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FACIAL PAINFACIAL PAIN
Babak Ashrafnejad MDBabak Ashrafnejad MD..
Common causes of facial painCommon causes of facial pain
 Odontogenic painOdontogenic pain
 HeadacheHeadache
 Musculosceletal painMusculosceletal pain
 TMJ painTMJ pain
 Neurogenic and neuropathic painNeurogenic and neuropathic pain
 Burning mouth syndromeBurning mouth syndrome
Odontogenic painOdontogenic pain
 Dental pulp :Dental pulp :
inflammationinflammation
TraumaTrauma
necrosisnecrosis
 Periodontal tissue injuriesPeriodontal tissue injuries
HEADACHEHEADACHE
 The most common cause of facial painThe most common cause of facial pain
next to odontogenic painnext to odontogenic pain
 MIGRANEMIGRANE
Vascular disorderVascular disorder
sterile trigeminal inflammationsterile trigeminal inflammation
with aura , without aurawith aura , without aura
 CLUSTER HEADACHECLUSTER HEADACHE
conjunctiva injection,lacrimation,nasalconjunctiva injection,lacrimation,nasal
conjestion,rhinorrhea,miosis,ptosisconjestion,rhinorrhea,miosis,ptosis
HEADACHEHEADACHE
 Chronic paroxysmal hemicraniaChronic paroxysmal hemicrania
 Lower half migraneLower half migrane
 Tension type headacheTension type headache
 Temporal arthritisTemporal arthritis
MUSCULOSCELETAL PAINMUSCULOSCELETAL PAIN
 Temporomandibular disordersTemporomandibular disorders
arthicular , myogenicarthicular , myogenic
1- myofacial pain: trigger point,1- myofacial pain: trigger point,
taut bandtaut band
2-TMJ : disk displacement, DJD2-TMJ : disk displacement, DJD
capsular inflammationcapsular inflammation
NEUROGENIC ANDNEUROGENIC AND
NEUROPATHIC PAINNEUROPATHIC PAIN
Trigeminal NeuralgiaTrigeminal Neuralgia
TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA
 Severe, unilateral pain in distributionSevere, unilateral pain in distribution
of trigeminal nerve.of trigeminal nerve.
 Stabbing pain in seconds.Stabbing pain in seconds.
 Grimace (tic douloureux)Grimace (tic douloureux)
 Type I (Idiopathic or primary), typeType I (Idiopathic or primary), type
II (secondary)II (secondary)
 Commonly after 50 y/o, F/m=2/1Commonly after 50 y/o, F/m=2/1
 Tic convulsifTic convulsif
TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA
Differential diagnosisDifferential diagnosis
 Cluster ticCluster tic
 Glossopharyngeal neuralgiaGlossopharyngeal neuralgia
craniopharyngeal paincraniopharyngeal pain
stabbing, burningstabbing, burning
bradycardia, hypotensionbradycardia, hypotension
asystole, syncopeasystole, syncope
TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA
Differential diagnosisDifferential diagnosis
 Geniculate neuralgiaGeniculate neuralgia
in sensory component of VIIin sensory component of VII
commonly in herpetic infectioncommonly in herpetic infection
Ramsay hunt syndromeRamsay hunt syndrome
 V nerve neuritis with tumor or otherV nerve neuritis with tumor or other
pathologypathology
TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA
Differential diagnosisDifferential diagnosis
 Post herpetic trigeminal neuralgiaPost herpetic trigeminal neuralgia
 Occipital neuralgiaOccipital neuralgia
greater occipital nervegreater occipital nerve
burning, stabbingburning, stabbing
 Reader syndromeReader syndrome
oculosympathetic paralysisoculosympathetic paralysis
pain with ptosis, miosispain with ptosis, miosis
TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA
Differential diagnosisDifferential diagnosis
 Atypical facial painAtypical facial pain
pain with unknown originpain with unknown origin
deep burning, aching, constantdeep burning, aching, constant
poorly localizedpoorly localized
independent to nerve distributionindependent to nerve distribution
areaarea
BURNING MOUTH SYNDROMEBURNING MOUTH SYNDROME
 In more than 40% of women (postIn more than 40% of women (post
menoposal)menoposal)
 Burning in oral regionBurning in oral region
 No pathologic changesNo pathologic changes
 Changes in esteradiol level effect onChanges in esteradiol level effect on
sensory branches of VII (Chordasensory branches of VII (Chorda
thympany)thympany)

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Facial pain

  • 1. FACIAL PAINFACIAL PAIN Babak Ashrafnejad MDBabak Ashrafnejad MD..
