口腔学英文课件：Facial pain

1、Facial pain,Section 1 Trigeminal neuralgia Section 2 Atypical facial pain,Section 1 Trigeminal neuralgia,Definition: Trigeminal neuralgia (TN, or TGN) is a neuropathic disorder characterized by episodes of intense pain in the face, originating from the trigeminal nerve.,Trigeminal neuralgia,Clinical

2、 classification: Primary TN: no organic disease no neurological signs Secondary TN: lesion nerve infringement with neurological signs,General consideration,It has been described as among the most painful conditions known to humankind. It is estimated that 1 in 15,000 or 20,000 people suffer from TN.

3、 In a majority of cases, TN symptoms begin appearing more frequently over the age of 50. It is more common in females than males. It commonly involves the maxillary nerve (V2) and mandibular nerve (V3) of the trigeminal nerve,Causes of primary TN,Several theories exist to explain the possible causes

4、 of this pain syndrome. It was once believed that the nerve was compressed in the opening from the inside to the outside of the skull. New leading research indicates that it is an enlarged blood vessel - possibly the superior cerebellar artery - compressing or throbbing against the microvasculature

5、of the trigeminal nerve near its connection with the pons. Such a compression can injure the nerves protective myelin sheath and cause hyperactive functioning of the nerve. This can lead to pain attacks at the slightest stimulation of any area served by the nerve as well as hinder the nerves ability

6、 to shut off the pain signals after the stimulation ends,Blood vessel compression,Compression may be related to an aberrant branch of the superior cerebellar artery that lies on the trigeminal nerve,Causes of secondary TN,Tumors in the middle cranial fossa second line medications include baclofen, l

7、amotrigine, oxcarbazepine, phenytoin, gabapentin, pregabalin, and sodium valproate. Uncontrolled trials have suggested that clonazepam and lidocaine may be effective.,Radiofrequency thermorhizotomy,The surgeon uses an electrode to heat the selected division or divisions of the nerve. Done well, this

8、 procedure can target the exact regions of the errant pain triggers and disable them with minimal numbness,Injections,Glycerol injections involve injecting an alcohol-like substance into the cavern that bathes the nerve near its junction. This liquid is corrosive to the nerve fibers and can mildly i

9、njure the nerve enough to hinder the errant pain signals.,Surgery,The evidence for surgical therapy is poor and it is thus only recommended if medical treatment is not effective. While there may be pain relief there is also frequently numbness post procedure. Microvascular decompression appears to r

10、esult in the longest pain relief. Gamma knife may also be effective, however the effectiveness decreases with time.,Surgery,Balloon compression A cost-effective percutaneous surgical procedure wirh excellent success rates This technique has been helpful in treating the elderly for whom surgery may n

11、ot be an option due to coexisting health conditions. Balloon compression is also the best choice for patients who have ophthalmic nerve pain or have experienced recurrent pain after microvascular decompression.,surgery,Peripheral nerve avulsion （IAN、ION） Surgical resection or cryotherapy of the peri

12、pheral nerves in the distribution of the pain but the pain relief these treatments bring is of relatively short duration (12 years).,Section 2 Atypical facial pain,Atypical facial pain was originally a dustbin diagnosis; that is, when all other possible causes of pain had been carefully considered a

13、nd excluded, the pain was considered to be atypical. It is now recognized that the group of patients who describe this painful condition often describe a similar pattern of events and there are sufficient common features to consider this as one disorder.,Atypical facial pain,Features The origin of t

14、he pain is often associated with an item of dental treatment, although sometimes careful questioning reveals a significant period of pain that caused the patient to seek treatment. The pain persists, despite the best efforts of the dentist, who may restore the tooth, root fill it or extract it, all

15、to no benefit.,Atypical facial pain,The pain itself is variable in nature and in severity but remarkably chronic in duration, lasting for years. Indeed it is often more than a year before the diagnosis is made. In general the pain is continuous. It may be sharp, aching, throbbing, burning, with some

16、 variation in intensity over time and responds poorly to common analgesics.,Atypical facial pain,There is a strong predilection for women and the more common age for diagnosis is the late forties or fifties. There is a strong association between this condition and anxiety and depression. No investigations are of great value in diagnosis, except whe