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Orofacial Pain

Orofacial pain involves discomfort in the head, face, oral cavity, and neck, with pain transduction, transmission, and modulation being key processes. It can be classified into somatic, neuropathic, psychological, and unknown origin types, with trigeminal neuralgia being a notable neuropathic condition characterized by sharp, electric shock-like pain. Diagnosis involves patient history, examination, and imaging, while management can be medical or surgical depending on the type and severity of the pain.

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12 views15 pages

Orofacial Pain

Orofacial pain involves discomfort in the head, face, oral cavity, and neck, with pain transduction, transmission, and modulation being key processes. It can be classified into somatic, neuropathic, psychological, and unknown origin types, with trigeminal neuralgia being a notable neuropathic condition characterized by sharp, electric shock-like pain. Diagnosis involves patient history, examination, and imaging, while management can be medical or surgical depending on the type and severity of the pain.

Uploaded by

drtehreemzahra
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Orofacial Pain

Dr. Maimoona Siddiq


• pain associated with the hard and soft tissues of the head, face,
oral cavity and neck.
• Pain Transduction is the conversion of a nociceptive stimulus to a
transmissible neuroelectrical signal
• It refers to activation of specialized nerves: A-Delta, C fibres
• Pain Transmission is the relay functions by which the message is
carried from the site of tissue injury to the brain regions underlying
perception.
• Pain Modulation neural process that acts specifically to reduce
activity in the transmission system
Pain Fibers
Classification of Orofacial Pain
• Somatic:
I. Visceral: TMJ pain, Salivary Gland
II. Odontogenic
III. Musculoskeletal : Myofacial Pain Dysfunction syndrome( MPDS )
• Neuropathic:
I. Nerve injury (trauma)
II. Trigeminal Neuralgia
III. Neuroma
IV. Post Herpetic
• Psychological: very rare
• Pain of Unknown Origin: Atypical Facial Pain (may or may not be
associated with psychogenic cause)
Glossary of Pain
Neuropathic Facial Pain
• Trigeminal Neuralgia
Trigeminal Neuralgia

• Age above 50 years


• incidence 8 : 100,000
• female-to-male ratio 1.6 : 1
• sharp, electric shock like pain in nerve distribution area
• Intense pain, lasts for few seconds to 1 minute, followed by a
refractory period
• a trigger zone is present: mechanical stimuli such as soft touch may
provoke an attack
• Common cutaneous trigger zones: corner of the lips, cheek, ala of the
nose, lateral brow, any intraoral site.
HOW TO MAKE DIAGNOSIS?
• History and pain character
• Examination
• Diagnostic nerve block
• MRI and radiological investigation
• Consult Neurologist if suspected Central lesion/disease
Pathophysiology
• Pressure on root entry zone (near Pons of brain stem)of tri-germinal
nerve by vascular loop, leading to demyelination
• Superior Cerebellar Artery
• Other diseases which have
similar symptoms: Brain Tumors,
Lyme Disease,
Multiple Sclerosis
Trigeminal Neuralgia

MANAGEMENT
MEDICAL:
Trigeminal Neuralgia
SURGICAL MANAGEMENT

PERIPHERAL CENTRAL
• Nerve resection • Microvascular Decopression
• Cryotherapy • Gamma Knife radiosurgery
• Absolute Alcohol Injection • Percutaneous Needle Rhizotomy
• Glycerol Injection • Balloon Compression of root
entry zone
Post Herpetic Neuralgia
• 80% V1 dermatome involved
• 10-15 % occurs in cases of Shingles ( herpes zoster)
• Neuralgia associated with rash in specific cutaneous dermatome
Neuroma
• After peripheral nerve transection, proximal portion of the nerve forms
sprouts in an effort to regain communication with the severed distal
component.
• sprouting occurs without distal segment communication, a stump of
neuronal tissue, Schwann cells, and other neural elements form.
• This stump, can become exquisitely sensitive to mechanical and chemical
stimuli
• burning or shocklike pain
• Frequently a positive Tinel sign is present.
TINNEL SIGN: tapping over the suspected neuroma produces sharp,
shooting, electric shock like pain

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