Facial Pain & NM Diseases

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Anonymous
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145176
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Facial Pain & NM Diseases
Updated:
2012-04-02 01:07:51
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Facial pain & NM dxes
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  1. Lyme Disease
    Bell's
  2. Earache
    Bell's
  3. Melkerson-Rosenthal
    Bell's (and heerfort)
  4. Heefort
    Bells'
  5. 1/5 cases of demyelinating diseases
    bell's
  6. symptoms regress in 1-2months
    bell's
  7. mimics pain of dental origin
    trigeminal neur
  8. one of highest suicide rates
    trigem
  9. classical pain
    • vascular--compresses trigem nerve root
    • idiopathic
  10. symptomatic
    assoc. w/ pathologic condition
  11. favors R side of face
    trigem
  12. Trigger stimulus--trigem
    • 1.lip
    • 2. nasolabial fold
    • 3. periorbital skin
  13. triggering factors (noise, light, sound)
    trigem neur
  14. mandibular branch most involved
    trigem
  15. trigger points internal
    exception: ear canal
    glossopharyngeal
  16. 25% are from neoplasms of skull base or aneurysms of posterior cranial fossa
    glossopharyngeal
  17. dx of exclusion
    atypical face pain
  18. "chasing" pain
    atypical face pain
  19. rule out infxns: sinus, dental, perio, ear
    atypical face pain
  20. Tx:
    1. gabapentin
    2. opiod analgesics
    3. psychotherapy
    4. antidepressants
    atypical face pain
  21. pain around eyes
    cluster head aches
  22. simulates toothache
    cluster
  23. need to pace restlessly
    cluster
  24. No trigger zone
    cluster
  25. alcolhol
    nitroglycerin

    precipitate pain
    cluster
  26. black men
    80% smokers

    hereditary
    cluster headaches
  27. tx:
    proper diagnosis to make sure no unnecesary end/extraction
    cluster headaches
  28. vasoconstriction of cerebral arteries
    migraines
  29. vasoconstriction leads to ischemia w/ compensating vasodilation
    migraines
  30. family hx common
    • migraines
    • cluster
  31. Tx:
    avoid triggers
    anti-inflammatory agents
    5-HT1 agonists
    dopamin antagonists
    migraine
  32. MGravis is an autoimmune dx w/ Abs to ...
    acetylcholine receptors
  33. defective neuromuscular transmission --> motor end plate normal
    m. gravis
  34. skeletal m.
    m. gravis
  35. noticed in head & neck first
    m. gravis
  36. m. gravis symptoms
    • 1. ptosis
    • 2. diplopia
    • 3. dysphagia
    • 4. dysarthria--slurring of words
    • 5. difficulty chewing
  37. jaw hangs open after meal
    m. gravis
  38. m. gravis biopsy
    • m. fiber degeneration
    • --small fibers
    • --fewer nuclei
    • --loss of rounded x-sectional shape
  39. ice pack test
    m. gravis
  40. 50% cases: have other autoimmune dx.
    m. gravis
  41. thymoma associated
    • m. gravis
    • (90% have circulating AchR)
  42. tx: m. gravis
    tymectomy (unless mildest cases)
  43. burning mouth location
    anterior 1/3
  44. burning mouth locations
    any oral site, including lips
  45. 2-3% adults affected
    burning mouth syndrome
  46. 14% post-menopausal women affected
    burning mouth syndrome
  47. burning mouth syndrome associated w:
    • 1. depression
    • 2. anxiety
    • 3. irritability
  48. b.m.syndrom local factors
    • 1. chronic mouth breathing
    • 2. tongue thrust
    • 3. candidiasis
    • 4. allergies
    • 5. xeroxtomia
  49. b.m.syndrome systemic factors
    • 1. vit. a or b12 deficiency
    • 2. diabetes
    • 3. chronic gastritis or regurgitation
    • 4. hypothyroidism
    • 5. estrogen deficiency
    • 6. AIDS
    • 7. psychosomatic disorder or depression
  50. b.m. syndrome txment
    • 1. correct underlying condition
    • 2. fire w/ fire
    • 3. mood altering drugs (chlordiaepoxide; clonazepam)
  51. dysgeusia
    onset of abnormal taste--> metallic, foul, rancid
  52. dysgeusia etiology
    • 1. underlying systemic disorder
    • 2. prior head/neck radiation
  53. 1/3 dysgeusia cases caused by:
    URT infxn
  54. dysgeusia local factors:
    • 1. Trichomoniasis
    • 2. oral galvanism
    • 3. periodontitis
    • 4. gingivitis
    • 5. chlorhexidine
  55. systemic factors of dysgeusia
    • 1. zinc; vit. a; b12 deficiency
    • 2. food sensitivities
    • 3. sjogren's
    • 4. liver dysfxn
    • 5. chron's dx
    • 6. addisons
    • 7. psychosis, depression
    • 8. pesticide ingestion
    • 9. systemic medications
  56. tx of dysgeusia
    • 1. refer to taste/smell center
    • 2. verify taste vs. olfactory disorder
  57. Frey syndrome etiology
    • parotid abscess
    • trauma
    • mandible sx

    ...parasymp fibers misdirected and regenerate along sympathetic paths
  58. frey syndrome prevention
    temporoparietal fascia flap
  59. Minor's starch iodine test
    frey
  60. frey txment:
    • 1. mild = none
    • 2. some: auriculotemporal or glossopharyngeal n.
    • 3. local botox injsnx
  61. 60% all arthritis cases
    osteoarthritis
  62. cause of osteoarthritis
    slower & less complete replacement of chondroblasts

    cartilage destroyed
  63. late sign= crepitation
    osteoa.
  64. Heberden's nodes
    osteo
  65. eburnation of bone
    osteo a--> sclerosis
  66. osteolysis of underlying bone
    osteoa
  67. bone spurs
    osteophytes

    osteo a
  68. irregularity & flattening of articular surface
    osteoa
  69. osteo a. txment
    • Palliative only
    • --Pain: analgesics
    • --other symptoms: NSAIDS
  70. Non-suppurative inflammatory destruction of joints
    R.A.
  71. synovitis
    R.A.
  72. Pannus
    reactive macrophage fibroblast proliferation from synovium
  73. symmetric infolvment
    R. arth
  74. small joints in hands & feet
    RA.
  75. Rheumatoid nodules
    beneath the skin near affected joint
  76. swan-neck deformity
    R.A
  77. 80% elevation to RF
    igG ab doesn't recognize self
  78. 50% ANA
    R.A.
  79. 75% TMJ cases
    R.A
  80. R.A. pain
    related to pressure on jt, not motion
  81. TmJ pain is
    • bilateral
    • symmetric
  82. rice bodies
    R.A.
  83. Txment:
    --NSAIDS
    --Corticosteroids
    R.A.

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