PURPOSE OF REVIEW: The purpose of this article is to focus on an excruciating disorder of the face, named atypical facial pain or persistent idiopathic facial pain (PIFP). It is considered an underdiagnosed condition with limited treatment options. Facial pain can be a debilitating disorder that affects patients' quality of life. Up to 26% of the general population has suffered from facial pain at some point in their lives. It is important to highlight the different types of facial pain to be able to properly manage this condition accordingly...
February 2017: Current Pain and Headache Reports
Noboru Noma, Kohei Shimizu, Kosuke Watanabe, Andrew Young, Yoshiki Imamura, Junad Khan
BACKGROUND: This report describes four cases of cracked tooth syndrome secondary to traumatic occlusion that mimicked trigeminal autonomic cephalalgias. All patients were referred by general practitioners to the Orofacial Pain Clinic at Nihon University Dental School for assessment of atypical facial pain. CLINICAL PRESENTATION: Case 1: A 51-year-old woman presented with severe pain in the maxillary and mandibular left molars. Case 2: A 47-year-old woman presented with sharp, shooting pain in the maxillary left molars, which radiated to the temple and periorbital region...
2017: Quintessence International
A Nader, M Kendall
No abstract text is available yet for this article.
April 2016: Journal of Pain: Official Journal of the American Pain Society
Viki Kumar, Jaspinder Kaur, Pallavi Pothuri, Sahiba Bandagi
BACKGROUND Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder of unknown etiology which can present at any age with symptoms of mucocutaneous, musculoskeletal, renal, central nervous system, and nonspecific clinical pictures making the disease a "master of mimicry". CASE REPORT A 53-year-old female, who was recently diagnosed with SLE, presented with right-sided sharp and electric shock-like facial pain starting at the side of her right nostril and traveling down the naso-labial fold and then back to the angle of the jaw, mostly in the region of V2-V3 distribution with no radiation beyond trigeminal distribution...
January 12, 2017: American Journal of Case Reports
Stacie Zelman, Michael C Goebel, David E Manthey, Seth Hawkins
Unruptured posterior communicating artery (PCOM) aneurysms can be difficult to diagnose and, when large (≥ 7mm), represent a substantial risk to the patient. While most unruptured PCOM aneurysms are asymptomatic, when symptoms do occur, clinical manifestations typically include severe headache (HA), visual acuity loss, and cranial nerve deficit. This case report describes an atypical initial presentation of a large unruptured PCOM aneurysm with symptoms mimicking trigeminal neuralgia, without other associated cranial nerve palsies or neurologic deficits...
November 2016: Western Journal of Emergency Medicine
J Agbaje, A De Laat, P Constantinus, P Svensson, L Baad-Hansen
Qualitative somatosensory testing (QualST) is a simple chairside test. It can be used to roughly assess the presence or absence of altered somatosensory function. To use QualST clinically, it is important to assess its agreement with quantitative sensory testing (QST). The aims of this study were to assess the agreement between QST and QualST when testing the modulation of facial sensitivity by capsaicin in healthy participants and to explore the agreement between QST and QualST in assessing the intraoral sensory function in clinical atypical odontalgia (AO) patients...
January 2017: Journal of Oral Rehabilitation
Mark McInturff, Anne Adamson, Chadwick Donaldson, Brenda L Nelson
A 19 year old female presents to the emergency room with right facial enlargement. Clinical examination revealed a soft tissue mass of the right buccal mucosa. Treated initially as infection, the patient later turned to clinic with now rapidly enlarging and intermittently painful mass. Computed tomography with contrast showed a low attenuated buccal mass with mild enhancement lateral to the right caudal maxilla and superior mandible. Biopsy was performed and microscopic examination showed cells with moderate pleomorphism with numerous atypical mitotic figures and occasional elongated "strap" cells with eccentric nuclei...
October 14, 2016: Head and Neck Pathology
Adrienne M Laury, Sarah N Bowe, Joshua Stramiello, Kevin C McMains
OBJECTIVES/HYPOTHESIS: To determine the primary diagnoses for which balloon catheter dilation (BCD) of sinus ostia is being employed in a profit-blind health care system, the Department of Defense. STUDY DESIGN: Retrospective chart review. METHODS: From January 1, 2011 to December 31, 2013, 319 consecutive patient charts were reviewed for International Classification of Diseases, Ninth Edition (ICD-9) diagnoses, presence of chronic rhinosinusitis (CRS) defined by the European Position Paper on Rhinosinusitis and Nasal Polyps (EPOS), preoperative Lund-Mackay scores, nasal endoscopy findings, sinuses dilated, postoperative outcomes, and complications...
September 23, 2016: Laryngoscope
Ilker Coven, Ezher H Dayısoylu
BACKGROUND: The sphenopalatine ganglion (SPG) may be involved in persistent idiopathic facial pain and unilateral headaches. The role of SPG blockade via intra oral route in the management of trigeminal neuralgia (TN) is worthy of study. METHODS: In this retrospective study, patient records included patients with atypical TN (type 2) that persisted in spite of conservative treatment for at least 2 years, and an average pain intensity from the craniofacial region visual analogue scale (VAS) before examination...
