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1.
Neurol Clin ; 41(1): 107-121, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36400550

RESUMO

Trigeminal neuralgia is characterized classically by recurrent, evocable, unilateral brief, electric, shocklike pains with an abrupt onset and cessation that affects one or more divisions of the trigeminal nerve. In recent years, the classification of trigeminal neuralgia has been updated based on further understanding. In this manuscript, the authors aim to explain the current understanding of the pathophysiology of trigeminal neuralgia, current diagnosis criteria, and the pharmacologic management and surgical treatments of options currently available.


Assuntos
Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/terapia , Neuralgia do Trigêmeo/tratamento farmacológico
2.
Dent Clin North Am ; 67(1): 141-155, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36404075

RESUMO

This article presents the case of a patient with persistent right-sided jaw pain with a history of multiple temporomandibular joint surgeries in the setting of persistent widespread body pain, the causes of which were fibromyalgia and osteoarthritis with multiple joint replacements, as well as psychological diagnoses of PTSD and depression. Despite extensive treatment from her orofacial pain team in combination with neurology and neurosurgery, her severe pain persisted, likely due to the consequences of untreated PTSD and depression, which led to avoidance of activities that would exacerbate her pain and thus to further disability and emotional deterioration.


Assuntos
Dor Crônica , Pessoas com Deficiência , Transtornos de Estresse Pós-Traumáticos , Feminino , Humanos , Transtornos de Estresse Pós-Traumáticos/complicações , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Dor Facial/etiologia , Dor Crônica/complicações , Comorbidade
3.
Dent Clin North Am ; 67(1): 71-83, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36404082

RESUMO

The International Classification of Orofacial Pain (ICOP) describes idiopathic pain as "unilateral or bilateral intraoral or facial pain in the distribution(s) of one or more branches of the trigeminal nerve(s) for which the etiology is unknown. Pain is usually persistent, of moderate intensity, poorly localized and described as dull, pressing or of burning character." Several diagnoses are included in the ICOP Idiopathic pain section, burning mouth syndrome and persistent idiopathic facial and dentoalveolar pain. This article, with a representative case presentation, briefly discusses common features that may lead to a common central cause for a variety of peripheral complaints.


Assuntos
Dor Facial , Neuralgia , Humanos , Dor Facial/diagnóstico , Dor Facial/etiologia , Neuralgia/complicações , Transtornos Somatoformes/complicações , Face
4.
Turk J Med Sci ; 52(5): 1627-1638, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36422504

RESUMO

BACKGROUND: Morphological differences that can lead the trigeminal nerve to neurovascular conflict and a new solitary pontine lesion are associated with the pathogenesis of trigeminal neuralgia (TN). In this case-control study, we aimed to contribute to the current discussions about the pathogenesis of TN by investigating the anatomical structures that may have an effect on the morphometric parameters of the trigeminal nerve. METHODS: This study included 25 patients with TN followed up for pain in the Department of Algology, Faculty of Medicine, and 25 age- and gender-matched controls. We performed morphometric measurements including the length and volume of the trigeminal nerve, cerebellopontine cistern, pons, and posterior fossa in the MRIs of these individuals. Comparative analyses were performed for the mean of the affected and unaffected sides of the TN patients and the right, left, and both sides of the control group. RESULTS: In patients with TN, on the affected side, length and volume of the trigeminal nerve and cerebellopontine cistern volume were found smaller than controls (p < 0.05). Pons volume was higher in patients with TN compared to controls (p < 0.05). The length of the affected nerve was significantly related to prepontine cistern length and cerebellopontine cistern volume (p < 0.05). DISCUSSION: The cerebellopontine cistern volume has a significant impact on the morphometric characteristics of the trigeminal nerve. Especially, whether the increase in the volume of pons causes a decrease in the volume of cerebellopontine cistern should be clarified with further research.


