Anatomically and physiologically based guidelines for use of the sphenopalatine ganglion block versus the stellate ganglion block to reduce atypical facial pain.

This literature review is designed to develop guidelines needed for the use of a sphenopalatine ganglion block versus a stellate ganglion block to reduce atypical facial pain. We have reviewed the basic anatomy of both ganglia and the physiological responses usually associated with each, and have given an opinion on appropriate use of these therapeutic modalities.

Parameters of odontostomatognathic disability: guidelines for evaluation of impaired simple and complex human functions involving the odontostomatognathic functional system.

This paper explores the current status and the future of efforts to establish parameters of disability for the odontostomatognathic functional system ("the teeth, mouth, jaws and related structures as they subserve the functions of mastication, deglutition, digestion, speech, facial expression, respiration, sexual activity, appearance and posture"). Illness, disorders, disease or injuries involving this functional system include a broad spectrum of problems that affect the dental and paradental structures. The dentist is the primary healthcare provider (HP) in the diagnosis, treatment and impairment/disability/handicap status (IDH) decisions. The authors point out that the first stage of establishing parameters of odontostomatognathic disability was accomplished with recognition in the AMA Guides to Evaluation of Permanent Impairment of the temporomandibular joint and the masticatory musculature. The second stage will be the AMA Guides publishing of an objective rating system for functional impairment of the temporomandibular joint and the masticatory musculature. Prior to the third stage of actually establishing parameters of odontostomatognathic disability, the authors suggest that multiple objectives must be accomplished, including: 1. a change in current healthcare terminology; 2. an agreement on the organization of human physiological systems; 3. medical community acceptance of the integrated structures and functions of the odontostomatognathic functional system; and 4. an appreciation of both Level I (joint and muscle dysfunction) and Level II (complex odontostomatognathic dysfunction including problems with mastication, deglutition, digestion, speech, facial expression, respiration, sexual activity, appearance and posture). The authors conclude that once these objectives are met, parameters of odontostomatognathic disability can be established.

Litigation and chronic facial pain.

Clinical studies have suggested that the presence of litigation in chronic pain syndromes may complicate diagnostic and treatment strategies. In addition, psychosocial factors may be prevalent in such cases. The present study explored the possible correlation in the facial pain population between patients in litigation and psychological disturbance as measured by the Minnesota Multiphasic Personality Inventory. Beck Depression Inventory and Wahler Symptom Checklist scores also were compared. One hundred eleven patients diagnosed with chronic facial pain were asked if they currently were involved in litigation related to their medical complaints. The result revealed that 18% of the 111 patients were in litigation at the time of their initial visit. The Minnesota Multiphasic Personality Inventory profiles showed that 45% of the litigation patients had four or more clinical scales above 70 (significantly elevated) on the Minnesota Multiphasic Personality Inventory. In contrast, only 18% of the patients who were not in litigation had four or more scales above the 70 criteria. Beck and Wahler scores also were more elevated for the litigation group. The results of the study indicate that chronic facial pain patients in litigation may present with more psychological disturbance as compared to those patients not in litigation.

Lateralization of chronic facial pain: fact or fiction.

Previous studies have shown that pain is generally reported more on the left side of the body. It has been hypothesized that patient report of left pain dominance may be due to the right hemisphere being less efficient in processing cutaneous sensory input while being dominant for emotional experience as compared with the left hemisphere of the brain. Only in cases of trigeminal neuralgia has self-report of pain been lateralized to the right side. Due to previous research findings, we postulated that other facial pain diagnoses may demonstrate a right-sided dominance due to the lack of neural crossover in the facial region. The results of the study found no significant difference between self-report of right- and left-sided facial pain within four diagnostic categories. It was concluded that the results of right lateralized pain with trigeminal neuralgia should not be generalized to the facial pain population as a whole.