2016: SpringerPlus
Fang Yu, Florence Chiang, Carlos Bazan
A 30-year-old male presented with left facial pain and numbness. Initial MRI demonstrated an enhancing mass involving the left trigeminal nerve. Follow-up imaging showed interval growth with erosion of the sphenoid body. Surgical resection was performed and immunohistochemistry staining was consistent with an atypical teratoid/rhabdoid tumor. Awareness of this entity and its imaging features such as diffusion restriction, intratumoral hemorrhage, and bony destruction, can help guide confirmatory diagnostic testing and appropriate therapy...
December 2016: Neuroradiology Journal
Shervin Rahimpour, Shivanand P Lad
Atypical neuropathic facial pain is a syndrome of intractable and unremitting facial pain that is secondary to nociceptive signaling in the trigeminal system. These syndromes are often recalcitrant to pharmacotherapy and other common interventions, including microvascular decompression and percutaneous procedures. Herein, the authors present two other viable approaches (nucleus caudalis dorsal root entry zone lesioning and motor cortex stimulation), their indications, and finally a possible treatment algorithm to consider when assessing patients with atypical facial pain...
July 2016: Neurosurgery Clinics of North America
Joanna M Zakrzewska
Persistent or chronic idiopathic facial pain, often called atypical facial pain, is often used as a diagnosis of exclusion. It is chronic pain in a nonanatomically distributed area of the face and mouth that can be episodic or continuous and described as a nagging dull pain that at times is severe. It is associated with other chronic pain conditions, psychological abnormalities, and significant life events. Investigations are all normal and early treatment can prevent chronicity. A multidisciplinary biopsychosocial approach with the use of antidepressants and cognitive behavior therapy provides the best chance of pain relief and improved quality of life...
July 2016: Neurosurgery Clinics of North America
Mehmet Ali Duman, Nilgün Selçuk Duru, Bahar Çalışkan, Hale Sandıkçı, Ferhat Çengel
BACKGROUND: Henoch-Schönlein Purpura (HSP) is a systemic hypersensitivity disease of unknown cause that is characterized by a purpuric rash and systemic manifestations, such as colicky abdominal pain, polyarthralgia, and acute glomerulonephritis. Common complications of HSP that lead to surgical intervention include intussusception, perforation, necrosis, and massive gastrointestinal bleeding. Unusual clinical manifestations of HSP may include edema of the scrotum and eyes. Lumbar swelling is rarely seen as a complication of HSP...
May 2016: Balkan Medical Journal
Radhika Besta, Y Uday Shankar, Ashwini Kumar, E Rajasekhar, S Bhanu Prakash
Trigeminal Neuralgia (TN) is considered as one of the most painful neurologic disorders affecting oro-facial region. TN is often diagnosed clinically based on the patients complete history of pain (severity, duration, episodes etc), relief of pain on test dose of Carbamazepine, regional block of long acting anaesthetic. However, Magnetic Resonance Imaging (MRI) plays an important and confirmatory role in showing Neuro Vascular Conflict (NVC) which is the commonest causative factor for TN. This article reviews the effectiveness of three-dimensional constructive interference in steady-state (3D-CISS) MRI in diagnosing the exact location, degree of neurovascular conflict responsible for classical as well as atypical TN and possible pre-treatment evaluation and treatment outcome...
March 2016: Journal of Clinical and Diagnostic Research: JCDR
Nicola Benedetto, Paolo Perrini
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.
February 2017: Journal of Neurosurgery
Yves Yamgoue, Etienne Pralong, Marc Levivier, Jocelyne Bloch
We report the successful treatment of recurrent facial pain by deep brain stimulation (DBS) of the ventroposteromedial thalamic nucleus (VPM-DBS), 10 years after VPM thalamotomy. A 62-year-old woman who suffered from an atypical right-sided trigeminal neuralgia of the V1 and V2 branches was successfully treated a decade ago with a radiofrequency VPM thermocoagulation. Ten years later, the same burning right-sided trigeminal pain progressively recurred and was resistant to medical treatments. A DBS procedure was proposed to the patient aiming to stimulate the vicinity of the preexisting stereotactic lesion...
2016: Stereotactic and Functional Neurosurgery
Kunal Gupta, Kim J Burchiel
BACKGROUND: Pain is a very commonly reported symptom and often drives patients to seek medical attention; however, it can prove a very difficult diagnostic conundrum and even more challenging to treat effectively. Accurately determining the primary pain generator is key, as certain conditions have efficacious medical and surgical treatments. We present a rare case of a man with multiple sclerosis presenting with spinal cord seizures causing dermatomal pain. While pain has been reported in the context of motor symptoms attributed to spinal cord seizures in a small number of spinal cord conditions, this case represents the first report of pain exclusively associated with spinal cord demyelination in multiple sclerosis...
April 20, 2016: Journal of Medical Case Reports
Ashley Ferro, Shadi Basyuni, Vijay Santhanam
INTRODUCTION: Silent sinus syndrome (SSS) is a rare disorder with protean manifestations. An absence of familiarity with ambiguous and atypical presentations may complicate diagnosis and delay management. CASE PRESENTATION: A 28year old female patient presented with a chronic history of headache, post-nasal discharge and recurrent facial pain refractory to analgesics. Enophthalmos and hypoglobus progressed over a period of 2 months, and a diagnosis of SSS was confirmed via imaging...
2016: International Journal of Surgery Case Reports
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