This document provides an overview of orofacial pain and discusses trigeminal neuralgia in particular. It begins by defining pain and noting that orofacial pain can result from diseases of the orofacial structures, musculoskeletal issues, peripheral or central nervous system diseases, or psychological abnormalities. It then discusses the cranial nerves involved in orofacial sensation before focusing on the trigeminal nerve and its distribution. The document explains that trigeminal neuralgia is the most common facial pain disorder resulting from trigeminal nerve involvement and describes its potential causes and clinical features such as paroxysmal episodes of intense, electric shock-like pain precipitated by light touch of trigger zones.
Orofacial pain is the field of dentistry devoted to the diagnosis and management of complex facial pain and oro motor disorder
Orofacial pain is the term covering any pain in the mouth , Jaw and face
1) The temporomandibular joint (TMJ) is a synovial joint that connects the mandible to the temporal bone. It has several parts including the articular eminence, fossa, condyle, capsule, ligaments, synovial fluid, and articular disc.
2) The articular disc sits between the condyle and fossa and divides the joint into two compartments. It allows the condyle to glide forward during opening and back during closing.
3) Four jaw muscles work in coordination to produce movements like opening, closing, protruding, and grinding. The lateral pterygoid muscle plays a key role in pulling the disc as the jaw opens
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document provides information about orofacial pain, including:
1. It classifies orofacial pains into somatic pain, musculoskeletal pain, neuropathic pain, and other conditions.
2. It describes how to clinically evaluate pain through taking a thorough patient history and looking for associated signs and symptoms.
3. It outlines typical orofacial pains like dental pain, periodontal pain, TMJ pain, and maxillary sinus pain, and how they present and are treated. It also covers psychogenic orofacial pains like facial arthromyalgia.
abscess advanced trauma life support anterio advanced trauma life support antibiotics apically repositioned flap dental diseases dr dr shabeel drshabeelâs face eye trauma lidocaine anodontia management medical medicine misuse and abuse orthodontics teeth braces pharmacy pn preparation dental students for community based ed presentations s abscess abscess tooth active orthodonti shabeel shabeel"s shabeelâs shabeelpn trends of antimicrobial usage in dental practice View all
âs abscess abscess advanced trauma life support anterio abscess tooth active orthodontics adolescent advanced trauma life support aesthetic dentistry airway management alignment of teeth amalgam anesthesia in dentistry anesthetics in dentistry anterior open bite antibiotic resistanace antibiotics antibiotics and leukopenia aphthous ulcers apically repositioned flap apicoectomy appliances arch dental arch form orthodontics braces arch length orthodontics braces arch wire orthodontist braces ayurvedha baby teeth bloger boil books braces braces teeth cancer canker sore pain cavity preparation children community based learning congenitally missing teeth cosmetic dentistry csf leaks dental dental anesthetics dental restorations dental teeth dento alveolar fractures disease
This document provides information on pain management. It begins with the history and theories of pain. It then discusses the neurophysiology of pain including nociception, transmission, modulation and perception. Gate control theory is explained in detail. Non-pharmacological approaches like rest, distraction, electrotherapy and exercise are covered. The WHO analgesic ladder is introduced and different classes of pharmacological pain medications like non-opioids, opioids, antidepressants and antiepileptics are summarized.
Orofacial pain can be somatic, neuropathic, or psychogenic in origin. Somatic pain results from stimuli affecting structures like teeth, skin or bone and is usually acute and localized. Neuropathic pain is abnormal nerve pain that may be paroxysmal or continuous, as seen in trigeminal neuralgia. Psychogenic pain has no physical cause and is characterized as diffuse, chronic pain that worsens with stress. Common causes of orofacial pain include dental diseases, sinusitis, temporomandibular joint disorders, and neurological conditions like trigeminal neuralgia.
Facial neuropathology Maxillofacial SurgeryLama K Banna
Â
Lecture 4 facial neuropathology
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
Orofacial pain is the field of dentistry devoted to the diagnosis and management of complex facial pain and oro motor disorder
Orofacial pain is the term covering any pain in the mouth , Jaw and face
1) The temporomandibular joint (TMJ) is a synovial joint that connects the mandible to the temporal bone. It has several parts including the articular eminence, fossa, condyle, capsule, ligaments, synovial fluid, and articular disc.
2) The articular disc sits between the condyle and fossa and divides the joint into two compartments. It allows the condyle to glide forward during opening and back during closing.
3) Four jaw muscles work in coordination to produce movements like opening, closing, protruding, and grinding. The lateral pterygoid muscle plays a key role in pulling the disc as the jaw opens
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
This document provides information about orofacial pain, including:
1. It classifies orofacial pains into somatic pain, musculoskeletal pain, neuropathic pain, and other conditions.
2. It describes how to clinically evaluate pain through taking a thorough patient history and looking for associated signs and symptoms.
3. It outlines typical orofacial pains like dental pain, periodontal pain, TMJ pain, and maxillary sinus pain, and how they present and are treated. It also covers psychogenic orofacial pains like facial arthromyalgia.
abscess advanced trauma life support anterio advanced trauma life support antibiotics apically repositioned flap dental diseases dr dr shabeel drshabeelâs face eye trauma lidocaine anodontia management medical medicine misuse and abuse orthodontics teeth braces pharmacy pn preparation dental students for community based ed presentations s abscess abscess tooth active orthodonti shabeel shabeel"s shabeelâs shabeelpn trends of antimicrobial usage in dental practice View all
âs abscess abscess advanced trauma life support anterio abscess tooth active orthodontics adolescent advanced trauma life support aesthetic dentistry airway management alignment of teeth amalgam anesthesia in dentistry anesthetics in dentistry anterior open bite antibiotic resistanace antibiotics antibiotics and leukopenia aphthous ulcers apically repositioned flap apicoectomy appliances arch dental arch form orthodontics braces arch length orthodontics braces arch wire orthodontist braces ayurvedha baby teeth bloger boil books braces braces teeth cancer canker sore pain cavity preparation children community based learning congenitally missing teeth cosmetic dentistry csf leaks dental dental anesthetics dental restorations dental teeth dento alveolar fractures disease
This document provides information on pain management. It begins with the history and theories of pain. It then discusses the neurophysiology of pain including nociception, transmission, modulation and perception. Gate control theory is explained in detail. Non-pharmacological approaches like rest, distraction, electrotherapy and exercise are covered. The WHO analgesic ladder is introduced and different classes of pharmacological pain medications like non-opioids, opioids, antidepressants and antiepileptics are summarized.
Orofacial pain can be somatic, neuropathic, or psychogenic in origin. Somatic pain results from stimuli affecting structures like teeth, skin or bone and is usually acute and localized. Neuropathic pain is abnormal nerve pain that may be paroxysmal or continuous, as seen in trigeminal neuralgia. Psychogenic pain has no physical cause and is characterized as diffuse, chronic pain that worsens with stress. Common causes of orofacial pain include dental diseases, sinusitis, temporomandibular joint disorders, and neurological conditions like trigeminal neuralgia.
Facial neuropathology Maxillofacial SurgeryLama K Banna
Â
Lecture 4 facial neuropathology
Maxillofacial Surgery
Dental Students Fifth Year second semester
Al Azhar University Gaza Palestine
Dr. Lama El Banna
https://twitter.com/lama_k_banna
The document discusses the classification and diagnosis of temporomandibular disorders (TMD). It describes different types of TMDs including masticatory muscle disorders, temporomandibular joint disorders, and conditions that mimic TMD. For diagnosing and treating TMDs properly, it is important to understand the various disorders, their causes, symptoms, and appropriate treatments as no single treatment is suitable for all TMD cases. Accurate diagnosis is crucial for effective management of patient disorders.
The document describes the development of the dental pulp and root formation. It discusses:
- How the dental pulp develops from mesenchymal cells that differentiate into odontoblasts and fibroblasts.
- How the dental papilla and follicle form during the bud and cap stages and their roles in tooth development.
- How odontoblasts and cementoblasts differentiate during the bell stage to lay down dentin and cementum.
- The development of blood vessels and nerves that enter the dental pulp.
- How root formation is directed by the Hertwig's epithelial root sheath and how this determines root morphology.
