Woda A, Pionchon P
Laboratoire de physiologie oro-faciale, U.F.R. d'Odontologie Université d'Auvergne, U.F.R. d'Odontologie 11, Bd Charles de Gaulle, 63000 Clermont-Fd, France.
Rev Neurol (Paris). 2001 Mar;157(3):265-83.
Atypical facial pain, stomatodynia, atypical odontalgia, masticatory muscle and some temporomandibular joint disorders are grouped together under the category of orofacial idiopathic pain as they reveal numerous common clinical features. For each of these entities, problems of definition and terminology are discussed. Epidemiological and demographic data and a semiological description are given. Proposed diagnostic criteria and some of the causes or mechanisms common to these entities are also described in this article. Firstly, the rôle of female hormones in the physiology and treatment of certain patients is suggested with regard to the marked prevalence of changes in oestrogen levels in patients with orofacial idiopathic pain. Postmenopausal osteoporosis and the hypothesis of neuralgia due to the presence of cavities of osteonecrosis are placed within the context of atypical facial pain. A neuropathic component is suggested for these pain entities. These latter may be linked to a phenomenon of central sensitisation that is induced and maintained by activity in the peripheral tissues. Clinical features of both atypical facial pain and atypical odontalgia have led several authors to advocate the existence of a sympathetic mechanism in the physiopathology of these entities. Moreover, some arguments emphasize similarities with Complex Regional Pain Syndromes of limbs. Lastly, psychosocial components are also considered as a common factor, but it is currently impossible to determine if the pain is the cause or the result of psychosocial problems. Currently, none of these mechanisms can be considered as a single established etiological factor. Indeed, each of these mechanisms can be observed in all types of orofacial idiopathic pain. This leads to the hypothesis that these different mechanisms may act on each target tissue but the details of interaction are still unknown.
非典型面部疼痛、口腔疼痛、非典型牙痛、咀嚼肌及一些颞下颌关节紊乱症，由于具有众多共同的临床特征，被归为口面部特发性疼痛类别。本文针对这些病症中的每一种，讨论了定义和术语问题。给出了流行病学和人口统计学数据以及症状学描述。本文还介绍了提议的诊断标准以及这些病症共有的一些病因或机制。首先，鉴于口面部特发性疼痛患者雌激素水平变化显著，提出了女性激素在某些患者生理及治疗中的作用。绝经后骨质疏松症以及骨坏死腔导致神经痛的假说被置于非典型面部疼痛的背景下进行讨论。这些疼痛病症被认为存在神经病理性成分。后者可能与外周组织活动诱导并维持的中枢敏化现象有关。非典型面部疼痛和非典型牙痛的临床特征使多位作者主张在这些病症的病理生理过程中存在交感神经机制。此外，一些论据强调了与肢体复杂性区域疼痛综合征的相似性。最后，心理社会因素也被视为一个共同因素，但目前尚无法确定疼痛是心理社会问题的原因还是结果。目前，这些机制中没有一种可被视为单一的确立病因。事实上，所有类型的口面部特发性疼痛中均可观察到这些机制中的每一种。这引发了一种假说，即这些不同机制可能作用于每个靶组织，但相互作用的细节仍不清楚。