Assuntos
Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/etiologia , Estudos de Casos e Controles , Nervo Trigêmeo/diagnóstico por imagem , Ponte/diagnóstico por imagem , Ponte/patologia , Imageamento por Ressonância Magnética
5.
Neurosurg Focus ; 53(5): E3, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36321284

RESUMO

OBJECTIVE: Trigeminal neuralgia (TN) secondary to tumor represents a rare and diverse entity, and treatment for secondary TN remains controversial. This report reviews a single institution's experience in treating secondary TN with stereotactic radiosurgery (SRS) and focuses on the durability of pain relief with respect to various treatment targets, i.e., the trigeminal nerve, offending tumor, or both. METHODS: Between the years 2009 and 2021, 21 patients with TN secondary to benign (n = 13) or malignant (n = 8) tumors underwent SRS. Barrow Neurological Institute (BNI) pain intensity scale scores were collected from patient electronic medical records at baseline, initial follow-up, and 1 and 3 years post-SRS. The interval change in BNI scale score (ΔBNI) at the various follow-up time points was also calculated to assess the durability of pain relief following SRS. RESULTS: The median follow-up period was 24 (range 0.5-155) months. Five patients (24%) received treatment to the trigeminal nerve only, 10 (48%) received treatment to the tumor only, and 6 (29%) had treatment to both the nerve and tumor. The overall radiation dosage ranged from 14 to 60 Gy delivered in 1-5 fractions, with a median overall dose of 26 Gy. The median dose to the tumor was 22.5 (range 14-35) Gy, delivered in 1-5 fractions. Of the treatments targeting the tumor, 25% were delivered in a single fraction with doses ranging from 14 to 20 Gy, 60% were delivered in 3 fractions with doses ranging from 18 to 27 Gy, and 15% were delivered in 5 fractions with doses ranging from 25 to 35 Gy. The most common dose regimen for tumor treatment was 24 Gy in 3 fractions. The median biologically effective dose (with an assumed alpha/beta ratio of 10 [BED10]) for tumor treatments was 43.1 (range 13.3-60.0) Gy. There was a significant difference in the proportion of patients with recurrent pain (ΔBNI score ≥ 0) at the time of last follow-up across the differing SRS treatment targets: trigeminal nerve only, tumor only, or both (p = 0.04). At the time of last follow-up, the median ΔBNI score after SRS to the nerve only was -1, 0 after SRS to tumor only, and -2 after SRS to both targets. CONCLUSIONS: SRS offers clinical symptomatic benefit to patients with TN secondary to tumor. For optimal pain relief and response durability, treatment targeting both the tumor and the trigeminal nerve appears to be most advantageous.


Assuntos
Neoplasias , Radiocirurgia , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/cirurgia , Radiocirurgia/métodos , Estudos Retrospectivos , Resultado do Tratamento , Dor/cirurgia , Neoplasias/cirurgia
6.
Neurol Res ; : 1-7, 2022 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-36418187

RESUMO

OBJECTIVES: Management of persistent idiopathic facial pain (PIFP) can be challenging. Sphenopalatine ganglion (SPG) has been the target for the interventional treatment of many facial pain syndromes. However, possible factors that may affect SPG block success are unknown. It was aimed to investigate the effect of neuropathic pain on SPG block outcomes in PIFP, which includes a heterogeneous patient group. METHODS: All of the patients underwent fluoroscopy-guided SPG block with an injection of 40 mg of 2% lidocaine and 8 mg of dexamethasone. The patients were assigned to 2 groups according to existence of neuropathic pain determined with the DN4 questionnaire score: 19 patients with neuropathic pain (Group 1) and 15 patients without neuropathic pain (Group 2). Preprocedural and postprocedural Visual Analog Scale (VAS) scores were compared between the 2 groups. RESULTS: The mean age of the patients was 47.65 ± 6.50 years. The average pain duration was 52.95 ± 34.81 weeks. A significantly greater decrease was detected in the VAS scores at 1 week (p = 0.036) and 1 month (p < 0.001) in Group 1 when compared to Group 2. Moreover, the proportion of patients with >50% improvement in the VAS scores at 1 week (p = 0.012) and 1 month (P = 0.017) was significantly lower in Group 1 than in Group 2. DISCUSSION: SPG block appears as a safe, effective, and rapid method to treat PIFP, especially in cases with neuropathic pain. Neuropathic pain may be a predictor for pain relief in interventional procedures targeting SPG in the treatment of PIFP.

