• Journal of Dental Anesthesia and Pain Medicine
• /
• v.19 no.2
• /
• pp.77-82
• /
• 2019

It is well known that trigeminal nerve injury causes hyperexcitability in trigeminal ganglion neurons, which become sensitized. Long after trigeminal nerve damage, trigeminal spinal subnucleus caudalis and upper cervical spinal cord (C1/C2) nociceptive neurons become hyperactive and are sensitized, resulting in persistent orofacial pain. Communication between neurons and non-neuronal cells is believed to be involved in these mechanisms. In this article, the authors highlight several lines of evidence that neuron-glial cell and neuron macrophage communication have essential roles in persistent orofacial pain mechanisms associated with trigeminal nerve injury and/or orofacial inflammation.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.22 no.1
• /
• pp.67-70
• /
• 2022

Persistent idiopathic facial pain is a rare and difficult condition to treat. Several pharmacological, nonpharmacological, and invasive treatment options have been used, with varying results. We report the case of a patient with intractable persistent idiopathic facial pain who responded favorably to a combination of botulinum toxin injections and pulsed radiofrequency treatment of the infraorbital nerve.

• Journal of Oral Medicine and Pain
• /
• v.45 no.4
• /
• pp.110-114
• /
• 2020

Myofascial pain (MFP) is one of the most common causes of persistent orofacial pain. Patients with chronic myofascial orofacial pain may present with diffuse heterotopic pain, complicating the correct diagnosis. Treatment of chronic MFP should focus on the elimination of aetiologic factors. This article describes two cases of chronic MFP of the masticatory muscles, whose symptoms were exacerbated after masseteric nerve neurectomy. The patients had suffered from irrelevant treatment which did not resolve the symptom. Their symptom was managed by conventional treatment protocol. These cases emphasize the importance of correct diagnosis and evidence-based approach.

• Journal of Oral Medicine and Pain
• /
• v.35 no.3
• /
• pp.221-227
• /
• 2010

MyoFascial Pain Syndrome(MFPS) is defined as a regional pain syndrome characterized by muscle pain caused by myofascial trigger points (MTrPs). Myofascial pain is a common cause of persistent regional pain such as neck pain, shoulder pain, headaches, and orofacial pain. Clinicians who deal with orofacial pain must also understand the role of myofascial pain. This case report presents the treatment of botulinum toxin A for chronic myofascial pain.

• Journal of Dental Anesthesia and Pain Medicine
• /
• v.20 no.6
• /
• pp.403-408
• /
• 2020

Trigeminal neuralgia (TN) involves chronic neuropathic pain, characterized by attacks of repeating short episodes of unilateral shock-like pain, which are abrupt in onset and termination. Anticonvulsants, such as carbamazepine, are the gold standard first-line drugs for pharmacological treatment. Microvascular decompression (MVD) surgery is often the course of action if pharmacological management with anticonvulsants is unsuccessful. MVD surgery is an effective therapy in approximately 83% of cases. However, persistent neuropathic pain after MVD surgery may require reintroduction of pharmacotherapy. This case report presents two patients with persistent pain after MVD requiring reintroduction of pharmacological therapy. Although MVD is successful for patients with failed pharmacological management, it is an invasive procedure and requires hospitalization of the patient. About one-third of patients suffer from recurrent TN after MVD. Often, alternative treatment protocols, including the reintroduction of medications, may be necessary to achieve improvement. This case report presents two cases of post-MVD recurrent pain. Further research is lacking on the success rates of subsequent medication therapy after MVD has proven less effective in managing TN.

• Journal of Oral Medicine and Pain
• /
• v.43 no.2
• /
• pp.52-55
• /
• 2018

In the present case study, we reported a female patient with sialodochitis fibrinosa in which a conservative ultrasound (US)-guided irrigation method was used to relieve her symptoms. A 30-year-old female patient visited Kyung Hee University Dental Hospital with chief complaints of persistent swelling and discomfort in the left facial area. Her primary symptom was facial swelling that was accompanied by neuropathological symptoms, such as itching, tingling, and warmth that usually continued for 3 to 4 days. During clinical examination of orofacial area, mild swelling and fever were noted in the left face including parotid region, and mild induration could be felt at the corresponding site; sialadenitis of the left parotid gland was tentatively diagnosed. Herein, we performed intraductal irrigation of the left parotid gland in three times per month and prescribed some medication. Thus, her signs and symptoms have been improved, and she did not experience a recurrence for 12-month follow-up to date. This study can support the usefulness of the US-guided irrigation method to treat the sialodochitis fibrinosa without remarkable side effects.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.40
• /
• pp.21.1-21.5
• /
• 2018

