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Atypical Facial Pain

AFP


Presentation

  • The presented case is distinct from previous reports. CLINICAL PRESENTATION: A 26-year-old woman presented with atypical facial pain. The neurological examination results were normal. Magnetic resonance imaging revealed a left parasellar mass.[ncbi.nlm.nih.gov]
  • A wide spectrum of psychiatric disorders was present.[ncbi.nlm.nih.gov]
  • Facial pain is a relatively frequent cause of presentation to both general medical and dental practitioners.[ncbi.nlm.nih.gov]
  • Here we present another case of a primary osteoma of the orbit presenting with atypical facial pain and discuss the relevant literature. [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • We present a patient with history of right facial pain successfully treated for refractory angina with SCS and had coincident near resolution of facial pain.[ncbi.nlm.nih.gov]
Noncompliance
  • Eight patients discontinued because of adverse effects and 2 patients were excluded because of noncompliance. Two patients completed the trial but were excluded from the analysis because they experienced no pain at the baseline visit.[ncbi.nlm.nih.gov]
Oral Ulcers
  • Oral mucosal lesions such as recurrent oral ulceration, lichen planus, blistering conditions will cause chronic pain but there are very clear signs which make diagnosis easy.[doi.org]
Suggestibility
  • This case suggests that vascular compression of the trigeminal nerve may be one of the mechanisms producing this syndrome and in these cases it might respond to baclofen.[ncbi.nlm.nih.gov]
  • The author suggests that the facial pain may have served as a defense against the emergence of psychosis.[ncbi.nlm.nih.gov]
  • A hypothesis of the mechanism is presented and a possible use of iprazochrome as a diagnostic tool is suggested.[ncbi.nlm.nih.gov]
  • The temporary improvement of pain scores with the active drug was thought to be too small to be of any clinical benefit, but suggests that vascular or neurogenic mechanisms may be involved in the aetiology of AFP.[ncbi.nlm.nih.gov]
  • We suggest a modified version of the IHS criteria for atypical facial pain.[ncbi.nlm.nih.gov]
Facial Pain
  • Atypical facial pain is dull and unrelenting and its site is ill-defined.[ncbi.nlm.nih.gov]
  • The IHS classification is insufficient to separate atypical facial pain from other primary headache and facial pain syndromes. We suggest a modified version of the IHS criteria for atypical facial pain.[ncbi.nlm.nih.gov]
  • This article discusses the differential diagnosis of facial pain and presents three cases of atypical facial pain.[ncbi.nlm.nih.gov]
  • Patients were aged 18-65 years and had at least a 6 months history of atypical facial pain.[ncbi.nlm.nih.gov]
  • We present a patient with history of right facial pain successfully treated for refractory angina with SCS and had coincident near resolution of facial pain.[ncbi.nlm.nih.gov]
Unilateral Facial Pain
  • METHOD: Thirteen patients with unilateral facial pain and septal contact points with lateral nasal wall structures who met our inclusion criteria were selected for endoscopic septoplasty.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To present the immediate and long-term efficacy of ultrasound-guided injections of local anesthetic and steroids in the pterygopalatine fossa in patients with unilateral facial pain that failed pharmacological and surgical interventions.[ncbi.nlm.nih.gov]
  • He described the classic trigeminal neuralgia, including paroxysms of unilateral facial pain, evoked by eating or speaking or touch, starting and ending abruptly, and associated with anxiety.[medlink.com]
Paroxysmal Facial Pain
  • facial pain Tic douloureux G50.1 Atypical facial pain G50.8 Other disorders of trigeminal nerve G50.9 Disorder of trigeminal nerve, unspecified Abbreviations used here: NEC Not elsewhere classifiable This abbreviation in the Tabular List represents “[icd10coded.com]
  • facial pain Tic douloureux atypical G50.1 ICD-10-CM Codes Adjacent To G50.1 G47.6 Sleep related movement disorders G47.61 Periodic limb movement disorder G47.62 Sleep related leg cramps G47.63 Sleep related bruxism G47.69 Other sleep related movement[icd10data.com]
Trigeminal Neuralgia
  • Of the 83 patients identified with trigeminal neuralgia where records were adequate, 35 (42%) also had atypical facial pain. Five of these had developed it before the onset of trigeminal neuralgia and could be examples of pretrigeminal neuralgia.[ncbi.nlm.nih.gov]
  • We report on our 20 year-long experience with the surgical treatment of facial pain in general and trigeminal neuralgia in particular. Our treatment algorithm for trigeminal neuralgia is presented.[ncbi.nlm.nih.gov]
  • Trigeminal neuralgia and atypical facial pain are common conditions of facial pain.[ncbi.nlm.nih.gov]
  • The pain is dull or burning, incessant, and, in contrast to trigeminal neuralgia, relatively poorly relieved by carbamazepine or diphenylhydantoin sodium; antidepressants and psychotropic agents are worth considering.[ncbi.nlm.nih.gov]
  • Excerpt from Striking Back: The Trigeminal Neuralgia and Face Pain Handbook by George Weigel and Kenneth F. Casey, M.D.: “Perplexed by…mixed-symptom cases, doctors began referring to them as ‘atypical trigeminal neuralgia.’[fpa-support.org]