7.
J Radiosurg SBRT ; 8(2): 117-125, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36275137

RESUMO

In Gamma Knife (GK) radiosurgery, dose rate decreases during the life cycle of its radiation source, extending treatment times. Prolonged treatments influence the amount of sublethal radiation injury that is repaired during exposure, and is associated with decreased biologically-equivalent dose (BED). We assessed the impact of treatment times on clinical outcomes following GK of the trigeminal nerve - a rare clinical model to isolate the effects of treatment times. This is a retrospective analysis of 192 patients with facial pain treated across three source exchanges. All patients were treated to 80 Gy with a single isocenter. Treatment time was analyzed in terms of patient anatomy-specific dose rate, as well as BED calculated from individual patient beam-on times. An outcome tool measuring pain in three distinct domains (pain intensity, interference with general and oro-facial activities of daily living), was administered before and after intervention. Multivariate linear regression was performed with dose rate/BED, brainstem dose, sex, age, diagnosis, and prior intervention as predictors. BED was an independent predictor of the degree of improvement in all three dimensions of pain severity. A decrease in dose rate by 1.5 Gy/min corresponded to 31.8% less improvement in the overall severity of pain. Post-radiosurgery incidence of facial numbness was increased for BEDs in the highest quartile. Treatment time is an independent predictor of pain outcomes, suggesting that prescription dose should be customized to ensure iso-effective treatments, while accounting for the possible increase in adverse effects at the highest BEDs.

8.
Neuromodulation ; 2022 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-36192281

RESUMO

INTRODUCTION: Craniofacial pain is a prevalent group of conditions, and when refractory to conventional treatments, it poses a significant burden. The last decade has seen a renewed interest in the multimodal management of pain. Interventions targeting the nucleus caudalis (NC) of the trigeminocervical complex have been available as a treatment option since the 1930s, yet evidence for efficacy remains limited. MATERIALS AND METHODS: We present a systematic review of the literature providing a historical perspective on interventions targeting the NC leading up to the present. We examine the various intervention techniques, clinical indications, and procedural efficacy. A novel outcome-reporting scheme was devised to enable comparison among studies owing to historically variable reporting methods. RESULTS: A review of the literature revealed 33 retrospective studies published over the last 80 years, reporting on 827 patients. The most common technique was the open NC dorsal root entry zone nucleotomy/tractotomy; however, there has been an emergence of novel approaches such as endoscopic and spinal cord stimulation in the last ten years. Regardless of intervention technique or preoperative diagnosis, 87% of patients showed improvement with treatment. CONCLUSIONS: The literature surrounding NC intervention techniques is reviewed. Recent advancements and the wide range of craniofacial pain syndromes for which these interventions show potential efficacy are discussed. New and less invasive techniques continue to emerge as putative therapeutic options. However, prospective studies are lacking. Furthermore, the evidence supporting even well-established techniques remains of poor quality. Future work should be prospective, use standard outcome reporting, and address efficacy comparisons between intervention type and preoperative diagnosis.

9.
J Dent Res ; : 220345221128226, 2022 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-36314491

RESUMO

Patients with persistent orofacial pain (POFP) can go through complex care pathways to receive a diagnosis and management, which can negatively affect their pain. This study aimed to describe 44-y trends in attendances at Welsh medical practices for POFP and establish the number of attendances per patient and referrals associated with orofacial pain and factors that may predict whether a patient is referred. A retrospective observational study was completed using the nationwide Secure Anonymised Information Linkage Databank of visits to general medical practices in Wales (UK). Data were extracted using diagnostic codes ("Read codes"). Orofacial and migraine Read codes were extracted between 1974 and 2017. Data were analyzed using descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 468,827 POFP and migraine diagnostic codes, accounting for 468,137 patient attendances, or 301,832 patients. The overall attendance rate was 4.22 attendances per 1,000 patient-years (95% confidence interval [CI], 4.21-4.23). The attendance rate increased over the study period. Almost one-third of patients (n = 92,192, 30.54%) attended more than once over the study period, and 15.83% attended more than once within a 12-mo period. There were 20,103 referral codes that were associated with 8,183 patients, with over half these patients being referred more than once. Odds of receiving a referral were highest in females (odds ratio [OR], 1.23; 95% CI, 1.17-1.29), in those living in rural locations (OR, 1.17; 95% CI, 1.12-1.22), and in the least deprived quintile (OR, 1.39; 95% CI, 1.29-1.48). Odds also increased with increasing age (OR, 1.03; 95% CI, 1.03-1.03). The increasing attendance may be explained by the increasing incidence of POFP within the population. These patients can attend on a repeated basis, and very few are referred, but when they are, this may occur multiple times; therefore, current care pathways could be improved.