- The formation of acellular cementum on root surfaces by
This document discusses the evaluation, classification, causes and treatment of orofacial pain. It defines orofacial pain as unpleasant sensation caused by noxious stimuli along nerve pathways to the central nervous system. The evaluation of orofacial pain patients involves medical history, pain characteristics, physical exam and diagnostic tests. Pain is classified as somatic, neurogenic or psychogenic based on origin. Common causes include local dental issues, neurological conditions like trigeminal neuralgia, and psychogenic factors. Treatment depends on diagnosis but may include medications, nerve blocks or surgery.
This document provides an overview of temporomandibular disorders (TMD). It discusses the history and description of TMD, including early terminology. Etiology is multifactorial and can be predisposing, precipitating, or perpetuating factors like occlusion, trauma, stress, and parafunctional habits. Common signs and symptoms include pain, joint sounds like clicking or crepitus, and limited jaw movement. Pain can originate from muscles, the TM joint, or dentition and be caused by factors like trauma, fatigue, or inflammation. Joint sounds result from irregular surfaces or uncoordinated movement. Limitation of movement can stem from muscle restriction, disk displacement, ligaments, or dislocation.
1. The document discusses various types of orofacial pain including somatic, neurogenic, and psychogenic pain. It describes trigeminal neuralgia as a common type of neurogenic pain characterized by sharp, electric shock-like pain in the face that is triggered by stimulation of specific trigger zones. 2. Evaluation of orofacial pain involves taking a thorough medical history and performing physical and neurological examinations. Differential diagnosis considers local causes as well as neurological disorders. 3. Treatment depends on the underlying cause but may include medications, nerve blocks, surgery, or a combination. Carbamazepine is first-line treatment for trigeminal neuralgia.
This document discusses temporomandibular joint disorders (TMJD), including normal anatomy, classifications, arthritis of the TMJ, and specific conditions like osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis. It provides details on the clinical manifestations, radiographic features, differential diagnosis, and treatment options for various TMJD conditions.
This document provides an overview of temporomandibular joint (TMJ) disorders, including their etiology, classification, common types, and management. Some key points:
- TMJ disorders involve the jaw joint and surrounding muscles and tissues, causing pain and limiting jaw function. They affect 10-15% of adults.
- Causes are multifactorial but often involve stress, anxiety, and bruxism. The most common type is myofascial pain dysfunction syndrome, originating from muscle tenderness rather than the joint.
- Types include disk displacement disorders, degenerative joint disease, arthritis, dislocations, and ankylosis. Symptoms and treatments vary depending on the specific disorder.
The document summarizes several cranial nerves and associated ganglia. It describes the Trigeminal nerve as the 5th cranial nerve that provides motor innervation to the muscles of mastication. It also outlines the three main branches of the Trigeminal nerve - the Ophthalmic, Maxillary, and Mandibular nerves. Each branch innervates different facial regions and structures such as the eyes, nose, mouth, and face. The document also briefly discusses some associated parasympathetic ganglia like the Ciliary, Pterygopalatine, and Otic ganglia.
This document discusses the causes, progression, and presentation of various periapical and periodontal infections and abscesses. It describes how untreated pulpitis can lead to periodontitis as bacteria spread through the root canal. Acute traumatic periodontitis is usually temporary and caused by occlusal trauma or dental procedures. Persistent irritation can lead to chronic periapical periodontitis characterized by bone resorption and granulation tissue formation. Abscesses may develop from these infections and spread in various directions depending on anatomical structures, presenting as facial swelling, palatal abscesses, or submandibular involvement in severe cases like Ludwig's angina.
Temporomandibular joint disorder (TMD), or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment. Because the disorder transcends the boundaries between several health-care disciplines â in particular, dentistry, neurology, physical therapy, and psychology â there are a variety of treatment approaches.
The document discusses the trigeminal nerve, including its anatomy and branches. It describes the maxillary nerve in detail, including its origin, course, branches both within the cranium and on the face. It discusses several clinical implications and conditions related to trigeminal nerve injury or involvement, such as trigeminal neuralgia, maxillary sinus infections, herpes zoster ophthalmicus, and tumors affecting the trigeminal nerve ganglia or branches.
This document discusses investigations for temporomandibular disorders (TMD). It defines TMD as clinical problems involving the jaw joint (TMJ) and muscles of mastication, characterized by facial pain and limited jaw movement. A thorough history and physical exam are important, including inspection of asymmetry and range of motion, and palpation of muscles and joints. Radiographic exams include panoramic x-rays to view teeth and bones, and MRI to view soft tissues like discs. Arthrography involves injecting dye into joints under fluoroscopy. Different imaging modalities provide views of bony and soft tissue structures to aid in diagnosing TMD issues like internal derangements, fractures, or cysts.
The document discusses the relationship between occlusion and temporomandibular disorders (TMDs). It notes that while occlusion is not the sole cause of TMDs, it can be a contributing factor through its effects on orthopedic stability. Orthopedic stability exists when the stable intercuspal position (ICP) of the teeth is aligned with the musculoskeletal stable position of the condyles. Misalignment between ICP and the condylar position can lead to orthopedic instability over time if heavy forces are placed on the system. The degree of orthopedic instability and the loading forces are factors that influence the risk of developing intracapsular TMD disorders.
This document provides information on the temporomandibular joint (TMJ), including its definition, structure, diagnosis, and treatment of TMJ disorders. Some key points:
- The TMJ is formed by the temporal bone and mandible, allowing hinging and sliding movements. It contains an articular disc that helps distribute forces.
- Common TMJ disorders include myofascial pain dysfunction syndrome, osteoarthritis, dislocations, and internal derangements (abnormal disc positioning).
- Diagnosis involves history, examination, and imaging like x-rays, CT, MRI. Treatment depends on the disorder but may include splint therapy, exercises, injections, or surgery.
Trigeminal Neuralgia
A neuropathic pain caused when trigger site stimulated by brushing, tilting head and shaving, stress and tiredness, cold and hot water, chewing and swallowing, touching and washing face, light breeze or wind on face etc.
The disease is mostly unilateral and can be treated by medications like Carbazepine, oxycarbamazepine, lamotrigine and phenytoin and gabapentin and surgeries like periferal injection, Glycerol injection in the gasserian Ganglion, periferal neurectomy, Cryotherapy, open or intracranial procedures Gammaknife radiosurgeries.
Fix your appointment at Dr. Sachdeva's Dental Institute, call us at:- +919818894041,01142464041
Follow our link:-
Google link:
https://business.google.com/dashboard/l/04970356233769420071
Facebook link for Dental Courses:
https://www.facebook.com/dentalcoursesdelhi/
Facebook link for Dental Treatments:
https://www.facebook.com/sachdevadental/
You tube Link:
https://www.youtube.com/user/drrajatsachdeva
Linkedin link:
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Twitter Page :
https://twitter.com/drrajatsachdeva
Instagram page :
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Practo Profile :
https://www.practo.com/delhi/doctor/dr-rajat-sachdeva-dentist
Blogger Profile :
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Facial Aesthetics Facebook Page :
https://www.facebook.com/facialaesthetics.delhi
Facial Aesthetics you tube channel :
http://www.youtube.com/channel/UCheM4wF9nWGXJYOmScvsQNw
Local anesthetics work by blocking sodium channels in nerve cell membranes, preventing the propagation of action potentials and conduction of sensations. This document discusses the classification, composition, mechanisms of action, and examples of commonly used local anesthetic drugs and vasoconstrictors. It also covers the techniques for maxillary nerve blocks and factors that influence the onset and duration of local anesthesia.
This presentation contains the detailed description about the courses, branches and supply of the Trigeminal Nerve, contains variations of maxillary nerve & Mandibular Nerve, and the detail about trigeminal Neurolgia and its managements
The document discusses various types of orofacial pain including trigeminal neuralgia, post-herpetic neuralgia, atypical facial pain, and burning mouth syndrome. It covers the etiology, pathophysiology, clinical manifestations, diagnosis and management of each condition. Chronic pain is defined as pain persisting beyond tissue healing. Neuroplastic changes in the central nervous system are believed to underlie chronic pain. Treatment involves cognitive therapy, medications like anticonvulsants, antidepressants and opioids, as well as surgical options in some cases.
Migraines and tension headaches are the two most common types of primary headaches. Migraines are characterized by severe pulsating pain that is often unilateral, lasting from 2-72 hours and accompanied by symptoms like nausea, sensitivity to light and sound. Tension headaches cause non-pulsating mild to moderate bilateral pain that feels like tightness or pressure around the head. Cervicogenic headaches originate from issues in the neck muscles or structures and cause unilateral pain that increases with neck movement. Secondary headaches are caused by underlying medical conditions and can include headaches due to head trauma, vascular disorders, infections or psychiatric disorders.
