Case report:
We present the case of a 51-year-old female patient, presenting with acute symptoms of pain around the right maxillary and mandibular region, lasting less than 60 seconds.
These attacks of pain became more frequent in the last year, up to an average of 3 attacks a week. They usually came after a paresthesia of the homolateral hemiface.
The clinical examination, supported by X-ray OPT and intraoral x-rays, did not reveal any dental pathology. Compression of homolateral trigger zones had a positive outcome.
A neurological imaging that showed no alterations completed the diagnosis.
Then we made a diagnosis of essential trigeminal neuralgia. The recommended therapy was Carbamazepine 100 mg tablets 2 times a day. We increased the dosage in the following weeks, up to a correct dosage of 200 mg 3 times a day.
Discussion:
Trigeminal neuralgia is one of the most frequent facial neuralgias.
It is possible to distinguish between an essential form of unknown etiology, a secondary form caused by inflammations, toxinfectious or mechanical factors and nerve pathologies, and a postherpetic form caused by herpes zoster infections involving the V cranial nerve.
Essential trigeminal neuralgia usually manifests after 40 years of age, in a ratio of M:F=2:3.
The seasons with the most frequent attacks of pain are spring and autumn. From a clinical point of view, essential trigeminal neuralgia causes acute, sudden unilateral pain, lasting no more than 60 seconds. Another important aspect is that everyday gestures can cause the pain, such as sneezing, chewing, speaking, or through a stimulation of the trigger zones.
The pain is often anticipated by prodromes, such as tic douloureux, facial rash, sensation of heat, lacrimation, nasal secretion or increase in salivation.
The treatment of essential forms is usually pharmacological. The drug of choice is Carbamazepine. In case of failure, it is possible to have recourse to the surgical therapy.
Conclusions:
Essential trigeminal neuralgia is one of the most frequent facial neuralgias. Knowing this pathology and a correct differential diagnosis with other facial neuralgias are crucial in order to avoid wrong diagnosis and treatment.
F. Inchingolo 1-4, A. D. Inchingolo1, M. Tatullo 2, M. Marrelli 4 , A.M. Inchingolo 3, F. Carbotti 1, A. Palladino 1, M. De Carolis 1, V. Angelini 1 , A.D. Inchingolo1, G. Dipalma1-4
1 Department of Odontostomatology and Surgery, University of Bari, Bari, Italy
3 Department of Odontostomatology and Surgery, University of Milano, Milano, Italy
4Department of Maxillofacial Surgery, Calabrodental Srl, Crotone, Italy