Workup

  • METHODS: Twenty patients with AFP and 12 patients with TNP participated after thorough clinical diagnostic workup. All patients underwent blink reflex (BR) recordings, habituation of the BR, and (except one patient with TNP) thermal QST.[ncbi.nlm.nih.gov]
  • In this review article, we describe the workup and diagnosis of PIFP and highlight recent literature regarding the pathophysiology and treatment of PIFP.[ncbi.nlm.nih.gov]
  • Upon examination and workup, no abnormality is noted. Within the group of chronic facial pain syndromes, PIFP represents a particular diagnostic challenge.[emedicine.medscape.com]
  • Retrieved February 15, 2010 from: Krolczyk, Stanley (2010) Persistent Idiopathic Facial Pain: Differential Diagnoses & Workup. Retrieved February 15, 2010 from: Slavin, K., Colpan, E., Munawar, N., et al (2006).[arizonapain.com]
  • Key points • For several cranial neuralgias, the diagnostic workup should include structural imaging with MRI with and without contrast to evaluate for evidence of inflammation or space-taking lesions, vascular imaging consisting of either MRA or CTA[medlink.com]

Treatment

  • Adverse effects were equally common during both treatments. CONCLUSION: Venlafaxine was only modestly effective in the treatment of AFP.[ncbi.nlm.nih.gov]
  • One patient received only one treatment since her pain symptoms resolved after the first treatment.[ncbi.nlm.nih.gov]
  • Twenty-one of fifty-eight patients (36.2 percent) with AFP had sixty-five dental and surgical treatments, with only one patient showing less pain as a result of the treatment.[ncbi.nlm.nih.gov]
  • Therefore, the treatment of AFP should be specified. There is also no consensus in the treatment of AFP. Two different treatment procedures on the trigeminal tract and nucleus in a series of cases with AFP are presented.[ncbi.nlm.nih.gov]
  • We report on our 20 year-long experience with the surgical treatment of facial pain in general and trigeminal neuralgia in particular. Our treatment algorithm for trigeminal neuralgia is presented.[ncbi.nlm.nih.gov]

