Neurophysiological assessment of craniofacial pain.
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This review deals with the diagnostic usefulness of neurophysiological testing in patients with craniofacial pain. Neurophysiological testing of trigeminal nerve function relies on trigeminal reflexes and laser-evoked potentials (LEPs). This review briefly describes the physiology of trigeminal reflexes and LEPs, reports normal values and highlights the neurophysiological abnormalities in the main clinical conditions. (+info)
Hamular Bursitis and its possible craniofacial referred symptomatology: two case reports.
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The diagnosis of craniofacial pain is conditioned by the interdisciplinary management of its presentation especially in the absence of unique and objective signs. Bursitis is a pathological entity recently found in the hamular area and should be included in the diagnosis for exclusion of temporomandibular disorders (TMD), ear-nose-throat pathologies, due to the similar symptomatology to other head and neck conditions. The hamular process bursitis is a painful condition that can easily be confused with glosopharinge or trigeminal neuralgia that generates an uncomfortable feeling in the oropharinge with ipsilateral referred--heteretopic-symptomatology to the head. This pathology, in chronic states, can be responsible for the amplification of the pain perceived by the central excitation effect. In this report are presented two clinical cases of hamular bursitis and its conservative therapeutic management. The recognition of the inflammation of the bursa of the tensor veli palati muscle supplies the specialist with another tool in the management of craniofacial pain. (+info)
Mechanisms of orofacial pain control in the central nervous system.
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Recent advances in the study of pain have revealed somatotopic- and modality-dependent processing and the integration of nociceptive signals in the brain and spinal cord. This review summarizes the uniqueness of the trigeminal sensory nucleus (TSN) in structure and function as it relates to orofacial pain control. The oral nociceptive signal is primarily processed in the rostral TSN above the obex, the nucleus principalis (Vp), and the subnuclei oralis (SpVo) and interpolaris (SpVi), while secondarily processed in the subnucleus caudalis (SpVc). In contrast, the facial nociceptive signal is primarily processed in the SpVc. The neurons projecting to the thalamus are localized mostly in the Vp, moderately in the SpVi, and modestly in the ventrolateral SpVo and the SpVc. Orofacial sensory inputs are modulated in many different ways: by interneurons in the TSN proper, through reciprocal connection between the TSN and rostral ventromedial medulla, and by the cerebral cortex. A wide variety of neuroactive substances, including substance P, gamma-aminobutyric acid, serotonin and nitric oxide (NO) could be involved in the modulatory functions of these curcuits. The earliest expression of NO synthase (NOS) in the developing rat brain is observed in a discrete neuronal population in the SpVo at embryonic day 15. NOS expression in the SpVc is late at postnatal day 10. The neurons receiving intraoral signals are intimately related with the sensorimotor reflexive function through the SpVo. In summary, a better understanding of the trigeminal sensory system--which differs from the spinal system--will help to find potential therapeutic targets and lend to developing new analgesics for orofacial-specific pain with high efficacy and fewer side effects. (+info)
Correlation of clinical and MRI findings of tempero-mandibular joint internal derangement.
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The most common clinical features of tempero-mandibular joint internal derangement are correlated with the MRI findings of shape of the disc in an attempt to find the etiology of tempero-mandibular joint internal derangement. In this study, the clinical parameters of pain, muscle tenderness, clicking with in the joint (like early, middle and late) are correlated with the MRI findings of disc shapes. (like biconcave, thick, lengthened, folded, adhesion). The study reveals any trauma that leads to muscle tenderness results in internal derangement of tempero-mandibular joint. (+info)
Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) or cranial autonomic features (SUNA)--a prospective clinical study of SUNCT and SUNA.
