Pains experienced over face because of either somatic origin or sympathetic disturbances are very peculiar. There will not be any evidence of clear pathology because of the deep seated source. These are some uncommon conditions which a pain clinician might come across in the pain clinic
This disorder includes pain arising from the temperomandibular joint and the masticatory muscles. Temperomandibular joint disease occurs in a milder form equally in both sexes but those presenting for treatment (approximately 5-10% of the population) are female in ratio of 8:1. This may be difficult to distinguish from atypical facial pain but there is usually a history of pain in muscles and/or joints, clicking, sticking or trismus (restricted mouth opening), and a feeling of buzzing or fullness in the ear. It can be bilateral. It is more intense in the morning or afternoon. It is exacerbated by movement or clenching. There will be tenderness of the joint capsule and muscles of mastication and trigger points can often be elicited. It lasts from weeks to years. Classically the pain is altered by the palpation of associated tender muscles and alleviated by the stretching of the muscle or the injection of local anaesthetic to the tender site.
TreatmentThis can be distinguished from atypical facial pain because of the continuous or throbbing pain felt in the teeth (tooth), is hypersensitive to all stimuli and may move from tooth to tooth.
Treatment - Medical Management
This is the sensation of a dry mouth, burning tongue and gums, with denture intolerance, disturbance of taste and salivation and no organic pathology. Physical examination will not reveal any problems. 50% of patients undergo spontaneous remission in 6 to 7 years.
Treatment - Medical Management
This term probably covers a number of entities with a different aetiology, all leading up to continuous pain in the cheek region, which cannot be provoked (such as trigeminal neuralgia), and which is not paroxysmal (such as cluster headache). The diagnosis of atypical facial pain is made often by exclusion of other causes of facial pain. It is quite common in middle-aged women. Most often they would have been diagnosed as trigeminal neuralgia, which would not have responded to medications or else their pain, would have been associated wrongly with dental problems and had continued despite dental extraction. Though the site of pain is in the face, it may not coincide with the distribution of any particular nerve and it may cross the midline.
The features are that it is a poorly localised, steady, deep burning, dull pain (in contrast to sharp pain of trigeminal neuralgia), which may be persistent or recurrent, uni-or bilateral, in the absence of muscular or joint problems and with no neurological signs akin to those of trigeminal neuralgia. Although the pain is episodic, it is unlike that of trigeminal neuralgia in that it builds up gradually to a climax and it may last for hours and even days.
The pain may be associated with other symptom complexes such as pain abdomen, dysfunctional uterine bleeding, headache and low back pain. These complexes may recur sequentially or simultaneously in response to stress. Sufferers exhibit depressive features. They are also preoccupied with finding alternative explanations for their conditions.
Treatment - Medical Management
Phantom tooth pain was coined in the year 1978.8 This is specially directed towards the deafferentation (loss of nerve connection) pain emerging after tooth extraction or oral surgery. Patient complains of constant, dull, deep ache with occasional spontaneous sharp pain. So many theories have been explained in this regard; however, the most accepted happens to be the one mentioned below.
Following tooth extraction, there will be initial shock and a brief shutdown of neural activity; the injured axon puts forth a number of sprouts. These sprouts are different from parent nerve. They readily generate action potentials either spontaneously or after stimulus. If these sprouts connect to appropriate receptor, more stable electrical characteristics are likely to be established and the hyperexcitability states recede.
However, in tooth extraction or root canal treatment, the access is permanently denied and hence the lightening pain. But why it does not happen in all patients is a big mystery.
Treatment
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