ABSTRACT
Background@#Neurovascular compression (NVC) is a well-known cause of trigeminal neuralgia (TN). However, patients with idiopathic TN (ITN) do not have evidence of NVC on magnetic resonance imaging (MRI), and other patients may remain asymptomatic despite evidence of NVC on MRI. This suggests that there may be additional risk factors for TN development other than NVC. Although epidemiological factors, such as age and sex differences, are useful for understanding the pathophysiology of TN, detailed statistics for each TN subtype are currently unavailable. Therefore, this study aimed to classify patients with TN into the following groups based on data extracted from past medical records: classical TN (CTN), secondary TN, and ITN. @*Methods@#The characteristics of the groups and their differences were explored. @*Results@#CTN was more common in women than in men, as previously reported, whereas ITN was more common in men than in women. The ratio of pain sites located on the right side of the face was high in all groups. Patients with CTN were also prone to NVC on the asymptomatic side. @*Conclusion@#By investigating TN subtype, it may be possible to elucidate the pathophysiology of TN. This would greatly improve treatment outcomes.
ABSTRACT
Background@#Neurovascular compression (NVC) is a well-known cause of trigeminal neuralgia (TN). However, patients with idiopathic TN (ITN) do not have evidence of NVC on magnetic resonance imaging (MRI), and other patients may remain asymptomatic despite evidence of NVC on MRI. This suggests that there may be additional risk factors for TN development other than NVC. Although epidemiological factors, such as age and sex differences, are useful for understanding the pathophysiology of TN, detailed statistics for each TN subtype are currently unavailable. Therefore, this study aimed to classify patients with TN into the following groups based on data extracted from past medical records: classical TN (CTN), secondary TN, and ITN. @*Methods@#The characteristics of the groups and their differences were explored. @*Results@#CTN was more common in women than in men, as previously reported, whereas ITN was more common in men than in women. The ratio of pain sites located on the right side of the face was high in all groups. Patients with CTN were also prone to NVC on the asymptomatic side. @*Conclusion@#By investigating TN subtype, it may be possible to elucidate the pathophysiology of TN. This would greatly improve treatment outcomes.
ABSTRACT
Most dental pain is caused by an organic problem such as dental caries, periodontitis, pulpitis, or trauma. Diagnosis and treatment of these symptoms are relatively straightforward. However, patients often also complain of abnormal dental pain that has a non-dental origin, whose diagnosis is challenging. Such abnormal dental pain can be categorized on the basis of its cause as referred pain, neuromodulatory pain, and neuropathic pain. When it is difficult to diagnose a patient's dental pain, these potential alternate causes should be considered. In this clinical review, we have presented a case of referred pain from the digastric muscle (Patient 1), of pulpectomized (Patient 2), and of pulpectomized pain (Patient 3) to illustrate referred, neuromodulatory, and neuropathic pain, respectively. The Patient 1 was advised muscle stretching and gentle massage of the trigger points, as well as pain relief using a nonsteroidal anti-inflammatory and the tricyclic antidepressant amitriptyline. The pain in Patient 2 was relieved completely by the tricyclic antidepressant amitriptyline. In Patient 3, the pain was controlled using either a continuous drip infusion of adenosine triphosphate or intravenous Mg2+ and lidocaine administered every 2 weeks. In each case of abnormal dental pain, the patient's diagnostic chart was used (Fig.2 and 3). Pain was satisfactorily relieved in all cases.