Prognosis

  • Comments on the excellent prognosis in treating the psychiatric syndromes associated with AFP are made.[ncbi.nlm.nih.gov]
  • Discussion includes the definition of persistent idiopathic facial pain and its pathophysiology, clinical features, demographics, lack of findings on physical examination, use of imaging modalities and consultations, differential diagnosis, treatment, and prognosis[ncbi.nlm.nih.gov]
  • Epidemiology and Prognosis Because of a lack of agreement on classification criteria, accurate figures on the frequency of PIFP are difficult to obtain.[emedicine.medscape.com]
  • Part 2: Management and prognosis. Br Dent J 1984;156:205-8. 19. Mock D, Frydman W, Gordon AS. Atypical facial pain: A retrospective study. Oral Surg Oral Med Oral Pathol 1985;59:472-4. 20. Pettengill C, Reisner-Keller L.[ijpm.info]
  • Group II is typically a painful postganglionic Homer syndrome with a self-limited course and excellent prognosis ( Salvesen 1999 ). Burning mouth syndrome.[medlink.com]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • The significance of these results to etiological theories of chronic pain lateralization is discussed.[ncbi.nlm.nih.gov]
  • The general characteristics, etiologic characteristics, pathophysiology, differential diagnostic criteria, and therapeutic options of trigeminal neuralgia and atypical facial pain are described.[ncbi.nlm.nih.gov]
  • AFP is a poorly understood condition, often without etiology, and most commonly treated symptomatically. The resolution of our patient's AFP is secondary to unclear mechanism(s).[ncbi.nlm.nih.gov]
  • Etiology It is usually idiopathic in nature.[practicalpainmanagement.com]

Epidemiology

  • Epidemiology and Prognosis Because of a lack of agreement on classification criteria, accurate figures on the frequency of PIFP are difficult to obtain.[emedicine.medscape.com]
  • Epidemiology of chronic daily headache. Eur J Med Res 2003;8:236-40. 9. Pascual J, Colás R, Castillo J. Epidemiology of chronic daily headache. Curr Pain Headache Rep 2001;5:529-36. 10. Zakrzewska JM.[ijpm.info]
  • Epidemiological studies are difficult to perform and interpret due to a lack of consensus on the nomenclature and definition of this disorder and the variation in study methodologies.[jcda.ca]
  • Epidemiological considerations Although the prevalence of joint related and muscle related symptoms has been studied, the epidemiology of chronic facial pain remains unclear.[jnnp.bmj.com]
  • The epidemiology and classification will be discussed and the diagnostic criteria presented together with a brief mention of management.[doi.org]
Sex distribution
Age distribution

Pathophysiology

  • Discussion includes the definition of persistent idiopathic facial pain and its pathophysiology, clinical features, demographics, lack of findings on physical examination, use of imaging modalities and consultations, differential diagnosis, treatment,[ncbi.nlm.nih.gov]
  • In particular, when the diagnosis is atypical facial pain, that is, a diffuse, nonanatomic orofacial pain of unknown pathophysiology, none of the surgical strategies that can cure trigeminal neuralgia should be used.[ncbi.nlm.nih.gov]
  • The general characteristics, etiologic characteristics, pathophysiology, differential diagnostic criteria, and therapeutic options of trigeminal neuralgia and atypical facial pain are described.[ncbi.nlm.nih.gov]
  • In this review article, we describe the workup and diagnosis of PIFP and highlight recent literature regarding the pathophysiology and treatment of PIFP.[ncbi.nlm.nih.gov]
  • Pathophysiology and Etiology The Headache Classification Subcommittee of the International Headache Society defines PIFP as follows [3] : Pain is in the face Pain is present daily and persists for all or most of the day Pain is confined at onset to a[emedicine.medscape.com]

Prevention

  • Long-term follow-up should be conducted to determine the analgesic effects and to prevent recurrence, even if the analgesic effect occurs in a short time.[ncbi.nlm.nih.gov]
  • […] persistent pain because there have been sporadic cases of facial pain associated with hydrocephalus. 1–3 Had brain-imaging examinations been performed for this patient before, the development of hydrocephalus could have been detected, and this might have prevented[anesthesiology.pubs.asahq.org]
  • Then your surgeon will carefully lift the artery or vein and place a tiny Teflon pad between the two structures to prevent further irritation of the trigeminal nerve.[neurosurgeonsofnewjersey.com]
  • In a small percentage of patients, anatomical variation prevents the maxillary nerve from being reached by this approach. Remember that the search here is in a superior-inferior direction, as the nerve is passing horizontally in the fissure.[what-when-how.com]
  • In elderly women, bisphosphonate therapy is often prescribed on a preventive basis and osteonecrosis of the jaw, as any iatrogenic disease in the setting of preventive care, is particularly unacceptable.[doi.org]

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