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23rd Annual Pain Medicine Meeting 2024
November 21-23, 2024 | Caesars Palace, Las Vegas, Nevada
6191
UNUSUAL PRESENTATION OF DENTAL ASSOCIATED JAW PAIN MISDIAGNOSED AS TRIGEMINAL NEURALGIA
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Part of Topic
Medically Challenging Cases
Unusual Presentation of Odontogenic Pain Misdiagnosed as Trigeminal Neuralgia
INTRO
•Trigeminal Neuralgia (TN) is a neuropathic disorder with recurrent pain along the distribution of the trigeminal nerve
•TN has no objective laboratory findings that confirm the diagnosis. Detailed history and exam is key.
•TN is mostly in the V2 and V3 distribution causing it to mimic odontogenic pain.
•It would be unusual to have a case of odontogenic pain misdiagnosed as TN given odontogenic pain usually has an identifiable dental cause such as caries.
PATIENT HISTORY AND COURSE
•45-year-old female with history of migraines
•Suffered fall from a scooter causing left mandibular fracture
•Underwent uncomplicated ORIF of mandible
•Continued pain after procedure
•Interventions received after initial fixation
•Extensive dental cleaning
•Mandible hardware explant
•Root canal
•Botox injections
•Oxcarbazepine trial
•Providers seen prior to pain management referral:
•2 Otolaryngologists
•Neurology
•Dentistry
CASE RESOLUTION
•Ultimately referred to pain management for consideration of TN block, nearly 2 years after her initial mandible fixation
•Detailed history and timeline was created of all of her procedures and specialty visits.
•Became clear that her pain was improving until her root canal after which she had worsening pain
•Deferred TN block due to belief that this was odontogenic pain and block would not present long-term solutions
•Case discussed with dental colleague and patient received dedicated dental CT scan
•Extracted affected tooth with resolution of her symptoms.
DISCUSSION
•This case demonstrates importance of detailed history in diagnosis of pain syndromes.
•H&P especially important in situations where patients see a wide array of specialists and have undergone numerous procedures (some potentially unwarranted)
•Taking the time to extensively chart review and perform a history can prevent undue procedures for patients, reduce patient harm, and lead to faster resolution of patient symptoms
•
REFERENCES
•Khawaja SN, Scrivani SJ. Trigeminal Neuralgia. Dent Clin North Am. 2023 Jan;67(1):99-115. doi: 10.1016/j.cden.2022.07.008. Epub 2022 Oct 27. PMID: 36404084.