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Benign Oral and Dental Disease
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Konrad S. Staines, Alexander Crighton
This is a diagnosis of exclusion and consequently can reflect the clinician’s diagnostic ability as much as the pain problem itself. It is best made by a specialist in oro-facial pain who can exclude some of the rarer but treatable head and neck pain problems. The older term of atypical facial pain should not be used.
Persistent Idiopathic Facial Pain
Published in Gary W. Jay, Clinician’s Guide to Chronic Headache and Facial Pain, 2016
Persistent idiopathic facial pain, formerly known as atypical facial pain and atypical facial neuralgia, is a diagnosis often given to those patients with facial pain that does not fit with other obvious diagnostic categories. These patients typically present with poorly localized, vaguely described, nonanatomic facial pain, and no evidence of a defined organic cause (1). Strictly speaking, these pains are not “atypical” but, rather, idiopathic. These are pains for which we do not yet have sufficient understanding. This realization has lead to the newer term for these disorders, namely persistent idiopathic facial pain.
Symptoms of Neurological Disease
Published in John W. Scadding, Nicholas A. Losseff, Clinical Neurology, 2011
Tim Fowler, Nick Losseff, John Scadding
There is also a group of patients who complain of a constant pain in the face who show no abnormal physical signs. The description of the pain does not fit into any well recognized category and often is said to be a deep aching involving the eye, nose, cheek, temple or jaw. It is usually unilateral but is sometimes bilateral, often widespread and at times may be described as being much more severe – tearing, ripping, pulling. This may be atypical facial pain.
Time course of the response to navigated repetitive transcranial magnetic stimulation at 10 Hz in chronic neuropathic pain
Published in Neurological Research, 2018
Aaron Lawson McLean, Susanne Frank, Noman Zafar, Albrecht Waschke, Rolf Kalff, Rupert Reichart
Lefaucheur and colleagues showed in several publications that the outcome of TMS on pain is dependent on pain location [7,18]. Patients with atypical facial pain and central ischaemic pain experienced a significant pain reduction in response to TMS, whereas patients with plexus lesion, fibromyalgia or spinal cord lesion experienced pain reduction less frequently [18,36–38]. In our study, 71% of patients with atypical facial pain showed a reduction of their chronic pain. Patients with upper or lower limb pain showed a positive response rate of 44 and 29%, respectively. This finding is similar to previous reports [18]. The difference might be caused by the specific stimulation localisations targeted on the motor cortex. In our study, in the case of atypical facial pain and upper limb pain, the hand area of the motor cortex was stimulated. For lower limb pain, the corresponding motor cortex area was stimulated. Lefaucheur described the heterotopic stimulation of motor cortex and stimulation of the motor cortex corresponding to pain location has been shown to result in a better outcome [18,19]. This may explain the good response to stimulation in patients with facial pain, where the hand area of the motor cortex was stimulated, which is close to the facial area on the motor cortex.
Long-term outcomes and predictors of percutaneous radiofrequency thermocoagulation of Gasserian ganglion for maxillary trigeminal neuralgia: a retrospective analysis of 1070 patients with minimum 2-year follow-up
Published in Annals of Medicine, 2022
Wenxing Zhao, Liqiang Yang, Ansong Deng, Zongjie Chen, Liangliang He
Atypical facial pain was characterized more by constant aching or burning aspects, and could appear along with recurrent paroxysmal typical TN. There was the evidence that as opposed to typically paroxysmal pain, atypical pain consisting of continuous component might improve differently after MVD [22,23]. Additionally, several previous researches studied confirmed that it was an important factor leading to TN recurrence after neurosurgical intervention [17,24], which was also proven in our study. When a patient with atypical facial whose symptoms are usually incongruent with the more common aetiology was encountered, the poor immediate pain relief rate could be near 16.6% (p = .046) and an almost 5.373-fold increase in recurrent risk was estimated during long-term follow-up (95% CI: 2.623, 11.004, p < .001). Meanwhile, several previous studies found that a better long-term efficacy was observed in patients who had not undergone a previous neurosurgical intervention [18,25]. We speculated that the number of previous operations could not influence outcome, and initial failed treatment was not a factor affecting the pain control according to univariate analysis (p = .105). But the high recurrence rate could be increased by facial hypaesthesia which was mostly remaining side effects from the previous ablative neurosurgical interventions, such as RFT, PBC, SRS and peripheral neurectomy. In our study, patients with remained facial hypaesthesia were more likely to experience a failure immediately after RFT (p = .020), which might be explained by lack of a clear response to electrical stimulation tests. And these patients had a 5.224-fold increased risk for recurrence (95% CI: 3.107, 8.784, p < .001) according to the multivariable analysis. For parts of these patients, their TSEP results before RFT procedure in this study illustrated a prolonged latency of P1 and N2 or a reduced amplitude of some waveforms. Results were better in patients with good initial response to medication, patients whose medication had initially failed had a 3.185-fold increased risk for recurrence over the long-term follow-up (95% CI: 2.087, 4.860, p < .001). By ROC analysis, patients were discriminated into high-risk group for recurrence with PI > 0.387, they had a 5.575-fold increase in recurrent risk (95% CI: 3.991, 7.788, p < .001). The prediction model with sensitivity= 70.6% and specificity = 83.7% could be expected to provide a helpful and clear contribution to decision-making in the routine clinical patients selection before RFT procedure.