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Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache attacks with cranial autonomic features (SUNA) are described, although SUNA is rarely reported. The phenotype of SUNCT and SUNA was characterized from a large series of patients (43 SUNCT, 9 SUNA). Three attack types were identified: stabs, groups of stabs and saw-tooth attacks. The mean duration of stabs was 58 s (1-600 s); stab groups, 396 s (10-1200 s); and saw-tooth, 1160 s (5-12 000s). The attack frequency was a mean of 59 attacks/day (2-600), and this depended largely on the type of attack. The pain was orbital, supraorbital or temporal in 38 (88%) SUNCT and 7 (78%) SUNA, and also occurred in the retro-orbital region, side, top, back of head, second and third trigeminal divisions, teeth, neck and ear. All SUNCT patients had conjunctival injection and tearing. Two SUNA patients had conjunctival injection, four had tearing, but none had both. Other cranial autonomic symptoms included nasal blockage, rhinorrhoea, eyelid oedema, facial sweating/flushing and ear flushing. Cutaneous stimuli triggered attacks in 74% of SUNCT but only in 22% of SUNA patients. The majority (95% SUNCT and 89% SUNA) had no refractory period between attacks. For SUNCT 58% and for SUNA 56% of patients were agitated with the attacks. We propose a new set of diagnostic criteria for these syndromes to better encompass the clinical presentations and which include a wider range of attack length, wider trigeminal pain distribution, cutaneous triggering and lack of refractory period. (+info)
Cervical plexus block helps in diagnosis of orofacial pain originating from cervical structures.
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Headache associated with cervical lesions is called cervicogenic headache and involves the occiput but not the orofacial region. However, patients occasionally present with orofacial pain accompanied by neck symptoms. This study investigates whether orofacial pain can originate from the neck and whether cervical plexus block can help in diagnosis. We enrolled eight patients suffering from chronic orofacial pain that had not been relieved by dental treatment. Radiographic and magnetic resonance imaging revealed abnormal findings in the neck in seven of them. To identify the origin of the orofacial pain, we firstly blocked peripheral sensory input from the oral cavity and surrounding tissues, followed by that from deep cervical structures. We injected local anesthetics around the painful orofacial region, then to the tender points in the masticatory and superficial cervical muscles (trigger point injection), and consequently around the cervical plexus. Pain was assessed using a pain relief score compared with pre-treatment control values. Local anesthesia in the painful oral region provided insufficient relief whereas trigger point injection significantly relieved pain. The amount of pain relief generated by the deep cervical plexus block was more significant than that produced by any other procedures. We conclude that certain types of orofacial pain originate from cervical structures and that a deep cervical plexus block can be helpful in differentially diagnosing such pain. (+info)
Which orthodontic archwire sequence? A randomized clinical trial.
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The aim of this study was to compare three orthodontic archwire sequences. One hundred and fifty-four 10- to 17-year-old patients were treated in three centres and randomly allocated to one of three groups: A = 0.016-inch nickel titanium (NiTi), 0.018 x 0.025-inch NiTi, and 0.019 x 0.025-inch stainless steel (SS); B = 0.016-inch NiTi, 0.016-inch SS, 0.020-inch SS, and 0.019 x 0.025-inch SS; and C = 0.016 x 0.022-inch copper (Cu) NiTi, 0.019 x 0.025-inch CuNiTi, and 0.019 x 0.025-inch SS. At each archwire change and for each arch, the patients completed discomfort scores on a seven-point Likert scale at 4 hours, 24 hours, 3 days, and 1 week. Time in days and the number of visits taken to reach a 0.019 x 0.025-inch SS working archwires were calculated. A periapical radiograph of the upper left central incisor was taken at the start of the treatment and after placement of the 0.019 x 0.025-inch SS wire so root resorption could be assessed. There were no statistically significant differences between archwire sequences A, B, or C for patient discomfort (P > 0.05) or root resorption (P = 0.58). The number of visits required to reach the working archwire was greater for sequence B than for A (P = 0.012) but this could not be explained by the increased number of archwires used in sequence B. (+info)
Cortical involvement during the description of head pain.
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Pain perception involves several cortical areas. Our purpose was to examine cortical activity in patients describing their cephalic pain with the MacGill Pain Questionnaire (MPQ). Two SPECT analyses were performed in pain-free periods in 10 patients with migraine (n=8) or myogenous facial pain (n=2). The MPQ was administered in the first session, while no task was to be performed during the second session. Differences were calculated using statistical parametric mapping (SPM99), also taking the MPQ pain rating index (PRI) as covariance. During the MPQ session, clusters of activation were observed in the orbitofrontal cortex, the insula and the anterior cingulate cortex (ACC) of the left brain, but not significantly so. Using the MPQ PRI as covariate, significant areas of activation were found in the left frontal lobe, the Brodmann area 32 and in the ACC. The description of pain seems to activate cortical areas similar to those involved in actual pain perception. (+info)