10.
Cureus ; 14(9): e28913, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36237778

RESUMO

Trigeminal postherpetic neuralgia has been reported to cause chronic headaches and facial pain. There are various modalities of treatment ranging from pharmacological to surgical treatment. However, these are frequently accompanied by undesirable side effects and minimal efficacy. Pulsed radiofrequency has been used to treat chronic pain but it is often seen as an unconventional treatment for postherpetic neuralgia. Nonetheless, the literature supports its use for alleviating pain with minimal complications. This case demonstrates that pulsed radiofrequency can successfully treat intractable pain secondary to postherpetic neuralgia affecting all three trigeminal dermatomes.

11.
Pain Physician ; 25(7): E1121-E1128, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36288599

RESUMO

BACKGROUND: Pulsed radiofrequency (PRF) is a percutaneous, micro-invasive, and micro-destructive neuromodulation technology. It has been reported to be useful in the treatment of supraorbital neuralgia (SN). However, the long-term effectiveness and safety of this technique in SN has not been reported yet. OBJECTIVES: To investigate the outcomes of PRF on supraorbital neuralgia (SN) in multi-centers and a long-term perspective. STUDY DESIGN: Retrospective case series. METHODS: Patients who underwent PRF for SN at 4 hospitals in Beijing between Jan 2007 and Jan 2021 were identified and reviewed for inclusion. Their demographic data and baseline conditions were statistically described, and their conditions of pain control were analyzed using Kaplan-Meier survival analyses. A survival curve was plotted, the cumulative proportion of pain-free at specific time points was determined, and the median pain-free time was estimated. Complications related to PRF treatment were summarized. The risk factors for initial pain control and pain-free survival were analyzed using logistic regression and Cox regression. RESULTS: A total of 116 patients were included; 91 (78.4%) patients got initial pain control with just one attempt of PRF. The maximum length of follow-up was 127 months, with a median of 18 months. During follow-up, 29 (31.9%) patients suffered from pain recurrence, and 11 (12.1%) were lost. The cumulative pain-free survival at 6 months, 1 year, 2 years, 3 years, 5 years, 8 years, and 10 years were estimated as 70%, 64%, 59%, 55%, 44%, 37%, and 37%, respectively. The median pain-free time was 52 months. No severe complications were observed or reported. Duration of disease could significantly influence initial pain control, while no risk factors for pain-free survival were recognized. LIMITATIONS: A retrospective study setting without a control group. CONCLUSION: The performance of PRF for the treatment of SN was confirmed to be favorable in a multicentric, relatively large scale, and long-term perspective.


Assuntos
Neuralgia , Tratamento por Radiofrequência Pulsada , Neuralgia do Trigêmeo , Humanos , Tratamento por Radiofrequência Pulsada/métodos , Estudos Retrospectivos , Neuralgia/terapia , Neuralgia do Trigêmeo/terapia , Manejo da Dor/métodos , Resultado do Tratamento
12.
J Pharm Bioallied Sci ; 14(Suppl 1): S65-S67, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36110700

RESUMO

Orofacial pain is one the commonest chronic oral health disorder. Yet, its complete management is still a researchable matter as it is a disorder which is caused due to various factors. It is very rare is find a single etiology leading to orofacial pain. It often encompasses multiple etiological factors. Hence it is important to understand that not one but multiple healthcare professionals are needed for its successful outcome and thus forming an interprofessional management team becomes important.

