John P. Gobetti

Trigeminal neuralgia versus atypical facial pain. A review of the literature and case report.

Trigeminal neuralgia and atypical facial pain are common conditions of facial pain. Although these two pain conditions are classically well separated in textbooks, a straightforward diagnosis may not always be possible because of the overlapping clinical signs and symptoms. In this article, a comparison and differentiation between the clinical and diagnostic features of these two pain conditions are presented. The general characteristics, etiologic characteristics, pathophysiology, differential diagnostic criteria, and therapeutic options of trigeminal neuralgia and atypical facial pain are described. A case report demonstrates the difficulties that can arise in the diagnosis and differentiation between the two disease entities. The article underscores the responsibility clinicians have in correctly diagnosing and managing patients with facial pain conditions.

Occipital neuralgia manifesting as orofacial pain

This is a case report and brief review of the literature on occipital neuralgia presenting as dental pain. A patient with a chief complaint of long-standing pain in the maxillary right posterior quadrant was evaluated. Dental examination demonstrated the pain was not of odontogenic origin. The patient was referred to a neurologist who was a chronic pain specialist and was diagnosed with a rare neurologic disorder, occipital neuralgia referring to the facial region. After conservative treatment, local nerve blocks, and physical therapy, the patient reported a dramatic improvement of symptoms and total absence of all orofacial pain. The case demonstrates an unusual cause of orofacial pain.

Incidence and significance of cardiac arrhythmia in geriatric oral surgery patients

We recorded heart rhythms of 40 older patients (20 medicated for cardiovascular disease and 20 not medicated for cardiovascular disease) during an outpatient oral surgery visit to determine overall arrhythmia incidence and severity, differences in incidence associated with cardiovascular medication status, and the impact of surgical intervention on arrhythmia incidence. We hypothesized that both groups would show similar arrhythmia numbers and types during surgical visits and that a history of medication for cardiovascular disease would not be an indicator of cardiac arrhythmia. Enrollment remained open until 20 patients older than 60 years of age from each group agreed to participate. Data were analyzed using the chi square statistic and Fishers exact test (2-tailed). Included in the study were 24 women and 16 men; their mean age was 70.5 years (range, 60 to 86 years). Arrhythmias were detected in 17 patients and 33 of the 160 recorded rhythms. None of the detected arrhythmias were considered life-threatening. Significantly more arrhythmias occurred before administration of anesthesia than during administration of epinephrine-containing local anesthetics (p = 0.0001), and a greater number of rhythm disturbances were seen during the surgical procedure when compared with anesthesia administration (p = 0.0170). No differences in arrhythmia incidence were seen with increasing age, when male patients were compared with female patients, or when patients pharmacologically treated for cardiovascular disease were compared with patients not taking cardiovascular therapeutic medications. We conclude that although arrhythmias in this ambulatory population are common, they are typically benign in character and cardiovascular medication status is not indicative of their presence. In addition, minor oral surgery intervention with local anesthetics used in recommended dosages has no effect on cardiac arrhythmia status in the ambulatory geriatric population.

Multiple recurrence of oral erythema multiforme after secondary herpes simplex: report of case and review of literature

Reviewed are the causes, diagnosis, and treatment methods of oral erythema multiforme. The relationship between herpes simplex virus and erythema multiforme is discussed, and the role of the dentist in the diagnosis and management is emphasized.

Nonspecific stomatitis-a presenting sign in pernicious anemia.

Recurrent nonspecific stomatitis may be an oral sign of pernicious anemia. Repeated examinations and blood studies are important when the cause of stomatitis is not clear on initial evaluation of a complaint of sore mouth. Three cases of pernicious anemia are presented to illustrate the similarities and differences in oral signs of pernicious anemia.

Fibrosarcoma misdiagnosed as a temporomandibular disorder: a cautionary tale.

Because of the abundance of articles on temporomandibular disorders in the dental literature, other sources of facial pain and mandibular dysfunction do not receive adequate diagnostic attention. The case report in this article describes a female patient who appeared for treatment with symptoms and signs similar to those encountered in subsets of temporomandibular disorders. Her condition was misdiagnosed, and she was treated for a temporomandibular disorder over an extended period before the correct diagnosis of high-grade pharyngeal fibrosarcoma was established. Once diagnosed, the tumor was treated aggressively with preoperative and postoperative combinations of chemotherapy and radiation. Despite the intensive therapy, the patient died. This case should remind the clinician that nonmusculoskeletal sources of persistent facial pain and dysfunction, including tumors, may be masked by or mimic temporomandibular disorders. If therapy does not produce the expected outcome, the diagnosis should be reexamined.