  • 2. Common causes of facial painCommon causes of facial pain  Odontogenic painOdontogenic pain  HeadacheHeadache  Musculosceletal painMusculosceletal pain  TMJ painTMJ pain  Neurogenic and neuropathic painNeurogenic and neuropathic pain  Burning mouth syndromeBurning mouth syndrome
  • 3. Odontogenic painOdontogenic pain  Dental pulp :Dental pulp : inflammationinflammation TraumaTrauma necrosisnecrosis  Periodontal tissue injuriesPeriodontal tissue injuries
  • 4. HEADACHEHEADACHE  The most common cause of facial painThe most common cause of facial pain next to odontogenic painnext to odontogenic pain  MIGRANEMIGRANE Vascular disorderVascular disorder sterile trigeminal inflammationsterile trigeminal inflammation with aura , without aurawith aura , without aura  CLUSTER HEADACHECLUSTER HEADACHE conjunctiva injection,lacrimation,nasalconjunctiva injection,lacrimation,nasal conjestion,rhinorrhea,miosis,ptosisconjestion,rhinorrhea,miosis,ptosis
  • 5. HEADACHEHEADACHE  Chronic paroxysmal hemicraniaChronic paroxysmal hemicrania  Lower half migraneLower half migrane  Tension type headacheTension type headache  Temporal arthritisTemporal arthritis
  • 6. MUSCULOSCELETAL PAINMUSCULOSCELETAL PAIN  Temporomandibular disordersTemporomandibular disorders arthicular , myogenicarthicular , myogenic 1- myofacial pain: trigger point,1- myofacial pain: trigger point, taut bandtaut band 2-TMJ : disk displacement, DJD2-TMJ : disk displacement, DJD capsular inflammationcapsular inflammation
  • 7. NEUROGENIC ANDNEUROGENIC AND NEUROPATHIC PAINNEUROPATHIC PAIN Trigeminal NeuralgiaTrigeminal Neuralgia
  • 8. TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA  Severe, unilateral pain in distributionSevere, unilateral pain in distribution of trigeminal nerve.of trigeminal nerve.  Stabbing pain in seconds.Stabbing pain in seconds.  Grimace (tic douloureux)Grimace (tic douloureux)  Type I (Idiopathic or primary), typeType I (Idiopathic or primary), type II (secondary)II (secondary)  Commonly after 50 y/o, F/m=2/1Commonly after 50 y/o, F/m=2/1  Tic convulsifTic convulsif
  • 9. TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA Differential diagnosisDifferential diagnosis  Cluster ticCluster tic  Glossopharyngeal neuralgiaGlossopharyngeal neuralgia craniopharyngeal paincraniopharyngeal pain stabbing, burningstabbing, burning bradycardia, hypotensionbradycardia, hypotension asystole, syncopeasystole, syncope
  • 10. TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA Differential diagnosisDifferential diagnosis  Geniculate neuralgiaGeniculate neuralgia in sensory component of VIIin sensory component of VII commonly in herpetic infectioncommonly in herpetic infection Ramsay hunt syndromeRamsay hunt syndrome  V nerve neuritis with tumor or otherV nerve neuritis with tumor or other pathologypathology
  • 11. TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA Differential diagnosisDifferential diagnosis  Post herpetic trigeminal neuralgiaPost herpetic trigeminal neuralgia  Occipital neuralgiaOccipital neuralgia greater occipital nervegreater occipital nerve burning, stabbingburning, stabbing  Reader syndromeReader syndrome oculosympathetic paralysisoculosympathetic paralysis pain with ptosis, miosispain with ptosis, miosis
  • 12. TRIGEMINAL NEURALGIATRIGEMINAL NEURALGIA Differential diagnosisDifferential diagnosis  Atypical facial painAtypical facial pain pain with unknown originpain with unknown origin deep burning, aching, constantdeep burning, aching, constant poorly localizedpoorly localized independent to nerve distributionindependent to nerve distribution areaarea
  • 13. BURNING MOUTH SYNDROMEBURNING MOUTH SYNDROME  In more than 40% of women (postIn more than 40% of women (post menoposal)menoposal)  Burning in oral regionBurning in oral region  No pathologic changesNo pathologic changes  Changes in esteradiol level effect onChanges in esteradiol level effect on sensory branches of VII (Chordasensory branches of VII (Chorda thympany)thympany)