Trigeminal neuralgia is a chronic pain condition that affects the trigeminal or 5th cranial nerve. It causes sudden, severe facial pain that feels like electric shocks. The pain is often triggered by everyday activities like eating or talking. It is commonly caused by compression of the trigeminal nerve by blood vessels near the brainstem. This can cause demyelination and hyperactivity of the nerve. Treatments include anticonvulsant medications and microvascular decompression surgery to relieve pressure on the nerve.
The document discusses the classification and diagnosis of temporomandibular disorders (TMD). It describes different types of TMDs including masticatory muscle disorders, temporomandibular joint disorders, and conditions that mimic TMD. For diagnosing and treating TMDs properly, it is important to understand the various disorders, their causes, symptoms, and appropriate treatments as no single treatment is suitable for all TMD cases. Accurate diagnosis is crucial for effective management of patient disorders.
The document describes the development of the dental pulp and root formation. It discusses:
- How the dental pulp develops from mesenchymal cells that differentiate into odontoblasts and fibroblasts.
- How the dental papilla and follicle form during the bud and cap stages and their roles in tooth development.
- How odontoblasts and cementoblasts differentiate during the bell stage to lay down dentin and cementum.
- The development of blood vessels and nerves that enter the dental pulp.
- How root formation is directed by the Hertwig's epithelial root sheath and how this determines root morphology.
- The formation of acellular cementum on root surfaces by
This document discusses the evaluation, classification, causes and treatment of orofacial pain. It defines orofacial pain as unpleasant sensation caused by noxious stimuli along nerve pathways to the central nervous system. The evaluation of orofacial pain patients involves medical history, pain characteristics, physical exam and diagnostic tests. Pain is classified as somatic, neurogenic or psychogenic based on origin. Common causes include local dental issues, neurological conditions like trigeminal neuralgia, and psychogenic factors. Treatment depends on diagnosis but may include medications, nerve blocks or surgery.
This document provides an overview of temporomandibular disorders (TMD). It discusses the history and description of TMD, including early terminology. Etiology is multifactorial and can be predisposing, precipitating, or perpetuating factors like occlusion, trauma, stress, and parafunctional habits. Common signs and symptoms include pain, joint sounds like clicking or crepitus, and limited jaw movement. Pain can originate from muscles, the TM joint, or dentition and be caused by factors like trauma, fatigue, or inflammation. Joint sounds result from irregular surfaces or uncoordinated movement. Limitation of movement can stem from muscle restriction, disk displacement, ligaments, or dislocation.
1. The document discusses various types of orofacial pain including somatic, neurogenic, and psychogenic pain. It describes trigeminal neuralgia as a common type of neurogenic pain characterized by sharp, electric shock-like pain in the face that is triggered by stimulation of specific trigger zones. 2. Evaluation of orofacial pain involves taking a thorough medical history and performing physical and neurological examinations. Differential diagnosis considers local causes as well as neurological disorders. 3. Treatment depends on the underlying cause but may include medications, nerve blocks, surgery, or a combination. Carbamazepine is first-line treatment for trigeminal neuralgia.
This document discusses temporomandibular joint disorders (TMJD), including normal anatomy, classifications, arthritis of the TMJ, and specific conditions like osteoarthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis. It provides details on the clinical manifestations, radiographic features, differential diagnosis, and treatment options for various TMJD conditions.
This document provides an overview of temporomandibular joint (TMJ) disorders, including their etiology, classification, common types, and management. Some key points:
- TMJ disorders involve the jaw joint and surrounding muscles and tissues, causing pain and limiting jaw function. They affect 10-15% of adults.
- Causes are multifactorial but often involve stress, anxiety, and bruxism. The most common type is myofascial pain dysfunction syndrome, originating from muscle tenderness rather than the joint.
- Types include disk displacement disorders, degenerative joint disease, arthritis, dislocations, and ankylosis. Symptoms and treatments vary depending on the specific disorder.
The document summarizes several cranial nerves and associated ganglia. It describes the Trigeminal nerve as the 5th cranial nerve that provides motor innervation to the muscles of mastication. It also outlines the three main branches of the Trigeminal nerve - the Ophthalmic, Maxillary, and Mandibular nerves. Each branch innervates different facial regions and structures such as the eyes, nose, mouth, and face. The document also briefly discusses some associated parasympathetic ganglia like the Ciliary, Pterygopalatine, and Otic ganglia.
This document discusses the causes, progression, and presentation of various periapical and periodontal infections and abscesses. It describes how untreated pulpitis can lead to periodontitis as bacteria spread through the root canal. Acute traumatic periodontitis is usually temporary and caused by occlusal trauma or dental procedures. Persistent irritation can lead to chronic periapical periodontitis characterized by bone resorption and granulation tissue formation. Abscesses may develop from these infections and spread in various directions depending on anatomical structures, presenting as facial swelling, palatal abscesses, or submandibular involvement in severe cases like Ludwig's angina.
Temporomandibular joint disorder (TMD), or TMJ syndrome, is an umbrella term covering acute or chronic inflammation of the temporomandibular joint, which connects the mandible to the skull. The disorder and resultant dysfunction can result in significant pain and impairment. Because the disorder transcends the boundaries between several health-care disciplines â in particular, dentistry, neurology, physical therapy, and psychology â there are a variety of treatment approaches.
The document discusses the trigeminal nerve, including its anatomy and branches. It describes the maxillary nerve in detail, including its origin, course, branches both within the cranium and on the face. It discusses several clinical implications and conditions related to trigeminal nerve injury or involvement, such as trigeminal neuralgia, maxillary sinus infections, herpes zoster ophthalmicus, and tumors affecting the trigeminal nerve ganglia or branches.
This document discusses investigations for temporomandibular disorders (TMD). It defines TMD as clinical problems involving the jaw joint (TMJ) and muscles of mastication, characterized by facial pain and limited jaw movement. A thorough history and physical exam are important, including inspection of asymmetry and range of motion, and palpation of muscles and joints. Radiographic exams include panoramic x-rays to view teeth and bones, and MRI to view soft tissues like discs. Arthrography involves injecting dye into joints under fluoroscopy. Different imaging modalities provide views of bony and soft tissue structures to aid in diagnosing TMD issues like internal derangements, fractures, or cysts.
The document discusses the relationship between occlusion and temporomandibular disorders (TMDs). It notes that while occlusion is not the sole cause of TMDs, it can be a contributing factor through its effects on orthopedic stability. Orthopedic stability exists when the stable intercuspal position (ICP) of the teeth is aligned with the musculoskeletal stable position of the condyles. Misalignment between ICP and the condylar position can lead to orthopedic instability over time if heavy forces are placed on the system. The degree of orthopedic instability and the loading forces are factors that influence the risk of developing intracapsular TMD disorders.
This document provides information on the temporomandibular joint (TMJ), including its definition, structure, diagnosis, and treatment of TMJ disorders. Some key points:
- The TMJ is formed by the temporal bone and mandible, allowing hinging and sliding movements. It contains an articular disc that helps distribute forces.
- Common TMJ disorders include myofascial pain dysfunction syndrome, osteoarthritis, dislocations, and internal derangements (abnormal disc positioning).
- Diagnosis involves history, examination, and imaging like x-rays, CT, MRI. Treatment depends on the disorder but may include splint therapy, exercises, injections, or surgery.
Trigeminal Neuralgia
A neuropathic pain caused when trigger site stimulated by brushing, tilting head and shaving, stress and tiredness, cold and hot water, chewing and swallowing, touching and washing face, light breeze or wind on face etc.
The disease is mostly unilateral and can be treated by medications like Carbazepine, oxycarbamazepine, lamotrigine and phenytoin and gabapentin and surgeries like periferal injection, Glycerol injection in the gasserian Ganglion, periferal neurectomy, Cryotherapy, open or intracranial procedures Gammaknife radiosurgeries.
