Dileep leads a research team working on the development of novel Zirconia Implant material, deemed to be the future of metal-free Implant Dentistry.
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I read Open Access journals to keep abreast of the recent development in my field of study. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. Peer Review Workflow Reviewers Guidelines. Guidelines for Guest Editors. Advertise With Us Kudos. Recent Articles. View More Articles. Methods: Seven patients with a diagnosis of odontogenic keratocyst were evaluated longitudinally to clinical and histological features, and pre- and postoperative radiographs were analyzed.
Results: No recurrence was observed during follow-up. Conclusion: Based on these results, the multimodal protocol proposed here was effective in the treatment of odontogenic keratocysts by reducing lesion size, avoiding possible damage to adjacent anatomical structures, and allowing a surgical procedure with less morbidity. Indexing Agencies. View Editorial Board. The Guest Edited Thematic Issues are published free of charge.
Centre Antipoison-Centre de Pharmacovigilance, France. UCB S. Westat, USA. University of Oxford, UK. Almac Sciences, Northern Ireland. Delft University of Technology, The Netherlands. Magnetic resonance imaging MRI is typically normal although there is a small incidence of definable pathology eg intracranial tumours, vascular anomalies.
Pain simulating trigeminal neuralgia may occur in young adults with multiple sclerosis due to the presence of a demyelinating plaque at the root entry of the trigeminal nerve into the pons. High-resolutions T2-CISS constructive interference in steady state sequences and magnetic resonance angiography MRA on 3T MRI scanners may show the tortuous artery compressing the trigeminal nerve at its entry to the pons.
These particular sequences may be useful in defining surgical treatment options, but are not otherwise indicated. Pharmacological therapy should be initiated if history and clinical examination strongly suggest trigeminal neuralgia. It is common practice to commence with carbamazepine mg twice daily and increase the dose as required. Monitoring serum levels is of little value. Newer anticonvulsant agents eg gabapentin, pregabaline and lamotrigine are generally effective, well tolerated and have low toxicity.
The most favoured treatment is microvascular decompression, which is an open microsurgical retro-sigmoid craniotomy to access the trigeminal nerve root. The aberrant loop of the artery, most commonly the superior cerebellar, is identified, gently moved from the nerve root and kept away by use of small pledgets of teflon felt.
In other surgical procedures, a needle is placed percutaneously via the foramen ovale using an image intensifier. These procedures include balloon compression, radiofrequency lesioning or glycerol injection partially lesioning the trigeminal ganglion.
A similar goal may be achieved by stereotactic radio-surgery using focused radiation to create a lesion within the nerve root. The glossopharyngeal and fibres of the vagus nerves supply sensation to the posterior third of the tongue and oropharynx. Glossopharyngeal neuralgia is an uncommon condition producing severe lancing pain in the oropharynx or base of the tongue when swallowing.
Rarely, the pain may be felt in the posterior mandibular region. The causation and quality of pain are similar to those of trigeminal neuralgia. Glossophayngeal neuralgia should be considered if a sharp pain occurs when swallowing.
However, pharyngeal disease or an ulcer at the base of the tongue is a far more common cause of this type of pain. It frequently responds to administration of carbamazepine. Uncommonly, migraine may present with prodromal symptoms followed by pain in the peri-orbital region, which may diffuse to the cheek and mandible. Management is as for typical migraine. Herpes zoster commonly affects a branch of the trigeminal nerve in the elderly and immunocompromised or immunosuppressed patients.
Burning, aching or, occasionally, lightening pain with tenderness over the affected dermatome may persist for many months after the vesicular lesions of shingles have resolved.
In established pain, carbamazepine, amitriptyline or gabapentin may minimise this distressing symptom. Tramadol or a regional nerve block may be effective where the pain is refractive. This anatomical variant may result from calcification of the stylohyoid ligament. There may be neck tenderness at the tip of the process. Although it is an uncommon cause of pain on swallowing, some patients report multiple specialist and dental consultations before the correct diagnosis is made.
Conservative treatment may temporarily relieve symptoms, but ultrasonic osteotomy is the treatment of choice where pain is troublesome. This inflammatory disease giant cell arteritis affects the media of medium-sized cranial arteries.
