By Maryam ArbabHouse Officer

CASE PRESENTATION

Date: 29 Aug, 2016

Patient ID: 43130

Name: M/O Javed

Age: 40

Address: Peshawar

CASE PRESENTATION

Chief Complaint: Pain on right side of the face.

CASE PRESENTATION

History Of Chief Complaint:• Pain on right side of the face for last five

months.• Sharp stabbing pain in the morning,

reduces during the day.• Pain in unilateral.• Pain is exacerbated with cold air, washing

face and smiling.• Pain radiated to the temporal region• Difficulty in performing daily chores.

CASE PRESENTATION

Past Dental History: Patient got her treatment done for the same complaint two months back. She was advised extractions for lower right 28, 29, 30, 31 but the symptoms didn’t relieve.

CASE PRESENTATION

Medical History:• Hypertension

CASE PRESENTATION

Family History:• Diabetes• Hypertension

CASE PRESENTATION

Medications:• Anti hypertensive drugs

CASE PRESENTATION

Clinical Examination: Extra Oral:A. Visual:

- No facial asymmetry - No abnormality presentB. Palpation: - Not tender on palpation

CASE PRESENTATION

Intra Oral:• DMFT- 16, 14 decayed- 28, 29, 30, 31 missing- 18, 17 filled- Normal mucosa - Normal tongue- No pathological lesion present

CASE PRESENTATION

Investigations: No clinical investigations were carried out.

Differential Diagnosis:1. Dental pain2. Sinus pain3. Post herpetic neuralgia4. Cluster headache5. Atypical facial pain6. Temporomandibular pain dysfunction

syndrome7. MPDS

CASE PRESENTATION

Specific Diagnosis: Trigeminal Neuralgia

CASE PRESENTATION

Trigeminal neuralgia has three branches:1. Ophthalmic divison2. Maxillary division3. Mandibular division

Trigeminal neuralgia affects one or more branches of trigeminal nerve.

CASE PRESENTATION

Pathophysiology:• Slowly evolving process, either caused

by the compression exerted on the nerve by a blood vessel or a tumor

• Or alteration of neural functions by a MS plaque at the level of dorsal root entry zone leads to increased excitability in some of the trigmenial afferents and subsequently to typical TGN.

CASE PRESENTATION

Management:• Patient Education: To establish patient’s

treatment goals and adherence to therapy.• Elimination of odontogenic pain. Medical Treatment:A. Drug Therapy:1. Anticonvulsants; drug of choice is

carbamazepine Initial dose is 100 mg BD This is increased 100 mg each day until the pain is controlled Maximum dose 800-1000 mg

CASE PRESENTATION

Surgical Treatment:1. Cryotherapy2. Neurectomy3. Alcohol injections4. Radio frequency5. Thermocoagulation6. Glycerol injections7. Micro compression

CASE PRESENTATION

THANK YOU