Fix your appointment at Dr. Sachdeva's Dental Institute, call us at:- +919818894041,01142464041
Follow our link:-
Google link:
https://business.google.com/dashboard/l/04970356233769420071
Facebook link for Dental Courses:
https://www.facebook.com/dentalcoursesdelhi/
Facebook link for Dental Treatments:
https://www.facebook.com/sachdevadental/
You tube Link:
https://www.youtube.com/user/drrajatsachdeva
Linkedin link:
https://www.linkedin.com/in/drrajatsachdeva/
Slideshare:
https://www.slideshare.net/drrajatsachdeva
Twitter Page :
https://twitter.com/drrajatsachdeva
Instagram page :
https://www.instagram.com/surgicalmasterrajat/
Practo Profile :
https://www.practo.com/delhi/doctor/dr-rajat-sachdeva-dentist
Blogger Profile :
http://drrajatsachdeva.blogspot.com/
Facial Aesthetics Facebook Page :
https://www.facebook.com/facialaesthetics.delhi
Facial Aesthetics you tube channel :
http://www.youtube.com/channel/UCheM4wF9nWGXJYOmScvsQNw
Local anesthetics work by blocking sodium channels in nerve cell membranes, preventing the propagation of action potentials and conduction of sensations. This document discusses the classification, composition, mechanisms of action, and examples of commonly used local anesthetic drugs and vasoconstrictors. It also covers the techniques for maxillary nerve blocks and factors that influence the onset and duration of local anesthesia.
This presentation contains the detailed description about the courses, branches and supply of the Trigeminal Nerve, contains variations of maxillary nerve & Mandibular Nerve, and the detail about trigeminal Neurolgia and its managements
The document discusses various types of orofacial pain including trigeminal neuralgia, post-herpetic neuralgia, atypical facial pain, and burning mouth syndrome. It covers the etiology, pathophysiology, clinical manifestations, diagnosis and management of each condition. Chronic pain is defined as pain persisting beyond tissue healing. Neuroplastic changes in the central nervous system are believed to underlie chronic pain. Treatment involves cognitive therapy, medications like anticonvulsants, antidepressants and opioids, as well as surgical options in some cases.
Migraines and tension headaches are the two most common types of primary headaches. Migraines are characterized by severe pulsating pain that is often unilateral, lasting from 2-72 hours and accompanied by symptoms like nausea, sensitivity to light and sound. Tension headaches cause non-pulsating mild to moderate bilateral pain that feels like tightness or pressure around the head. Cervicogenic headaches originate from issues in the neck muscles or structures and cause unilateral pain that increases with neck movement. Secondary headaches are caused by underlying medical conditions and can include headaches due to head trauma, vascular disorders, infections or psychiatric disorders.
Trigeminal neuralgia is a chronic pain condition that affects the trigeminal or 5th cranial nerve. It causes sudden, severe facial pain that feels like electric shocks. The pain is often triggered by everyday activities like eating or talking. It is commonly caused by compression of the trigeminal nerve by blood vessels near the brainstem. This can cause demyelination and hyperactivity of the nerve. Treatments include anticonvulsant medications and microvascular decompression surgery to relieve pressure on the nerve.
This document discusses classifications of pain. It defines pain according to several organizations and researchers. It notes the historical understanding of pain from Greek, Latin, and early philosophers' perspectives. It then describes types of pain based on speed of onset and duration, including experimental, transient, acute, and chronic pain. It also discusses types based on stimulation level, including somatic and visceral pain. The document outlines specific pains such as headaches, toothaches, and trigeminal neuralgia. It concludes by defining abnormal pains including hyperalgesia, allodynia, hyperpathia, and phantom limb pain.
DISEASES OF NERVES AND MUSCLES
Pain is defined as an âunpleasant sensory and emotional
experience that is associated with actual or potential
tissue damage, or described in such terms even in the
absence of any obvious damage.â
Nociceptive pain
on the one hand, is caused by actual tissue injury and inflammation, such as seen with pulpal involvement of a tooth secondary to dental caries, and is an important physiological protective mechanism
Neuropathic pain
on the other hand, is caused by dysfunction of the central and/or peripheral nervous system in the absence of active injury or inflammation, such as post-herpetic neuralgia, that results in neurosensory signs and symptom
CLSSIFICATION
Trigeminal neuralgia
Glossopharyngeal neuralgia
Sphenopalatine ganglion neuralgia
Raederâs paratrigeminal
Atypical pain/neuralgia
Postherpetic facial neuralgia
Migrainous neuralgia
Occipital neuralgia
Geniculate neuralgia
Superior laryngeal neuralgia
Tympanic plexus neuralgia
Trigeminal neuralgia âEtiology
Dental pathosisâdental pathosis is believed by some investigators to be involved with the onset of trigeminal neuralgia.
Excessive tractionâsecondary to excessive traction on the various divisions of the fifth nerve, being influenced by maxillo-mandibular relationship.
3 .âĸ Allergicâit can be secondary to an allergic and hypersensitivity reaction causing edema of the trigeminal nerve root.
4âĸ IschemiaâWolf thought that ischemia at various portions of the trigeminal pathway might be responsible for the paroxysms of pain.
5. Compression distortion phenomenonâJannetta and others have shown subtle changes of a compression- distortion phenomenon which is usually caused by arterial loops of atherosclerotic vessels. Vessels become elongated with advancing age and withatherosclerotic involvement gain abnormal positions by wedging into the spacebetween the pons and trigeminal nerve. It is postulated that with progressive material elongation, fascicles of adjacent nerves later suffer myelin injury and pain results.
6âĸ Mechanical factorsâlike pressure due to aneurysms of the intrapetrous portion of the internal carotid artery that may erode through the floor of the intracranial fossa to exert a pulsatile irritation on the ventral side of the trigeminal ganglion.
7âĸ Anomalies of superior cerebellar arteryâit is the most recently blamed cause for trigeminal neuralgia. It lies in contact with the sensory root of the nerve and implicated as a cause of demyelination. Surgical elevation of artery or decompression of the sensory root has high success rate in relieving paroxysmal pain in case of idiopathic trigeminal neuralgia.
8âĸ Secondary lesionâconditions such as carcinoma of the maxillary antrum, nasopharyngeal carcinoma, tumors of peripheral nerve root, intracranial vascular anomalies,and multiple sclerosis may be presented with trigeminal pain.
2.Glossopharyngeal neuralgia
The most common causes of glossopharyngeal neuralgia are
intracranial or extracranial
This document discusses different types of otalgia (ear pain), including the neuroanatomy involved and various causes of ear pain. It describes peripheral and neuropathic pain in the ear and discusses three specific types of neuralgia - glossopharyngeal neuralgia, geniculate neuralgia, and stylohyoid syndrome. For glossopharyngeal neuralgia, it outlines the symptoms and potential causes, including compression of the 9th and 10th cranial nerves, and discusses management with anticonvulsant drugs, surgery, or microvascular decompression.
Injuries and diseases that affect the nervous system (lesson 9)Jenil Urianza-Moises
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This document identifies and describes common injuries and diseases that can affect the nervous system. It discusses concussions, contusions, encephalitis, meningitis, rabies, epilepsy, amnesia, poliomyelitis, cerebral palsy, and Parkinson's disease. The objective is to help the reader understand these ailments and their symptoms. The document provides examples and evaluations to test understanding of these nervous system conditions.
Symptomatology and pathophysiology of trigeminal neuralgia copypriyanka susruth
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Trigeminal neuralgia is characterized by brief, severe, stabbing pains in the face that are often triggered by trivial stimuli. It is mostly caused by blood vessel compression of the trigeminal nerve root. Diagnosis involves unilateral facial pain in the trigeminal nerve distribution that is provoked by triggers. Treatment options include carbamazepine medication or microsurgical decompression/ablative surgeries if drugs fail.
This document discusses different types of headaches, their causes, and features. It describes two main types of headaches - intracranial and extracranial. Intracranial headaches originate from structures inside the skull and can be caused by meningitis, low cerebrospinal fluid pressure, migraines, or alcohol consumption. Extracranial headaches come from sources outside the skull like muscle spasms, nasal/sinus infections, or eye disorders. Migraines are thought to involve vasospasm and ischemia while meningitis causes the most severe pain over the entire head.
these slides are important for medical people mbbs students bds students paramedical staff and nurses as well can get knowledge regarding the topic headache
The document discusses orofacial pain and provides details on evaluating and diagnosing different types of facial pain. It describes:
1) How to clinically evaluate pain based on its onset, localization, characteristics, course, and factors that alter it. Inability to localize pain or radiation may indicate a neurogenic component.
2) The main types of chronic orofacial pain which are musculoskeletal, neuropathic and neurovascular. Neuropathic pain includes trigeminal neuralgia and glossopharyngeal neuralgia.
