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Abboud T, Malinova V, Rohde V, Mielke D. Radiofrequency thermocoagulation under neuromonitoring guidance and general anesthesia for treatment of refractory trigeminal neuralgia. Acta Neurochir (Wien) 2024; 166:56. [PMID: 38302773 PMCID: PMC10834569 DOI: 10.1007/s00701-024-05964-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/06/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Radiofrequency thermocoagulation (RFT) for refractory trigeminal neuralgia is usually performed in awake patients to localize the involved trigeminal branches. It is often a painful experience. Here, we present RFT under neuromonitoring guidance and general anesthesia. METHOD Stimulation of trigeminal branches at the foramen ovale with the tip of the RFT cannula is performed under short general anesthesia. Antidromic sensory-evoked potentials (aSEP) are recorded from the 3 trigeminal branches. The cannula is repositioned until the desired branch can be stimulated and lesioned. CONCLUSION aSEP enable accurate localization of involved trigeminal branches during RFT and allow performing the procedure under general anesthesia.
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Affiliation(s)
- Tammam Abboud
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Vesna Malinova
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Dorothee Mielke
- Department of Neurosurgery, University Medical Center Göttingen, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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Ryan K, Crighton A. Trigeminal neuralgia and trigeminal neuropathic pain. Br Dent J 2024; 236:323-328. [PMID: 38388612 DOI: 10.1038/s41415-024-7068-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 02/24/2024]
Abstract
It is very important that the dental team are aware of the varied presentations of pain in the mouth, face and other parts of the trigeminal region which are not directly caused by teeth or oral structures. Our understanding of underlying causes in this complex area is evolving. Ultimately, patients who present with what may at first seem to be oral or dental problems will require specialist input in secondary care with potential for use of systemic medications. This article reviews the common non-dental pains encountered in the orofacial region related to dysfunction of the trigeminal nerve.
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Affiliation(s)
- Kevin Ryan
- Department of Oral Medicine, Glasgow Dental Hospital and School, NHS Greater Glasgow and Clyde, UK.
| | - Alexander Crighton
- Department of Oral Medicine, Glasgow Dental Hospital and School, NHS Greater Glasgow and Clyde, UK
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Levin D, Gerges T, Acquadro M. A Case Report of Sphenopalatine Ganglion Block Relieving Chronic Pain Post-Dental Bone Graft Surgery. Cureus 2023; 15:e45266. [PMID: 37720120 PMCID: PMC10504432 DOI: 10.7759/cureus.45266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 09/19/2023] Open
Abstract
Chronic orofacial pain, by definition, is a pain that can anatomically extend anywhere between the area just under the orbitomeatal line, anterior to the pinnae, and above the neck. It occurs for 15 days or more per month, lasting four or more hours daily, for at least three months. Chronic orofacial pain, including persistent idiopathic facial pain syndrome, can significantly impact patients' quality of life and pose challenges for effective management. This case report describes a successful transnasal approach in treating a patient with severe oral pain following a bone graft surgery by blocking the sphenopalatine ganglion. The block provided significant pain relief and improved the patient's daily functioning. This minimally invasive treatment option offers an alternative for managing chronic orofacial pain after dental procedures such as bone graft surgery.
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Affiliation(s)
- Danielle Levin
- Anesthesiology, St. Elizabeth's Medical Center, Brighton, USA
| | - Teddy Gerges
- Anesthesiology, St. Elizabeth's Medical Center, Brighton, USA
| | - Martin Acquadro
- Anesthesiology, St. Elizabeth's Medical Center, Brighton, USA
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Kasahara S, Kato Y, Takahashi K, Matsudaira K, Sato N, Fukuda K, Toyofuku A, Niwa S, Uchida K. Improvement in persistent idiopathic facial pain with comorbid ADHD using the combination of a dopamine system stabilizer and psychostimulant: A case report. Clin Case Rep 2023; 11:e7552. [PMID: 37346882 PMCID: PMC10279936 DOI: 10.1002/ccr3.7552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/14/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023] Open
Abstract
Key Clinical Message Persistent idiopathic facial pain (PIFP) and attention-deficit/hyperactivity disorder (ADHD) may coexist and can be improved with ADHD medications. Thus, clinicians should screen for ADHD by a multidisciplinary approach when treating PIFP and differentiate between other odontogenic disorders. Abstract We report a case of a woman with persistent idiopathic facial pain (PIFP) and attention-deficit/hyperactivity disorder (ADHD) that markedly improved with the administration of a combination of aripiprazole (APZ) and methylphenidate (MP) treatment. Screening for ADHD and administration of APZ and/or MP may be considered in treating PIFP.