It may present as claudication when chewing, together with a constant unilateral headache and diffuse pain around the ear. Pain experienced while eating results from involvement of the media in the masseteric artery. Waiting for a positive result before commencing treatment can result in permanent ocular damage due to concurrent inflammation of the ophthalmic arteries. The presence of tenderness and hypersensitivity over the superficial temporal artery, together with a raised erythrocyte sedimentation rate ESR , warrants immediate commencement of oral prednisolone commonly 50 mg daily.
The dose of prednisolone is titrated depending on ESR and clinical response, and it is frequently necessary to continue drug therapy for more than six months. This demyelinating disease may mimic trigeminal neuralgia and cause intermittent lancing facial pain. It should always be considered, particularly in a younger adult who has other neurological deficits. MRI is usually diagnostic in this condition. Musculoskeletal causes of orofacial pain are common. It is important to differentiate temporomandibular joint dysfunction TMD from myofascial pain, which is more frequent.
In myofascial pain syndrome, there is frequently pain and tenderness over the masticatory muscles. A trigger point and muscle fatigue on chewing may be present. Patients presenting with pain around the ear are sometimes referred to a dentist, with a provisional diagnosis of TMJ dysfunction when aural causes are excluded.
However, dental treatment is not indicated unless the above clinical findings are present. TMD is not a diagnosis of exclusion. An OPG reveals joint morphology and makes for easy comparison of the two sides. Initially, myofascial pain and TMD should be treated conservatively by resting the joint restricting opening and chewing , application of heat and use of simple analgesia. The combination of paracetamol, alternating two-hourly with a non-steroidal anti-inflammatory agent, is frequently effective.
Diazepam, 5 mg, at night when muscle tenderness is present may provide relief through its skeletal muscle relaxant and anxiolytic effects. The patient should be referred for dental assessment if there is no response to conservative measures. A removable acrylic occlusal splint, worn at night, may relieve myofascial pain, inflammation 10 and, in cases of bruxism, prevent wear of the teeth from grinding. However, many authorities are of the opinion that these splints are of little value in most cases of TMD.
Their empirical use when TMD is suspected should therefore be discouraged. Some investigators believe TMD may precipitate migraine, and masticatory muscle hyperactivity often occurs in a migraine attack. Although this may occur, splints rarely prevent headache recurrence. This safe, outpatient procedure is effective in many cases of TMD where there are no major morphological changes. The joint is lavaged and a steroid solution inserted.
However, the duration of pain relief is variable. Open joint surgery is reserved for patients who do not respond to the above management, or those with marked joint derangement. Patients are increasingly being managed with pain control and other non-surgical options. Even when there is restricted, painful jaw opening, the preferred treatment is arthroscopy and arthrocentesis.
A mental health and social history is essential when assessing facial pain, as depression and anxiety may increase pain severity and make its management more difficult. Conversely, persistent facial pain may amplify a neurosis or psychosis. Depression and anxiety are more common in elderly women living alone, although it is seen at all ages. In addition, there is a small number of patients in whom a diagnosis cannot be made.
Low-dose tricyclic antidepressants taken before retiring, together with a supportive environment, often lead to significant pain reduction in these patients. In undiagnosed facial pain, nerve block may relieve the pain and aid in determining the site from which it originates. The source is likely to be local if an injection of a short-acting local anaesthetic lignocaine close to the pain site provides temporary relief. A long-acting agent, including bupivacaine with adrenaline, should then be administered.
This will provided time for the inflamed nerve to recover from repeated stimulation at the peripheral nerve endings. Adding a steroid to the anaesthetic solution may provide relief in excess of the duration of the anaesthetic.
If no improvement is gained, the pain is likely to be central in origin. The mean duration of relief was 27 days. This is a particularly useful and safe technique in elderly patients with occipital neuralgia in whom poly-pharmacy increases the risks of adverse drug interactions. Facial pain is a common presentation in clinical practice. The great majority of cases are due to diseases of the oral cavity, but the remainder often prove to be a diagnostic challenge.
However, almost all cases can be diagnosed correctly and the pain controlled with a systematic approach using investigations judiciously. Quail med. Competing interests: None. Provenance and peer review: Not commissioned, externally peer reviewed. Australian Family Physician. Search for: Search AFP.
Filter Relevance Date. Issues by year. Volume 44, Issue 12, December Background Facial pain is one of the most common neurological complaints together with headache, and back and abdominal pain.
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