3) Trigeminal neuralgia is characterized by severe, brief, stabbing pains on one side of the face and can be caused by neurovascular compression. Glossopharyngeal neural
This document classifies and describes the pathophysiology of various headache types. It discusses primary headaches like migraines, cluster, and tension headaches that originate in the head. It also covers secondary headaches that are referred pain from other areas, such as sinus headaches from sinus inflammation, spinal headaches from low cerebrospinal fluid pressure, and hormonal headaches related to changes in estrogen levels. For each type, it provides the theories of their pathophysiological causes and lists common symptoms to help with diagnosis. In total, it examines eight different headache classifications and their underlying biological mechanisms.
Referred pain, also known as reflective pain, is pain perceived in a location other than where the painful stimulus originates. There are several proposed mechanisms to explain referred pain, with the convergence-projection theory being the most widely accepted. This theory suggests that afferent nerve fibers from different structures converge on the same spinal cord neurons, resulting in pain being perceived elsewhere. Other mechanisms like central sensitization may also play a role in referred pain. Certain organs have characteristic referred pain patterns, such as cardiac pain often radiating to the left arm, helping clinicians diagnose conditions.
The first cranial nerve, or CNI, is the olfactory nerve which carries sensory information for the sense of smell from the olfactory mucosa to the brain. It originates in the nasal cavity and can regenerate if damaged. Lesions to the olfactory nerve can impair smell but do not affect pain sensation from the nasal epithelium, which is carried by the trigeminal nerve instead.
This document provides an introduction to headaches, including their prevalence, origins, symptoms, pathophysiology, classification, and types. Some key points:
- Headaches are the most common neurological disorder and reason patients seek medical attention.
- Tension-type headaches are the most prevalent primary headache, affecting 69% of the population. Migraines affect 16%.
- Headaches can originate from extracranial structures like sinuses, eyes, teeth, and ears, or intracranial structures like arteries and dural veins.
- Pathophysiology involves stimulation of nociceptors and transmission of pain signals through small myelinated fibers to the thalamus.
- Classification systems
This document summarizes the pain pathway in the human body. It begins with an introduction to pain and its characteristics. It then discusses the different types of pain sensations conducted by different nerve fibers. It explains Gate Control Theory and the differences between somatic and visceral sensory function. It provides details on pain receptors, the pathway of sensory impulses from receptors to the brain, and examples of tooth pulp pain and referred pain. It concludes with management strategies for pain.
Trigeminal neuralgia is a disorder characterized by severe, sporadic facial pain caused by malfunction of the trigeminal nerve. The pain is often triggered by simple activities like eating, talking, or brushing teeth. It commonly affects middle-aged or elderly patients and is more frequent in women. While the exact cause is often unknown, trigeminal neuralgia is frequently caused by compression of the trigeminal nerve by blood vessels at the root of the brain. Carbamazepine is usually the first-line treatment, while microvascular decompression surgery may also be considered.
Headaches can originate from either intracranial or extracranial structures. Intracranial headaches are caused by disturbances to pain-sensitive structures within the cranial vault like the meninges or blood vessels, and present with pain referred to specific areas of the head. Extracranial headaches arise from muscle tension, nasal/sinus irritation, or eye disorders, causing pain that is also referred to the head surface. The document outlines various headache types and their origins, as well as warning signs that could indicate an underlying secondary cause for the pain.
Third cranial nerve palsies can cause weakness of the muscles innervated by the third cranial nerve, resulting in ptosis, mydriasis and an outwardly turned eye. Common causes include aneurysm, trauma, and intracranial mass lesions. Investigation involves a thorough neurological exam, CT or MRI scan, and cerebral angiography if aneurysm is suspected. Fourth cranial nerve palsies cause double vision when the eye turns inward, and are often idiopathic or caused by head trauma. Sixth cranial nerve palsies cause the eye to turn inward sluggishly, with common causes being diabetes, tumors, infections, and increased intracranial pressure. Trigeminal neuralgia causes
Similar to Facial pain 2021 elshall converted (20)
Congestive Heart failure is caused by low cardiac output and high sympathetic discharge. Diuretics reduce preload, ACE inhibitors lower afterload, beta blockers reduce sympathetic activity, and digitalis has inotropic effects. Newer medications target vasodilation and myosin activation to improve heart efficiency while lowering energy requirements. Combination therapy, following an assessment of cardiac function and volume status, is the most effective strategy to heart failure care.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us:Â https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
PGx Analysis in VarSeq: A Userâs PerspectiveGolden Helix
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Since our release of the PGx capabilities in VarSeq, weâve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your labâs goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
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Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
 A statistics is a measure which is used to estimate the population parameter
 Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
BBB and BCF
control the entry of compounds into the brain and
regulate brain homeostasis.
restricts access to brain cells of bloodâborne compounds and
facilitates nutrients essential for normal metabolism to reach brain cells
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
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In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
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Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsMuskanShingari
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Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
Acne treatment can take time, and consistency in skincare routines and treatments is crucial. Consulting a dermatologist can help tailor a treatment plan that suits individual needs and reduces the risk of scarring or long-term skin damage.
âEnvironmental sanitation means the art and science of applying sanitary, biological and physical science principles and knowledge to improve and control the environment therein for the protection of the health and welfare of the publicâ.The overall importance of sanitation are to provide a healthy living environment for everyone, to protect the natural resources (such as surface water, groundwater, soil ), and to provide safety, security and dignity for people when they defecate or urinate .Sanitation refers to public health conditions such as drinking clean water, sewage treatment, etc. All the effective tools and actions that help in keeping the environment clean come under sanitation. Sanitation refers to public health conditions such as drinking clean water, sewage treatment. All the effective tools and actions that help in keeping the environment clean and promotes public health is the necessary in todays life.
2. Pain
5/18/2021 9:03 PM Oelshall
âAn unpleasant sensory
and emotional experience
associated with actual or
potential tissue damage,
or described in terms of
such damage.â
3. Orofacial pain (OFP) is the presenting
symptom of a broad spectrum of diseases
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Disease of the
oro-facial
structures
Generalized
musculoskeletal or
rheumatic disease
Peripheral or
CNS disease
Psychological
abnormality
As a symptom, it may be due to
The pain may be referred
from other sources
(eg. cervical muscles or
intracranial pathology).
or
OFP may also occur in the absence
of detectable physical, imaging, or
laboratory abnormalities
4. Cranial nerves responsible for orofacial pain
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ī¨ Trigeminal nerve,(CN V) is the dominant
nerve that relays sensory impulses from the
orofacial area to the central nervous system.
ī¨ Facial (CN VII),
ī¨ Glossopharyngeal (CN IX),
ī¨ Vagus (CN X) nerves
5. Trigeminal nerve
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ī¨ Skin of face,
ī¨ Forehead and scalp
ī¨ The top of the head
ī¨ Conjunctiva and bulb of the eye
ī¨ Oral and nasal mucosa
ī¨ External aspect of the tympanic membrane
ī¨ Teeth
ī¨ Anterior two-thirds of tongue
ī¨ Masticatory muscles
ī¨ TMJ
ī¨ Meninges of anterior and middle cranial fossae
6. The most common facial pain disorder resulted
from involvement of trigeminal nerve is
Trigeminal neuralgia
5/18/2021
7. 5/18/2021 9:03 PM Oelshall
âĒ One disease affecting the
trigeminal nerve is trigeminal
neuralgia.
âĒ A person experiencing
trigeminal neuralgia may suffer
an episode of facial pain that can
last as long as two minutes.
âĒ The cause of this disease is
not currently known, but it may
have to do with blood vessels
putting pressure on the trigeminal
nerve as it leaves the brain
stem.
trigeminal neuralgia
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âĸBellâs palsy is a weakness or
paralysis of the muscles on one
side of the face.
âĸThe facial nerve is often
damaged by inflammation and
causes one side of the face to
droop.
âĸOther symptoms of Bellâs palsy
may be pain in or behind the
ear, drooping, excessive tearing
or dry eyes, numbness on one
side of the face, or increased
sensitivity to sound.
Bellâs Palsy
11. Glossopharyngeal (CN IX)
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ī¨ Mucosa of the pharynx;
ī¨ Palatine tonsils;
ī¨ Posterior one-third of the
tongue;
ī¨ Internal surface of the
tympanic membrane;
ī¨ Skin of the external ear
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Oelshall
Glossopharyngeal Neuralgia
Glossopharyngeal
neuralgia is a condition
believed to be caused by
irritation of the 9th
cranial nerve.
In which there are
repeated episodes of
severe pain in the
tongue, throat, ear, and
tonsils, which can last
from a few seconds to a
few minutes.