13.
Rev Neurol (Paris) ; 2022 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-36150938

RESUMO

In 1787, Alexis Pujol (1739-1804) wrote the first monograph exclusively on trigeminal neuralgia which he called "tic douloureux", or painful tic. Although it was not a seminal description, his monograph was a valuable clinical summary that helped his contemporaries make an exact diagnosis, even though it did not offer proven treatments. Unlike most in his day, Pujol adhered to the theory of electricity, seeing it as the vector of information transmission by the nerve. This made him a precursor and put him in a position to propose a novel pathophysiological theory of pain, not yet qualified as neuralgic. His thinking illustrates that, at the dawn of the nineteenth century, a provincial physician working alone was able to make his contribution to building medical knowledge, particularly in the field of neurology. After a brief biography of Pujol, this article will cite from his book to show the relevance of his clinical observations, which are still valuable today. Without omitting the inspiration, he took from his predecessors, this article also mentions the work of those who followed in his footsteps.

14.
J Int Med Res ; 50(9): 3000605211047704, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36172992

RESUMO

Painful post-traumatic trigeminal neuropathy (PPTTN) can result from iatrogenic injury to one or more branches of the trigeminal nerve during oral surgical procedures such as tooth extractions. Like other chronic neuropathic pain conditions, PPTTN can significantly alter the patient's quality of life, especially when pharmacological treatment is ineffective or not tolerated. As such, new treatment options have been investigated, including local injections of botulinum toxin type A (BTX-A). A 29-year-old woman presented to our tertiary orofacial pain clinic for evaluation of chronic electric shock-like pain attacks and severe allodynia in the territory of the right inferior alveolar nerve and buccal nerve following right mandibular third molar extraction 3 years prior. Following several failed attempts at classic pharmacological management (including carbamazepine, venlafaxine, duloxetine, pregabalin, clonazepam, and amitriptyline), BTX-A injections were administered in the vicinity of the right mental nerve. This treatment provided significant improvement in the patient's condition and overall quality of life with no significant adverse effects. Because both neuropathies were significantly improved by remote BTX-A injections, this case report provides preliminary clinical evidence supporting spinopetal transport of BTX-A, as shown in animal models, as an underlying pathophysiological mechanism of BTX-A-mediated analgesia.


Assuntos
Toxinas Botulínicas Tipo A , Neuralgia , Amitriptilina/uso terapêutico , Animais , Toxinas Botulínicas Tipo A/uso terapêutico , Carbamazepina/uso terapêutico , Clonazepam/uso terapêutico , Cloridrato de Duloxetina/uso terapêutico , Humanos , Nervo Mandibular , Neuralgia/tratamento farmacológico , Pregabalina/uso terapêutico , Qualidade de Vida , Cloridrato de Venlafaxina/uso terapêutico
15.
World Neurosurg ; 2022 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-36089282

RESUMO

OBJECTIVE: The effectiveness of gamma knife radiosurgery (GKRS) for the management of trigeminal schwannomas (TS) has been established. Although GKRS has been shown to inhibit tumor growth, the effect of GKRS on the symptoms caused by TS has not been sufficiently studied. In this study, symptomatic changes following GKRS for the management of symptomatic TS were investigated using long-term follow-up results. METHODS: A retrospective analysis was performed on 32 patients with TS who underwent GKRS between May 1994 and December 2016. Clinical charts, radiographic results, and surgical records were reviewed. To evaluate whether symptoms improved after GKRS, patient demographics, GKRS profile, radiological tumor size change, and tumor location were analyzed. RESULTS: Tumor control after GKRS for symptomatic TS was 87%. The improvement rates for facial pain at 6, 12, and 24 months after GKRS were 46%, 72%, and 86%, respectively. For the same time intervals, facial hypesthesia improved by 12%, 46%, and 52%, respectively. Of the patients with diplopia, 17% had improved symptoms 12 months after GKRS, and 50% of the patients improved after 24 months. CONCLUSIONS: GKRS can be an effective treatment modality for TS tumor control and shows favorable results in improving TS-related symptom, especially facial pain.

