McMonagle B, Connor S, Gleeson M
Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
J Laryngol Otol. 2011 Jun;125(6):649-50. doi: 10.1017/S0022215111000168. Epub 2011 Feb 28.
To present a rare cause of facial pain, and the differential diagnosis of a lesion of the mandibular division of the trigeminal nerve.
A 19-year-old woman presented to a tertiary referral skull base centre with right periorbital pain and a progressive, right-sided deficit of the mandibular division of the trigeminal nerve. Clinical examination revealed right-sided hypoaesthesia in the mandibular division of the trigeminal nerve dermatome, mild trismus and some wasting of the right masseter muscle. Computed tomography and magnetic resonance imaging scans revealed a small area of mildly enhancing soft tissue centred within the foramen ovale, with concentric enlargement. Surgery was undertaken via an infratemporal fossa (Fisch) type D approach. A vascular lesion was found filling the foramen ovale, with no obvious nerve separate from the lesion. The lesion was removed en bloc. Histopathological analysis demonstrated a venous haemangioma within the nerve.
Facial pain is common, and may be wrongly attributed to trigeminal neuralgia. A thorough clinical examination must be performed to identify subtle neurological abnormalities, and appropriate imaging undertaken to exclude rare causes, such as this venous haemangioma of the mandibular division of the trigeminal nerve.
介绍一种罕见的面部疼痛病因以及三叉神经下颌支病变的鉴别诊断。
一名19岁女性因右侧眶周疼痛及三叉神经下颌支进行性右侧功能缺损就诊于一家三级转诊颅底中心。临床检查发现三叉神经下颌支皮节右侧感觉减退、轻度牙关紧闭及右侧咬肌轻度萎缩。计算机断层扫描和磁共振成像扫描显示以卵圆孔为中心有一小片轻度强化的软组织区域，并呈同心性增大。通过颞下窝（Fisch）D型入路进行手术。发现一个血管病变占据卵圆孔，未发现与病变明显分离的神经。病变被整块切除。组织病理学分析显示神经内有静脉性血管瘤。
面部疼痛很常见，可能被错误地归因于三叉神经痛。必须进行全面的临床检查以识别细微的神经异常，并进行适当的影像学检查以排除罕见病因，如这种三叉神经下颌支静脉性血管瘤。