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Affiliation(s)
- Satoshi Kasahara
- Department of Anesthesiology and Pain Relief CenterThe University of Tokyo HospitalTokyoJapan
- Department of Pain MedicineFukushima Medical University School of MedicineFukushimaJapan
| | - Yuichi Kato
- Department of Pediatric Dentistry, School of Life Dentistry at TokyoNippon Dental UniversityTokyoJapan
| | - Kaori Takahashi
- Department of Dental AnesthesiologyTokyo Dental CollegeTokyoJapan
| | - Ko Matsudaira
- Department of Pain MedicineFukushima Medical University School of MedicineFukushimaJapan
| | - Naoko Sato
- Nursing DepartmentThe University of Tokyo HospitalTokyoJapan
| | - Ken‐Ichi Fukuda
- Division of Special Needs Dentistry and Orofacial PainTokyo Dental CollegeTokyoJapan
| | - Akira Toyofuku
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental SciencesTokyo Medical and Dental UniversityTokyoJapan
| | - Shin‐Ichi Niwa
- Department of Psychiatry, Aizu Medical CenterFukushima Medical UniversityAizuwakamatsuJapan
| | - Kanji Uchida
- Department of Anesthesiology and Pain Relief CenterThe University of Tokyo HospitalTokyoJapan
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Kasahara S, Takao C, Matsudaira K, Sato N, Tu TTH, Niwa SI, Uchida K, Toyofuku A. Case report: Treatment of persistent atypical odontalgia with attention deficit hyperactivity disorder and autism spectrum disorder with risperidone and atomoxetine. FRONTIERS IN PAIN RESEARCH 2022; 3:926946. [PMID: 35935670 PMCID: PMC9353025 DOI: 10.3389/fpain.2022.926946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Chronic pain has recently been associated with developmental disorders [autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD)]. Regarding chronic pain in adulthood, fibromyalgia, migraine, and chronic low back pain have been associated with ADHD. The ICD-11 disease classification categorizes these pain diseases as chronic primary pain, suggesting high comorbidity with developmental disorders in chronic primary pain. Atypical odontalgia (AO) is a persistent tooth pain that occurs in the absence of any of the usual dental causes, most of which are triggered by dental treatment. Conditions characterized by tooth pain with no apparent cause are also classified as chronic primary pain. Approximately half the patients with AO are diagnosed with psychiatric disorders; the most common are depression (15.4%) and anxiety disorders (10.1%). However, there are no reports on neurodevelopmental disorders comorbid with AO. In the present study, we report a case of a 46-year-old man with numerous complaints (e.g., occlusal instability, difficulty eating, difficulty speaking), who took work leave due to worsening of his symptoms after periodontal scaling (“gingival recession” and “aggressive periodontal treatment”) and frequently expressed dissatisfaction and anger at the hospital, making the dental treatment difficult. After a referral to a psychiatrist specializing in chronic pain, AO and previously undiagnosed comorbidity of ASD and ADHD were confirmed. Atypical antipsychotic risperidone for ASD irritability and an ADHD medication, atomoxetine dramatically reduced anger, pain, anxiety, depression, and pain catastrophizing thoughts, leading to reduced obsession with his symptoms and less frequent complaints. After risperidone (1 mg/day) + atomoxetine (120 mg/day) were ultimately prescribed after adjustment, he was able to return to work 226 days after initiation of psychiatric treatment. Recent studies show that comorbidity of developmental disorders in patients with chronic pain is likely to be undetected. Clinicians should include screening for ASD and ADHD not only in cases of fibromyalgia, migraine, and chronic low back pain, but also in orofacial pain such as AO and other treatments for chronic primary pain. For patients diagnosed with ASD or ADHD, an effective drug therapy for ASD and ADHD should be considered.
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Affiliation(s)
- Satoshi Kasahara
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
- Department of Pain Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
- *Correspondence: Satoshi Kasahara
| | - Chihiro Takao
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ko Matsudaira
- Department of Pain Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
- Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical and Research Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoko Sato
- Nursing Department, The University of Tokyo Hospital, Tokyo, Japan
| | - Trang Thi Huyen Tu
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Basic Dental Science, Faculty of Odonto-Stomatology, The University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Shin-Ichi Niwa
- Department of Psychiatry, Aizu Medical Center, Fukushima Medical University, Aizuwakamatsu, Japan
| | - Kanji Uchida
- Department of Anesthesiology and Pain Relief Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Akira Toyofuku
- Department of Psychosomatic Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Jürgens J. Specialist Pain Therapy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:423. [PMID: 34369373 DOI: 10.3238/arztebl.m2021.0207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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May A. In Reply. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:424. [PMID: 34369375 DOI: 10.3238/arztebl.m2021.0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Boström JP. Radiosurgical Methods. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:423. [PMID: 34369372 DOI: 10.3238/arztebl.m2021.0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Seidl O. Psychology Rather Than Morphology. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:424. [PMID: 34369374 PMCID: PMC8380835 DOI: 10.3238/arztebl.m2021.0208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Otmar Seidl
- *Klinik und Poliklinik für Psychiatrie und Psychotherapie Sektion für Psychosomatische Medizin und Psychotherapie LMU Klinikum München
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