16.
Artigo em Inglês | MEDLINE | ID: mdl-36141454

RESUMO

Capsaicin is a chili peppers extract, genus Capsicum, commonly used as a food spice. Since ancient times, Capsaicin has been used as a "homeopathic remedy" for treating a wild range of pathological conditions but without any scientific knowledge about its action. Several studies have demonstrated its potentiality in cardiovascular, nephrological, nutritional, and other medical fields. Capsaicin exerts its actions thanks to the bond with transient receptor potential vanilloid subtype 1 (TRPV1). TRPV1 is a nociceptive receptor, and its activation starts with a neurosensitive impulse, responsible for a burning pain sensation. However, constant local application of Capsaicin desensitized neuronal cells and leads to relief from neuropathic pain. In this review, we analyze the potential adjuvant role of Capsaicin in the treatment of different pathological conditions either in internal medicine or dentistry. Moreover, we present our experience in five patients affected by oro-facial pain consequent to post-traumatic trigeminal neuropathy, not responsive to any remedy, and successfully treated with topical application of Capsaicin. The topical application of Capsaicin is safe, effective, and quite tolerated by patients. For these reasons, in addition to the already-proven beneficial actions in the internal field, it represents a promising method for the treatment of neuropathic oral diseases.


Assuntos
Capsicum , Neuralgia , Capsaicina/uso terapêutico , Odontologia , Humanos , Neuralgia/tratamento farmacológico , Extratos Vegetais/uso terapêutico
17.
Curr Pain Headache Rep ; 26(10): 725-740, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36057073

RESUMO

PURPOSE OF REVIEW: Giant cell arteritis (GCA) is a chronic, inflammatory condition, primarily affecting the medium and larger arteries. The purpose of this narrative review is to describe GCA in the context of headache and facial pain, based on a case and the available current literature. Understanding the etiology, pathophysiology, the associated conditions, and the differential diagnoses is important in managing GCA. RECENT FINDINGS: In a patient presenting with unilateral facial/head pain with disturbances of vision, GCA should be considered in the differential diagnosis. There is an association of GCA with several comorbid conditions, and infections including coronavirus-19 (COVID-19) infection. Management of GCA primarily depends upon the identification of the affected artery and prompt treatment. Permanent visual loss and other serious complications are associated with GCA. GCA is characterized by robust inflammation of large- and medium-sized arteries and marked elevation of systemic mediators of inflammation. An interdisciplinary approach of management involving the pertinent specialties is strongly recommended.


Assuntos
COVID-19 , Arterite de Células Gigantes , Humanos , Arterite de Células Gigantes/complicações , Arterite de Células Gigantes/diagnóstico , Arterite de Células Gigantes/terapia , Artérias Temporais , COVID-19/complicações , Dor Facial , Cefaleia/complicações , Doença Crônica , Mediadores da Inflamação
18.
Clin Imaging ; 91: 9-13, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-35973272

RESUMO

PURPOSE: To assess the value of preoperative 3D-FIESTA and MR angiography (MRA) in endoscopic resection of epidermoid cysts presenting with trigeminal neuralgia (TN). METHODS: 3D-FIESTA and MRA were performed before neuroendoscopy in 32 cases of epidermoid cysts with TN, and the tumors were grouped into types A, B, C, and D according to the relationship between the tumor and adjacent nerves and arteries (Hitoshi Kobata's classification). Evaluation of the neuroendoscopic resectability of different types of tumors, included gross total tumor removal (GTR), subtotal tumor removal (STR), and partial tumor removal (PTR). During the 5-year follow-up, symptoms were assessed based on facial pain relief using the Barrow Neurological Institute (BNI) score. RESULTS: The coincidence rate between MRI classification of the tumor and the operation was 100%. Type B tumors were the most common (18/32, 56.3%). Type A tumors showed the highest resectability (9/9, 100%), followed by type B tumors (14/18, 77.8%). Moreover, microvascular decompression was performed in all 4 cases of type C and 1 case of type D tumors. During follow-up, 23 patients showed marked improvement in symptoms (15, 8 of BNI I or II), 8 cases showed partial improvement (BNI III), and only 1 case of type C tumor was associated with poor facial pain relief, which recurred 5 years later (BNI IV). CONCLUSIONS: Preoperative high-resolution MR can accurately analyze the relationship between epidermoid cysts and adjacent nerves and arteries. It could act as a powerful tool in the evaluation of tumor resectability and the prognosis of surgery.


