Etiology:
Mechanism is not completely understood.
It is thought to be vasoconstriction or vasospasm of portions
of cerebral arteries leading to cerebral ischemia, followed
by vasodialation with subsequent pain and cerebral edema.
Clinical features:
Prevalent in 3rd through 5th decade of life but 1st
symptoms often begin at puberty .
Affects women more than men.
Frequency of attacks is variable, may occur at frequent
intervals over a period of years or only few occasions
during lifetime.
are
parietal,
Treatment:
Includes variety of drugs- acetylsalicyclicacid , codeine ,
ergotamine, methysergide, norepinephrine.
Prognosis is good and condition may undergo complete and
permanent remission.
M CQ
:
8. Condylar hyperplasia:
a. Is a developmental disorder
b. Is an inflammatory disorder
c. Causes ankylosis
d. None of the above
Right
TMJ
effusion
GLOSSOPHARYNGEAL NEURALGIA:
Pain similar to that of trigeminal neuralgia but not as common as
that
Clinical features:
Etiology is unknown.
No gender predilection is there.
Occurs in middle-aged or older persons.
Certain actions precipitate these trigger zones as swallowing,
talking, yawning or coughing.
Diagnosis:
Much the same as for trigeminal neuralgia, is a clinical
diagnosis based on history and examination.
Computed tomography and MRI are prescribed to detect
related intra or extracranial disease.
Treatment:
Resection of extracranial portion of nerve or intracranial
section.
Many patients require use of membrane stabilizing
throbbing episodes
Localized to
maxillary antrum
Pain may be bilateral with wide extra facial distribution
COMMON FEATURE
1. Pain provoked by trauma or dental treatment
2. In older edentulous case, patient cannot wear
oedema of face
FEATURES SUGGESTIVE OF
PSYCHOGENIC (ATYPICAL) FACIAL PAIN:
Women of middle age or older mainly affected
Absence of organic signs
Pain often poorly localised
Description of pain may be bizarre
Delusional symptoms occasionally associated
the symptoms
be relieved
Important to avoid unnecessary surgery
Sometimes good response to antidepressive
treatment
periodontal membrane
Pain severe and throbbing in character
Teeth hypersensitive to any stimulus
Often widespread and bilateral, occasionally localized
Some cases precipitated by dental procedure as fitting of bridge
or extraction
percussion
precipitate condition
These patients best considered to have
(Marbach, 1986)
Many cases arise without history of extraction or pulp
extirpation
Atypical odontalgias not abolished with dental local
OROFACIAL DYSKINESIA
Condition is thought to be result of either an extrapyramidal
disorder or complication of phenothiazine therapy
Edentulous patients with both upper and lower dentures in
gross malocclusion, exhibited involuntary movements typical of
orofacial dyskinesia
Symptoms disappear when dentures with proper physiologic
craniomandibular relationships were given
Clinical features:
Occurs in persons over 60 years.
Characterized by severe,
involuntary ,dystonic movements
of facial, oral and
cervical musculature.
Movements as lip-smacking
,lip-licking,protrusion of lips
,protrusion of tongue and
mandible are seen.
Condition can occur alone
or inassociation with torticollis
or generalized dystonia
Treatment:
Surgical operations as in case of parkinsons disease
causes improvement in symptoms.
Correction of denture occlusion may be an effective
procedure.
MIGRAINE:
Also called migraine syndrome.
It is dominantly inherited disorder characterized by varying degree
of recurrent vascular headache, photophobia, sleep disruption and
depression.
Is a paroxysmal, unilateral
and rarely bilateral, disabling
headache.
Etiology:
Mechanism is not completely understood.
It is thought to be vasoconstriction or vasospasm of portions
of cerebral arteries leading to cerebral ischemia, followed
by vasodialation with subsequent pain and cerebral edema.
Clinical features:
Prevalent in 3rd through 5th decade of life but 1st
symptoms often begin at puberty .
Affects women more than men.
Frequency of attacks is variable, may occur at frequent
intervals over a period of years or only few occasions
during lifetime.
are
parietal,
Treatment:
Includes variety of drugs-acetylsalicyclicacid , codeine ,
ergotamine, methysergide, norepinephrine.
Prognosis is good and condition may undergo complete and
permanent remission.
Etiology:
It is a disease of cellular immunity.
Vasculitic damage is mediated by activated CD4+T helper
cells responding to an antigen presented by macrophages.
Inflammatory response affects internal elastic lamina.