Background: The purpose of this study was to evaluate the clinical outcomes of treatment of non-odontogenic atypical orofacial pain using botulinum toxin-A. Methods: This study involved seven patients (seven females, mean age 65.1 years) who had non-odontogenic orofacial pain (neuropathic pain and atypical orofacial pain) and visited the Seoul National University Bundang Hospital between 2015 and 2017. All medication therapies were preceded by botulinum toxin-A injections, followed by injections in the insignificant effects of medication therapies. Five of the seven patients received intraoral injections in the gingival vestibule or mucosa, while the remaining two received extraoral injections in the masseter and temporal muscle areas. Results: In five of the seven patients, pain after botulinum toxin-A injection was significantly reduced. Most of the patients who underwent surgery for dental implantation or facial nerve reconstruction recovered after injections. However, the pain did not disappear in two patients who reported experiencing persistent pain without any cause. Conclusions: The use of botulinum toxin-A for the treatment of non-odontogenic neuropathic orofacial pain is clinically useful. It is more effective to administer botulinum toxin-A in combination with other medications and physical therapy to improve pain.

• Journal of Oral Medicine and Pain
• /
• v.41 no.3
• /
• pp.118-125
• /
• 2016

Purpose: The aims of this study were to evaluate the clinical characteristics of patients with altered sensation and/or pain, and to determine outcome predictors affecting persistent neuropathy. Methods: Patients who complained an altered sensation or pain following trigeminal nerve trauma were involved in this study. To determine outcome predictors affecting persistent neuropathy, the patients were divided into two groups; transient vs. persistent, and the clinical phenotypes are compared between groups. Data were analyzed with t-tests, chi-square, and multiple regression analyses with 95% confidence interval and p<0.05 significance level. Results: A total of 111 patients were included: 23 with transient and 88 persistent groups. The panoramic result and pin-prick test score were statistically different between the groups. Radiating symptoms after blunt and pinprick stimuli were also significantly different between groups. The results revealed that the presence of a neurologic lesion in the panoramic view result, reduced sensation in the pinprick test, and radiation in the pinprick test could affect the persistent group. Conclusions: The presence of a neurologic lesion in panoramic view result and reduced sensation and radiating symptoms in the pin prick test would be defining features of one of the main clinical features of persistent neuropathy. These features could serve as outcome predictors diagnosing the permanent nerve injury in trigeminal nerve.

• The Journal of the Korean dental association
• /
• v.38 no.6 s.373
• /
• pp.567-569
• /
• 2000

Many teeth have been mistakenly extracted or endodontically treated because of an incorrect diagnosis of orofacial pain including toothache, A case report of persistent toothache originating from a malignant lymphoma of left maxilary sinus is presented. Root canal therapy and extraction of left upper quadrant teeth from canine to second molar did not resolve the chief complaint. The patient was referred to a neurologist and was diagnosed with a malignant lymphoma, a rare lesion of the maxillary sinus. The case stresses the importance of malignant neoplasms of maxillary sinus as a potential etiologic factor in the differential diagnosis of orofacial pain.

• Journal of Oral Medicine and Pain
• /
• v.49 no.2
• /
• pp.29-34
• /
• 2024

Acute malocclusion can occur in conditions related to temporomandibular joint (TMJ) disorders. This report presents two cases of acute malocclusion related to posterior disc displacement according to complete disc tearing. A 65-year-old male and an 88-yearold female presented with TMJ pain and occlusal discrepancies. Clinical examination, computed tomography, and magnetic resonance imaging revealed complete disc tearing and posterior displacement of a partial disc fragment. Dental cast analysis revealed a slight anterior and lateral deviation of the mandible toward the non-affected side; however, clinically, significant occlusal changes were not observed. This was attributed to the displacement of a small disc fragment rather than the entire disc. Including the cases presented, most instances of complete disc tearing responded well to conservative treatment such as pharmacotherapy and physical therapy, resulting in pain alleviation, and residual occlusal changes were tolerable for the patients in their daily activities. However, persistent occlusal changes or severe chewing difficulty may require surgical intervention.