Neuralgias trigeminales post-traumáticas en la cavidad oral / Post traumatic trigeminal neuralgia in the oral cavity

Las neuralgias trigeminales post-traumáticas (NTPT) son una de las causas más frecuentes de dolor neuropático en la cavidad oral. En la inmensa mayoría de los casos estas neuropatías son consecuencia de lesiones iatrogénicas o accidentales de terminaciones nerviosas periféricas tras la realización de procedimientos quirúrgicos en la cavidad oral, siendo la lesión del nervio dentario inferior y la del nervio lingual tras la extracción de terceros molares las más frecuentes. Así mismo durante los últimos años la incidencia de este tipo de lesiones ha experimentado un aumento considerable como consecuencia del auge de “nuevos” procedimientos quirúrgicos como la implantología o la cirugía ortognática. Es importante mencionar que muchos pacientes pueden desarrollar tras este tipo de lesiones nerviosas un cuadro de dolor continuo asociado a alteraciones sensoriales importantes que puede alterar de forma muy considerable y de por vida su la calidad de vida. Todo ello hace indispensable que hoy en que todos los profesionales de la salud bucal posean un correcto conocimiento de esta entidad clínica. Por ello este artículo pretende mostrar al lector los aspectos más relevantes y actuales de la fisiopatología, diagnóstico, y tratamiento de las NTPT (AU)

Post-traumatic trigeminal neuralgias (PTTN) are one of the most frequent causes of neuropathic pain in the oral cavity. In the majority of cases these neuropathies are a consequence of iatrogenic or accidental lesions to peripheral nerve terminals after surgical procedures in the oral cavity, being the inferior alveolar nerve and the lingual nerve the most frequently affected after third molar extractions. Additionally the incidence of this type of lesions during the last years has experienced a considerable increase due to “new” surgical procedures such as implantology and orthognathic surgery. It is important to mention that once these nerve lesions occur many patients may develop symptoms such as continuous pain associated to sensory alterations that can alter considerably and forever their quality of life. For all these reasons it is indispensable that all oral health professionals can correctly identify this clinical entity. Thus this article pretends to show the most relevant physiological, diagnostic, and therapeutic aspects of PTTN (AU)

Psychological and sleep quality differences between chronic daily headache and temporomandibular disorders patients.

The aim of this study was to investigate whether chronic daily headache (CDH) and temporomandibular disorders (TMD) patients present with different psychological and sleep quality characteristics. Sixty-seven patients diagnosed with CDH, according to classification criteria from Silberstein et al., were matched by age and sex with 67 patients who had a primary diagnosis of myofascial pain (MP) and 67 patients with a primary diagnosis of TMJ intracapsular pain (IC) according to the Research Diagnostic Criteria for TMD. The CDH group was comprised of three mutually exclusive diagnostic groups: chronic migraine (n = 35); chronic tension-type headache (n = 26); 'other CDH' (n = 6). All patients completed a battery of psychological and sleep quality questionnaires. All CDH subgroups showed similar psychological and sleep quality profiles. Pain intensity and duration were controlled in the multivariate analyses (Mancova) by treating them as covariates. The CDH and MP groups revealed higher levels of psychological distress than the IC group on most psychological domains. The MP group also revealed numerically higher levels of psychological distress in most psychological domains than the CDH group, although these differences were generally not significant. We did not find significant differences between the three groups on post traumatic stress symptoms either. Sleep quality was significantly worse in the MP group than in the CDH and IC groups. These results are discussed in the context of multimodal patient evaluation and treatments that are often necessary for successful clinical management.

Long-term results of functional open surgery for the treatment of internal derangement of the temporomandibular joint.

We studied 20 consecutive patients with internal derangements of the temporomandibular joint (TMJ), a median of 51 months after open operation on the joint and a rehabilitation programme. The design was a retrospective clinical study. The maximal opening and lateral active movements and the presence of clicking and joint pain were recorded preoperatively, after complete rehabilitation, and at the time of follow-up. Patients completed visual analogue scales of pain before operation and at the time of follow-up. Operation and postoperative rehabilitation reduced the variability of the opening and lateral movements, significantly increased maximal opening, and reduced clicking and pain.