Scrivani S J, Keith D A, Kulich R, Mehta N, Maciewicz R J
Department of Oral and Maxillofacial Surgery, Columbia-Presbyterian Medical Center, School of Dental and Oral Surgery, New York, New York 10032, USA.
J Orofac Pain. 1998 Fall;12(4):287-92.
Six cases are reported in which the primary complaint was episodic, recurrent facial pain that was triggered by a taste stimulus. The pain first occurred days to weeks after head and neck surgery. Patients reported that a food stimulus placed in the mouth evoked episodic, electric shock-like pain in a preauricular location on the surgical side. The smell of food or, less reliably, emotional excitement could also trigger pain. Mandibular movement did not evoke the pain, and between lancinating attacks there was either no pain or only mild discomfort. Following an episode of pain, there was a refractory period during which the pain could not be elicited. Physical examination demonstrated a preauricular sensory loss of variable distribution. No abnormal sweating or vasomotor findings were clinically apparent. No odontogenic, muscular, salivary gland, neurologic, or psychologic pathology was found to explain the clinical symptoms. The pain was not relieved with standard doses of anticonvulsants that are commonly used to treat trigeminal neuralgia. The duration of the recurrent pain symptoms in this group was 8 to 132 months without remission. Gustatory neuralgia may be a discrete syndrome that results from abnormal interactions between salivary efferent fibers and trigeminal sensory afferent fibers in the injured auriculotemporal nerve. The unique features of the disorder make it a potentially useful clinical model for the investigation of autonomic/sensory interactions in neuropathic pain.
本文报告了6例病例，其主要诉求为发作性、复发性面部疼痛，由味觉刺激引发。疼痛首次出现在头颈部手术后数天至数周。患者报告称，将食物刺激物放入口中会在手术侧耳前部位引发发作性电击样疼痛。食物的气味或者不太可靠的情绪激动也可能引发疼痛。下颌运动不会引发疼痛，在刺痛发作之间要么没有疼痛，要么只有轻微不适。一次疼痛发作后，会有一段不应期，在此期间无法引发疼痛。体格检查显示耳前感觉丧失，分布各异。临床上未发现异常出汗或血管舒缩方面的表现。未发现牙源性、肌肉性、唾液腺、神经性或心理性病变可解释临床症状。常用治疗三叉神经痛的标准剂量抗惊厥药物无法缓解疼痛。该组复发性疼痛症状的持续时间为8至132个月，未缓解。味觉性神经痛可能是一种独立的综合征，由受损耳颞神经中唾液传出纤维与三叉神经感觉传入纤维之间的异常相互作用所致。该疾病的独特特征使其成为研究神经病理性疼痛中自主神经/感觉相互作用的潜在有用临床模型。