14. vagus (CN X)
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ī¨ Skin at the back of
the ear;
ī¨ Posterior wall and īŦoor
of external auditory
meatus.
ī¨ Tympanic membrane.
ī¨ Meninges of posterior
cranial fossa.
ī¨ Pharynx.
ī¨ Larynx.
15. 5/18/2021
ī¨ The vagus nerve is one of the largest nerve
systems in the body.
ī¨ The name vagus is Latin for "wandering,"
which describes the long and complicated
path this nerve takes through the body and
all of the different systems it comes in
contact with.
ī¨ In some cases this nerve is linked to medical
conditions such as low blood pressure, and in
other cases doctors will stimulate this nerve
to help treat disorders such as epilepsy.
16. Classification of the pain
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I- According to location
II- According to origin
17. I- According to location
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1- Neuritis
Inflammation of nerve ending induced by chemical,
microbial or toxic agents âĻ..Burning sensation
II- Neuralgia
Paroxysmal pain along the course of the nerve
III-Psychogenic
No anatomical distribution, no clinical cause, not
interfere with eating or sleeping
18. II- According to origin
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1. Somatic pain
2. Neurogenous pain
3. Psychogenic pain
4. Referred pain
5. Vascular pain & headache.
20. Somatic pain
It resulting from stimulation of normal neural
structures that innervates body tissue
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Origin: Skin & MM
Nature: Burning or pricking in nature
Character: Localized
Pts can identify its site
For Example:
Thermal pain: Pizza, hot instrument
Chemical pin: aspirin burn
Mechanical: traumatic ulcer
Superfacial ulceration due to systemic
disease eg; leukemia
Superficial
Deep
21. Deep pain
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joint
Muscle
Bone
Collection of
infected fluid in
bone as in
abscess
OVER
stretching or
Contraction
Rupture
of some fibers
TMJ
22. Character of deep somatic pain
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1- Bone pain will be throbbing in nature
2- May be referred involve area supplied with
the same sensory nerve
3- Muscle and joint pain: dull aching in nature.
4- Patient can hardly identify the source of the
pain.
23. II- According to origin
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1. Somatic pain
2. Neurogenous pain
3. Psychogenic pain
4. Referred pain
5. Vascular pain & headache.
31. Referred pain
ī¨ Is pain that perceived at a location other than the site
of the painful stimulus.
ī¨ An example is the case of angina pectoris brought on
by a myocardial infarction, where pain is often felt in
the neck, shoulders, and back rather than in the
thorax (chest), the site of the injury
ī¨ Referred pain is not felt at the site of disease but felt
at distance site
ī¨ Radiating pain is the extension of pain from original site
to another site with persistance of pain at original site
5/18/2021
32. II- According to origin
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1. Somatic pain
2. Neurogenous pain
3. Psychogenic pain
4. Referred pain
5. Vascular pain & headache.
35. Tension headache
ī¨ A tension headache is the most common type
of headache.
ī¨ It can cause mild, moderate, or intense pain
behind your eyes and in your head and neck.
ī¨ Some people say that a tension headache feels
like a tight band around their forehead.
ī¨ Most people who experience tension
headaches have episodic headaches
5/18/2021
36. Migraine
ī¨ Migraine is a neurological condition that can
cause multiple symptoms.
ī¨ It's frequently characterized by intense,
debilitating headaches.
ī¨ Symptoms may include nausea, vomiting,
difficulty speaking, numbness or tingling,
and sensitivity to light and sound.
ī¨ Migraines often run in families and affect
all ages
5/18/2021
37. Cluster headache
ī¨ Cluster headache (CH) is a neurological
disorder characterized by recurrent
severe headaches on one side of the head,
typically around the eye.
ī¨ There is often accompanying eye watering,
nasal congestion, or swelling around the eye
on the affected side.
ī¨ These symptoms typically last 15 minutes to
3 hours
5/18/2021
39. Cranial arteritis.
ī¨ Or Temporal arteritis is a form of vasculitis
(inflammation of the blood vessels) in
temporal arteries.
ī¨ Also known as giant cell arteritis or Horton's
arteritis
ī¨ Frequently it causes headaches, scalp
tenderness, jaw pain and vision problems.
Untreated, it can lead to blindness.
5/18/2021
42. Facial Neuralgias
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The classic neuralgias that affect the craniofacial
region are a unique group of neurologic disorders
involving the cranial nerves and are characterized by
II.Neurogenous pain
Brief episodes of
shooting, often
electric shockâ
like pain along
the course of
the affected
nerve branch.
pain-free periods
between attacks
and refractory
periods
immediately
after an attack,
during which a
new episode
cannot be
triggered
trigger zones on
the skin or
mucosa that
precipitate
painful attacks
when touched.
43. 5/18/2021 9:03 PM Oelshall
These clinical characteristics differ from
neuropathic pain, which tends to be
- constant
- has a burning quality
- without the presence of trigger zones.
II.Neurogenous pain
44. Facial Neuralgias resulting in Neurogenous pain
1-Trigeminal neuralgia
2-Glossopharyngeal n. Paroxysmal
4- Post herpetic neuralgia
5- Post traumatic pain
6- Atypical odontalgia Non paroxysmal
7- Bellâs palsy
8- Freyâs auriculo-temporal syndrome
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45. TRIGEMINAL NEURALGIA
tic douloureux
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II.Neurogenous pain
People with this pain often twitch, which is where trigeminal
neuralgia gets its French nickname 'tic douloureuxâ,
meaning "painful twitchâ.
46. TRIGEMINAL NEURALGIA
tic douloureux
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It is a sharp sever paroxysmal pain along the course of
trigeminal nerve with un-definitive etiology
It is the most common of the cranial neuralgias
âĸ Chiefly affects individuals older than 50 years of age.
When younger individuals are involved, suspicion of a
detectable underlying lesion such as a tumor, an
aneurysm, or multiple sclerosis must be increased.
II.Neurogenous pain
47. Etiology and Pathogenesis.
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The cause of the majority of cases of TN remains
controversial, but approximately 10% of cases have
detectable underlying pathology such as:
1- Tumor of the cerebellar pontine angle,
2- Multiple sclerosis, MS
3- A vascular malformation.
The remainder of cases of TN (90%) are classiīŦed as
idiopathic.
Several theories exist regarding the etiology of TN.
II.Neurogenous pain
49. 5/18/2021 9:03 PM Oelshall
ī¨ The most widely accepted theory
is that a majority of cases of
TN are caused by an
atherosclerotic blood vessel
(usually the superior cerebellar
artery) pressing on and grooving
the root of the trigeminal nerve.
ī¨ This pressure results in focal
demyelinization and
hyperexcitability of nerve īŦbers,
which will then fire in response
to light touch, resulting in brief
episodes of intense pain.
II.Neurogenous pain
51. 5/18/2021 9:03 PM Oelshall
ī¨ Evidence for this theory includes the
observation that neurosurgery that removes
the pressure of the vessel from the nerve root
by use of a microvascular decompression
procedure eliminates the pain in a majority of
cases.
II.Neurogenous pain
52. 5/18/2021 9:03 PM Oelshall
ī¨ Additional evidence for this theory was obtained
from a study using tomographic magnetic
resonance imaging (MRI), which showed that
contact between a blood vessel and the
trigeminal nerve root was much greater on the
affected side.
54. Clinical Features
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The majority of patients with TN present with
characteristic clinical features, which include episodes
of intense shooting stabbing pain that lasts for a few
seconds and then completely disappears.
The pain has an electric shockâlike quality and is
unilateral except in a small percentage of cases.
The maxillary branch is the branch that is most
commonly affected, followed by the mandibular branch
and (rarely) the ophthalmic branch. Involvement of
more than one branch occurs in some cases.
II.Neurogenous pain
55. 5/18/2021 9:03 PM Oelshall
ī¨ Pain in TN is precipitated by light touch on a
âtrigger zoneâ present on the skin or mucosa within
the distribution of the involved nerve branch.
ī¨ Common sites for trigger zones include the nasolabial
fold and the corner of the lip.
II.Neurogenous pain
56. TRIGGER FACTORS
Touching Washing of
face Shaving
Teeth
cleaning Cold breeze Eating
Talking
Application
of lotions and
cosmetics
patients often protect the trigger zone with their hand or
an article of clothing.