Assuntos
Cisto Epidérmico , Neuroendoscopia , Neuralgia do Trigêmeo , Angiografia/efeitos adversos , Cisto Epidérmico/complicações , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/cirurgia , Dor Facial/complicações , Dor Facial/cirurgia , Humanos , Imageamento por Ressonância Magnética/efeitos adversos , Recidiva Local de Neoplasia/complicações , Neuroendoscopia/efeitos adversos , Resultado do Tratamento , Neuralgia do Trigêmeo/diagnóstico por imagem , Neuralgia do Trigêmeo/cirurgia
19.
J Dent Anesth Pain Med ; 22(4): 289-294, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35991358

RESUMO

Background: Orofacial pain is defined as pain felt in the soft or hard tissues of the head, face, mouth, and neck. Chronic orofacial pain is often challenging to diagnose and difficult to treat. Due to the lack of available information about the prevalence and clinical form of orofacial pain, this study aimed to evaluate the characteristics of chronic orofacial pain in patients presenting at the Department of Oral Medicine of Shahid Beheshti Dental School between 2012 and 2022. Methods: In this retrospective study, we evaluated the files of 121 patients at the Department of Oral and Maxillofacial Diseases of Shahid Beheshti Dental School, which were completed during 2012-2022. We extracted the required information from these files. Results: In total, 121 files were included in the study (30 male, 91 female). The mean age of the patients was 43.68 ± 16.79 years. The most common diagnosis in patients with chronic orofacial pain was temporomandibular disorders (TMD) (55.3%). Among pain-related factors, psychological factors showed the highest frequency (30.5%). Opening and closing (43.8%) had the highest frequency among factors that increased pain, and the rest (6.6%) had the highest frequency among the factors that reduced pain. Most patients experienced unilateral pain over the masseter area. Most patients reported their pain intensity to be greater than 7 in the verbal analog scale (VAS). The most common symptom associated with pain was joint noise (37.1%). Conclusion: A ten-year retrospective evaluation of patient files showed that more than half of the patients with chronic orofacial pain had TMD.

20.
Biosensors (Basel) ; 12(8)2022 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-36005050

RESUMO

There is no consensus on the role of electromyographic analysis in detecting and characterizing the asymmetries of jaw muscle excitation in patients with temporomandibular disorders (TMD). To analyze the TMD patients (n = 72) in comparison with the healthy controls (n = 30), the surface electromyography (sEMG) of the temporalis anterior muscle (TA) and masseter muscle (M) was recorded while a maximal biting task was performed. The differences in the asymmetry of the relationship between the masseter muscles were assessed in a module to determine the sensitivity (Sn) of binomial logistic models, based on the dominance of the TA or the M muscle, in accurately predicting the presence of TMD. All assumptions were met, and comparisons between the groups showed significant differences for the TA muscle ratio (p = 0.007), but not for the M muscle ratio (p = 0.13). The left side was predominant over the right side in the TMD group for both the TA (p = 0.02) and M muscles (p = 0.001), while the non-TMD group had a higher frequency of the right side. Binary logistic regression showed a significant model (χ2 = 9.53; p = 0.002) for the TA muscle with Sn = 0.843. The model for the M muscle also showed significance (χ2 = 8.03; p = 0.005) with Sn = 0.837. The TMD patients showed an increased TA muscle ratio and asymmetry of left dominance, compared to the healthy subjects. Both of the binomial logistic models, based on muscle dominance TA or M, were moderately sensitive for predicting the presence of TMD.


Assuntos
Músculo Temporal , Transtornos da Articulação Temporomandibular , Eletromiografia , Feminino , Humanos , Músculo Masseter/fisiologia , Músculo Temporal/fisiologia
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