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By Maryam ArbabHouse Officer
CASE PRESENTATION
Date: 29 Aug, 2016
Patient ID: 43130
Name: M/O Javed
Age: 40
Address: Peshawar
CASE PRESENTATION
Chief Complaint: Pain on right side of the face.
CASE PRESENTATION
History Of Chief Complaint:• Pain on right side of the face for last five
months.• Sharp stabbing pain in the morning,
reduces during the day.• Pain in unilateral.• Pain is exacerbated with cold air, washing
face and smiling.• Pain radiated to the temporal region• Difficulty in performing daily chores.
CASE PRESENTATION
Past Dental History: Patient got her treatment done for the same complaint two months back. She was advised extractions for lower right 28, 29, 30, 31 but the symptoms didn’t relieve.
CASE PRESENTATION
Medical History:• Hypertension
CASE PRESENTATION
Family History:• Diabetes• Hypertension
CASE PRESENTATION
Medications:• Anti hypertensive drugs
CASE PRESENTATION
Clinical Examination: Extra Oral:A. Visual:
- No facial asymmetry - No abnormality presentB. Palpation: - Not tender on palpation
CASE PRESENTATION
Intra Oral:• DMFT- 16, 14 decayed- 28, 29, 30, 31 missing- 18, 17 filled- Normal mucosa - Normal tongue- No pathological lesion present
CASE PRESENTATION
Investigations: No clinical investigations were carried out.
Differential Diagnosis:1. Dental pain2. Sinus pain3. Post herpetic neuralgia4. Cluster headache5. Atypical facial pain6. Temporomandibular pain dysfunction
syndrome7. MPDS
CASE PRESENTATION
Specific Diagnosis: Trigeminal Neuralgia
CASE PRESENTATION
Trigeminal neuralgia has three branches:1. Ophthalmic divison2. Maxillary division3. Mandibular division
Trigeminal neuralgia affects one or more branches of trigeminal nerve.
CASE PRESENTATION
Pathophysiology:• Slowly evolving process, either caused
by the compression exerted on the nerve by a blood vessel or a tumor
• Or alteration of neural functions by a MS plaque at the level of dorsal root entry zone leads to increased excitability in some of the trigmenial afferents and subsequently to typical TGN.
CASE PRESENTATION
Management:• Patient Education: To establish patient’s
treatment goals and adherence to therapy.• Elimination of odontogenic pain. Medical Treatment:A. Drug Therapy:1. Anticonvulsants; drug of choice is
carbamazepine Initial dose is 100 mg BD This is increased 100 mg each day until the pain is controlled Maximum dose 800-1000 mg
CASE PRESENTATION
Surgical Treatment:1. Cryotherapy2. Neurectomy3. Alcohol injections4. Radio frequency5. Thermocoagulation6. Glycerol injections7. Micro compression
CASE PRESENTATION
THANK YOU