57. 5/18/2021 9:03 PM Oelshall
ī¨ Intraoral trigger zones can confuse the
diagnosis by suggesting a dental disorder,
and TN patients often īŦrst consult a dentist
for evaluation.
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ī¨ Just after an attack,
there is a refractory
period when touching
the trigger zone will
not precipitate pain.
ī¨ The number of attacks
may vary from one or
two per day to several
per minute.
60. 5/18/2021 9:03 PM Oelshall
ī¨ Half an inch finger sign: The patient points
to the trigger area with his finger away by
half an inch to avoid touching it.
II.Neurogenous pain
61. 5/18/2021 9:03 PM Oelshall
Diagnosis.
ī¨ The diagnosis is based on the history of
shooting pain along a branch of the trigeminal
nerve, precipitated by touching a trigger
zone, and possibly examination that
demonstrates the shooting pain.
ī¨ A routine cranial nerve examination will be
normal in patients with idiopathic TN, but
sensory and/or motor changes may be evident
in patients with underlying tumors or other
CNS pathology.
II.Neurogenous pain
62. 5/18/2021 9:03 PM Oelshall
ī¨ Local anesthetic blocks, which temporarily
eliminate the trigger zone, may also be
helpful in diagnosis.
ī¨ Since approximately 10% of TN cases are
caused by detectable underlying pathology,
enhanced MRI of the brain is indicated to
rule out tumors, multiple sclerosis, and
vascular malformations.
66. Mechanism of action of anticonvulsants,
antiepileptic or antiseizure drugs)
ī¨ Anticonvulsants suppress the excessive
rapid firing of neurons during seizures.
ī¨ Anticonvulsants also prevent the spread
of the seizure within the brain.
ī¨ Conventional antiepileptic drugs may block
sodium channels or enhance Îŗ-
aminobutyric acid (GABA) function.
5/18/2021
67. ī¨ Several antiepileptic drugs have multiple or
uncertain mechanisms of action.
ī¨ Next to the voltage-gated sodium channels
and components of the GABA system, their
targets include GABAA receptors, the GAT-1
GABA transporter, and GABA transaminase.
ī¨ Additional targets include voltage-
gated calcium channels, SV2A, and ι2δ.
ī¨ By blocking sodium or calcium channels,
antiepileptic drugs reduce the release of
excitatory glutamate, whose release is
considered to be elevated in epilepsy, but also
that of GABA. 5/18/2021
68. ī¨ This is probably a side effect or even the
actual mechanism of action for some
antiepileptic drugs, since GABA can itself,
directly or indirectly, act proconvulsively.
ī¨ Another potential target of antiepileptic
drugs is the peroxisome proliferator-
activated receptor alpha.
5/18/2021
69. 5/18/2021 9:03 PM Oelshall
Since TN may have temporary or
permanent spontaneous remissions, drug
therapy should be slowly withdrawn if a
patient remains pain free for 3 months.
70. 5/18/2021 9:03 PM Oelshall
ī¨ Clinicians treating TN must be aware that
drug therapy often becomes less effective
over time and that progressively higher
doses may be required for pain control.
ī¨ In cases in which drug therapy is
ineffective or in which the patient is unable
to tolerate the side effects of drugs after
trials of several agents, surgical therapy is
indicated.
II.Neurogenous pain
2. Surgical
71. SURGICAL
1. Injection of phenol or alcohol into
a trigeminal ganglion
2. Radiofrequency coagulation of a
branch
3. Sectioning of sensory root of
trigeminal ganglion inside the
cranium
4. Microvascular decompression
72. PREVENTION
While the condition itself can't be prevented, there are
a number of things patients can do to
avoid triggering attacks:
ī¨ Wash with cotton pads and warm water over the
face
ī¨ Rinse the mouth with water after eating, if tooth-
brushing triggers pain
ī¨ Eat and drink food and beverages at room temperature
ī¨ Chew on the unaffected side
ī¨ Eat soft foods, if eating is becoming a problem
74. POSTHERPETIC NEURALGIA
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ī¨ Etiology and Pathogenesis.
Herpes zoster, is caused by the reactivation of latent
varicella-zoster virus that results in both pain and
vesicular lesions along the course of the affected
nerve.
Approximately 15 to 20% of cases of herpes zoster
involve the trigeminal nerve although the majority of
these cases affect the ophthalmic division of the īŦfth
nerve, resulting in pain and lesions in the region of the
eyes and forehead.
II.Neurogenous pain
75. 5/18/2021 9:03 PM Oelshall
Herpes zoster of the maxillary and mandibular
divisions is a cause of facial and oral pain as
well as of lesions.
In a majority of cases, the pain of herpes
zoster resolves within a month after the lesions
heal.
Pain that persists longer than a month is
classiīŦed as postherpetic neuralgia (PHN)
although some authors do not make the
diagnosis of PHN until the pain has persisted
for longer than 3 or even 6 months.
II.Neurogenous pain
76. 5/18/2021 9:03 PM Oelshall
ī¨ PHN may occur at
any age, but the
major risk factor
is increasing age.
ī¨ Elderly patients
also have an
increased risk of
experiencing severe
pain for an
extended period of
time.
II.Neurogenous pain
77. 5/18/2021 9:03 PM Oelshall
Clinical Manifestations.
Patients with PHN experience persistent pain,
paresthesia, hyperesthesia, and allodynia
months to years after the zoster lesions have
healed.
The pain is often accompanied by a sensory
deīŦcit, and there is a correlation between
the degree of sensory deīŦcit and the severity
of pain.
II.Neurogenous pain
78. 5/18/2021 9:03 PM Oelshall
Management.
ī¨ Many treatment options are available for
the management of PHN, and the method
chosen should depend on the severity of
the symptoms as well as the general
medical status of the patient.
ī¨ Treatment includes topical and systemic,
drug therapy and surgery.
II.Neurogenous pain
79. 5/18/2021 9:03 PM Oelshall
ī¨ Topical therapy includes the use of topical
anesthetic agents, such as lidocaine, or analgesics,
particularly capsaicin.
ī¨ Lidocaine used either topically or injected gives
short-term relief from severe pain.
ī¨ Capsaicin, an extract of hot chili peppers that
depletes the neurotransmitter substance when used
topically, has been shown to be helpful in reducing
the pain of PHN, but the side effect of a burning
sensation at the site of application limits its
usefulness for many patients.
II.Neurogenous pain
80. 5/18/2021 9:03 PM Oelshall
ī¨ The use of tricyclic antidepressants is a well-
established method of reducing the chronic
burning pain that is characteristic of PHN.
ī¨ Because a signiīŦcant number of elderly
patients cannot tolerate the sedative or
cardiovascular side effects associated with
tricyclic antidepressants, the use of other
drugs, particularly gabapentin, has been
advocated.
II.Neurogenous pain
81. 5/18/2021 9:03 PM Oelshall
ī¨ When medical therapy has been ineffective
in managing intractable pain, nerve blocks or
surgery at the level of the peripheral nerve
or dorsal root have been effective for some
patients.
ī¨ The best therapy for PHN is prevention.
There is evidence that the use of antiviral
drugs, particularly famciclovir, along with a
short course of systemic corticosteroids
during the acute phase of the disease may
decrease the incidence and severity of PHN
II.Neurogenous pain
83. 5/18/2021 9:03 PM
Oelshall
Glossopharyngeal Neuralgia
Glossopharyngeal
neuralgia is a condition
believed to be caused by
irritation of the 9th
cranial nerve.
In which there are
repeated episodes of
severe pain in the
tongue, throat, ear, and
tonsils, which can last
from a few seconds to a
few minutes.
87. POST-TRAUMATIC NEUROPATHIC PAIN
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Etiology and Pathogenesis.
ī¨ Trigeminal nerve injuries may result from
facial trauma or
surgical procedures, such as the removal of impacted
third molars, the placement of dental implants, the
removal of cysts or tumors of the jaws, or osteotomies.
ī¨ In some individuals, nerve injury results only in
numbness whereas others experience pain that may be
either spontaneous or triggered by a stimulus.
ī¨ The pain associated with nerve injury often has a burning
quality.
II.Neurogenous pain
88. 5/18/2021 9:03 PM Oelshall
Total nerve section (neurotmesis)
Frequently causes permanent nerve damage, resulting in
anesthesia and/or dysesthesia.
Nerve injuries
Minor nerve injuries (neurapraxia)
Do not result in axonal degeneration but may cause
temporary symptoms of parasthesia for a few hours or days.