Multinucleated giant cells are histologic hallmark of this
condition.
Clinical features:
Occurs in older persons between 55 to 80 years.
Onset may be slow and insidious or may develop
suddenly with headache , burning , throbbing pain.
Pain is preceded by malaise , chills , fever , weight loss ,
anorexia , nausea ,vomiting and with increased erythrocyte
sedimentation rate.
Histologic features:
Intima and tunica media proliferation with resultant luminal
stenosis , disruption of internal elastic lamina by mononuclear cell
infiltrate , invasion and necrosis of media progressing to
panarteritic involvement by mononuclear cells , giant cell
formation with granulomata within mononuclear cell infiltrate ,
intravascular thrombosis.
Treatment:
Corticosteroid therapy has good response.
Clinical features:
Develops in any age.
Usually follows extraction of multirooted tooth when it has
been traumatic.
Pain arises within few days to several weeks after extraction.
Emotional disturbance ,ingestion of alcohol,menstrual periods
can also elicit the pain
Differential diagnosis:
Local pain due to traumatic injury to soft tissue or bone
during extraction.
Subacute thyroiditis-produces referred pain in posterior
portion of mandible,occurs in over 35% of patients with
thyroiditis.
Treatment:
HORNERS SYNDROME:
Also called sympathetic ophthalmoplegia.
It is condition characterized by miosis or contraction of pupil of
eye due to paresis of dilator of pupil.
Ptosis or dropping of eyelid due to paresis of smooth muscle
elevator of upper lid.
forms:progressive
muscular
atrophy,amyotrophic
Etiology is unknown.
Called as motor system disease since all forms manifest
corticospinal and anterior horn degeneration with either
bulbar or limb muscle involvement.
Clinical features:
PROGRESSIVE MUSCULAR ATROPHY:
characterized by progressive weakness of limbs with muscular
atrophy,reflex loss and sensory disturbances.
Shows hereditary pattern.
Affects male more frequently than female.
PSEUDOBULBAR PALSY:
It results from loss or disturbance of cortical innervations of bulbar
nuclei.
Treatment:
No specific treatment.
Disease is fatal,although temporary remissions occur.
PERIODIC PARALYSES:
Called as paramyotonia.
Characterized by episodes of flccid muscle weakness occurring at
irregular intervals.
Most conditions are hereditary.
Divided into primary and secondary disorders.
Features include:
-Are hereditary.
-Alteration in serum potassium levels.
-Myotonia co-exists.
-Results due to defective ion channels.
Clinical features:
Manifested by cramping , stiffness , weakness of muscles of
face , neck , fingers and hands upon exposure to cold.
Eyelids are closed and face has mask-like appearance.
Tongue show cramping after drinking cold liquids and speech
becomes slurred.
MULTIPLE SCLEROSIS:
Also known as disseminated sclerosis.
It is an idiopathic inflammatory demyelinating disease of CNS.
Etiology:
It is an autoimmune process.
Some believe HHV-6(human herpes virus) while others implicate
Chlamydia pneumonia as causative agent.
Environmental factors may also be responsible.
Clinical features:
Frequently seen between 20 to 40 years.
Female affected more than males in ratio of 2:1.
Familial incidence is often observed.
Disease is characterized by:
Ocular disturbances as retrobulbar neuritis,nystagmus and
diplopia.
Charcots triad is
patients.
Treatment:
No treatment.
Patient dies due to supervening infection.
MENIERES DISEASE:
Also known as endolymphatic hydrops.
Is an inner ear(labyrinthine) disorder in which there is
increase in volume and pressure of endolymph of inner ear.
Patient presents with waxing and waning hearing loss and
tinnitus associated with vertigo.
Etiology
Current theory states that it is response of inner ear to injury.
Autopsy have shown an increase in volume of endolymph with
distention of entire endolymphatic system.
This leads to permanent damage to both vestibular and cochlear
apparatuses.
Clinical features:
Characterized by deafness,tinnitus and vertigo.
Begins in middle age.
Low-pitched tinnitus is described as roar or hum or hissing
sound.
Deafness described as inner ear deafness of conductive type
which fluctuates in degree.
Treatment:
Some patients react favorably to vasodilators as histamine
or niacin.
Surgical intervention can be considered to relieve the
vertigo,consisting of section of 8th nerve or destructive
labyrinthotomy.
Some cases are hereditary and others follow later In life due to
injury or disease.
Condition
MARIN
AMAT SYNDROME
OR
MARCUS