Serious nerve damage (axonotmesis)
Results in the degeneration of neural īŦbers although the
nerve trunk remains intact.
It cause symptoms for several months but have a good
prognosis for recovery after axonal regeneration is
complete.
90. Manifestation
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Patients with nerve damage may experience
persistent burning pain arising from trauma plus:
II.Neurogenous pain
Anesthesia=loss of sensation
Paraesthesia=feeling of pins and needles
Allodynia=Pain by non painful stimuli
Hyperalgesia=Exaggerated response to
mild painful stimuli
93. 5/18/2021 9:03 PM Oelshall
It is peripheral facial weakness of
unknown etiology affecting any age group
of either sex.
How did Bellâs palsy get its name?
Sir Charles Bell was a Scottish surgeon
who described the nerve supply to the
facial muscles over 200 years ago.
Bellâs palsy
II.Neurogenous pain
94. 5/18/2021 9:03 PM Oelshall
ī¨ Bellâs palsy is recognized as a unilateral
paralysis of the facial nerve.
ī¨ The dysfunction has been attributed to an
inīŦammatory reaction involving the facial
nerve.
ī¨ A relationship has been demonstrated between
Bellâs palsy and the isolation of herpes simplex
virus 1 from nerve tissues.
ī¨ Bellâs palsy must be differentiated from
other causes of facial nerve paralysis, such as
herpes zoster of the geniculate ganglion
(Ramsay Hunt syndrome).
95. Pathogenesis of Bellâs palsy
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Geneculate ganglion
Stylomastoid foramen
Facial nerve
Petrosal artery Stylomastoid artery
Fibrous C T
Middle meningeal External carotid
Inflammation of Facial
nerve inside the canal
demyelination & edema
loss blood supply
II.Neurogenous pain
96. 5/18/2021 9:03 PM Oelshall
ī¨ Its etiology is unknown and there is no local
or systemic causes can be identified.
ī¨ It may be immunologically mediated or
associated with infection especially viral
infection
II.Neurogenous pain
98. Clinically
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ī¨ Very rapid onset, patient may wake up with facial paralysis
ī¨ Bellâs palsy begins with slight pain around one ear and along the
mandibular angle, followed by an abrupt paralysis of the muscles on
that side of the face.
ī¨ The eye on the affected side stays open, the corner of the mouth
drops.
ī¨ As a result of masseter weakness, food is retained in both the upper
and lower buccal and labial folds.
ī¨ The facial expression changes remarkably.
ī¨ Due to impaired blinking, corneal ulcerations from foreign bodies can
occur.
ī¨ Involvement of the chorda tympani nerve leads to loss of taste
sensation on the anterior two-thirds of the tongue and reduced
salivary secretion.
100. 5/18/2021 9:03 PM Oelshall
ī¨ Eyelid drooping and difficulty closing one (or
both) upper eyelids are classic findings in Belleâs
palsy.
101. ī¨ Asymmetric or
incomplete
smiles, decrease
in forehead
wrinkling, nasal
stuffiness, and
mild difficulty
with speaking are
also common
signs.
5/18/2021
102. ī¨ Frequent early
symptoms include
abrupt onset of dry
eye and tingling
around the mouth,
with progression to
more complete
facial palsy
occurring within one
to several days.
5/18/2021
103. Treatment
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ī¨ Systemic corticosteroids within the first few days
after the onset of paralysis.
ī¨ Combining steroids with antiherpetic drugs such as
acyclovir may decrease the severity and length of
paralysis.
ī¨ It is also helpful to protect the eye with lubricating
drops or ointment and a patch if eye closure is not
possible.
ī¨ In chronic condition, surgical decompression of the
nerve in the stylomastoid canal is effective
Disease of Nervous system
105. Freyâs auriculo-temporal
syndrome
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Disease of Nervous system
In this condition there is
flushing and sweating of the skin
of the face innervated by the
auriculotemporal nerve whenever
salivation is stimulated
(gustatory sweating).
106. Freyâs auriculo-temporal syndrome
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Mandibular nerve
Auriculo-temporal
Disease of Nervous system
Paroted
glands
Sweat
glands
Periauricular &
temporal region
Sympathetic fibers
107. Etiology
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Surgery
Neoplasm
Inflammation
Damage of
auriculotemporal
nerve
In Parotid
Innervations of sweat
glands by the
parasympathetic
salivary fibers
108. Clinically
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ī¨ During eating:
Flushing, sweating and paroxysmal pain in
periauricular & temporal region
ī¨ Between attacks
Hyperesthesia or anesthesia of periauricular &
temporal region
109. 5/18/2021 9:03 PM Oelshall
ī¨ Diagnosis:
Nerve block of auriculotemporal will relieve
symptoms.
ī¨ Treatment:
Sectioning of auriculotemporal nerve
112. Burning Mouth Syndrome
(Glossodynia)
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ī¨ The patient suffering from burning sensation
of mucosa without definitive causes
ī¨ Pain dose not follow anatomical pathway
ī¨ No lab. Findings
ī¨ No neurological findings
Psychogenic pain
113. Etiology
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The cause of BMS is unknown, but a number
of factors have been suspected such as:
1- Hormonal imbalance (postmenopausal)
2- Allergic reaction
3- Dry mouth
4- Chronic rubbing of mucosa
5- Psychogenic
114. CLINICAL MANIFESTATIONS
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ī¨ Women experience symptoms of BMS seven
times more frequently than men.
ī¨ Mainly complain at tongue, lips and cheek
ī¨ Burning intermittent or constant pain
ī¨ Diffuse pain, patient can not identify the site
of the pain
ī¨ Pain is relieved by eating drinking or chewing
ī¨ Normal oral mucosa or mild atrophic
ī¨ Depression symptoms, lack of appetite,
insomnia,
115. Diagnosis
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1- Exclusion of possibility of any oral or
dental lesions
2-Careful clinical examination & lab
investigation to detect undiagnosed anemia
3- If it unilateral, exam the cranial nerves.
117. 5/18/2021 9:03 PM Oelshall
âĸMPD, or masticatory myalgia, is a
psychophysiologic disease that primarily
involves
the muscles of mastication and not the TMJ.
âĸWomen are affected more frequently than
men.
118. 5/18/2021
âĸMPD frequently is confused with painful conditions
affecting the TMJ, such as degenerative arthritis
or internal derangements,
âĸbecause patients with primary MPD can develop
these diseases secondarily, and patients with
primary joint disease can develop secondary MPD.
âĸBetter understanding of the causes and
pathogenesis of this condition now makes its
diagnosis easier, however, and its treatment more
effective.
119. Myo-fascial pain dysfunction syndrome
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ī¨ It is a chronic disorder characterized by
Clicking
Trismus
Pain
+ Absence of pathologic abnormality of TMJ
Psychogenic causes
120. 5/18/2021 9:03 PM Oelshall
ī¨ Stress seems to be an important factor in the
development of MPD.
ī¨ It is hypothesized that centrally induced
increases in muscle activity, frequently combined
with the presence of parafunctional habits such
as clenching or grinding of the teeth, result in
the associated muscle fatigue, pain, and
dysfunction.
ī¨ Similar symptoms also occasionally can result,
however, from muscle overextension, muscle
overcontraction, or trauma
122. Etiology
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Muscle over
Extension Or Contraction
intermaxillary space over closure of mouth
Muscle fatigue
Oral habits due to psychic factors
Grinding clenching bruxism
123. 5/18/2021 9:03 PM Oelshall
Altered chewing pattern
Chewing on one
side
Deviation of
bite to avoid
painful tooth
Malerupted
tooth
Muscle over
extension, over
contraction or
spasm
Sertonin,
histamin, kinin,
PG release
Inflammation
& pain
124. Clinically
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1-Unilateral pain
Pain over ear or periauricular area
Pain dull, sharp, pressure, burning as described by
the pts
Pain intensity: mild to sever
Pain may described as a vague pain affecting the
whole side of the face
Pain may radiate to forehead, occipital, temporal,
cervical region or the mandibular angel
Pain increased with tension, fatigue or chewing
125. 5/18/2021 9:03 PM Oelshall
2-Active trigger point
Area of muscle that is tender on palpation
It include temporalis, masseter, digastric,
ptrygoid, sternomastoid
3-Deviation
Deviation of the jaw towards the affected
side on opening
126. Late clinical manifestations
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ī¨ Limitation of the jaw function
The patient cannot open his mouth widely
except with gentle pressure on lower jaw
ī¨ Clicking
detected by palpation