Department of Oral Diagnostic Sciences, Nihon University School of Dentistry, Tokyo, Japan; Division of Clinical Research, Dental Research Center, Nihon University School of Dentistry, Tokyo, Japan.
Department of Endodontics, Nihon University School of Dentistry, Tokyo, Japan.
J Endod. 2017 Jul;43(7):1201-1206. doi: 10.1016/j.joen.2017.02.002. Epub 2017 May 2.
Painful trigeminal neuropathy attributed to a space-occupying lesion (code 13.1.2.5 in the International Classification of Headache Disorders, 3rd edition [beta version]) is an orofacial pain condition that has characteristics of classical trigeminal neuralgia but is caused by a space-occupying lesion. We present 4 cases of intracranial lesions mimicking odontogenic pain as follows: case 1, a 61-year-old woman presented with a chief complaint of aching soreness in the right mandibular molar area for 1 year; case 2, a 59-year-old man presented with severe pain in the left maxillary and mandibular molars; case 3, a 72-year-old man presented with a chief complaint of facial shock-like pain on the left side; and case 4, a 75-year-old man presented with a chief complaint of paroxysmal pain and numbness in the buccal gingiva of the right mandibular molar region. Cases 1 and 2 had trigeminal neuralgia, which had previously been incorrectly attributed to osteoma and maxillary sinus retention cyst, respectively, and resulted in inappropriate dental surgical procedures. All patients subsequently underwent magnetic resonance imaging, and the results were consistent with intracranial disease. Magnetic resonance images revealed acoustic neuromas in the cerebellopontine angle in cases 1, 2, and 4 and a small meningioma near the entry to the left Meckel cave in case 3. Cases 1, 3, and 4 had these lesions removed; after which, their pain resolved. Before dental treatment, dental practitioners should focus not only on dental imaging but also on the patient's medical history and pain characteristics.
因占位性病变引起的痛性三叉神经病变(国际头痛疾病分类,第 3 版[β版]中的代码 13.1.2.5)是一种口面痛病症,具有典型的三叉神经痛特征,但由占位性病变引起。我们介绍了 4 例模仿牙源性疼痛的颅内病变如下:病例 1,一位 61 岁女性,主要诉右下颌磨牙区酸痛 1 年;病例 2,一位 59 岁男性,主要诉左上颌和下颌磨牙剧痛;病例 3,一位 72 岁男性,主要诉左侧面部电击样疼痛;病例 4,一位 75 岁男性,主要诉右侧下颌磨牙区颊侧牙龈阵发性疼痛和麻木。病例 1 和 2 均为三叉神经痛,此前分别错误地归因于骨瘤和上颌窦潴留囊肿,并导致了不适当的牙科手术。所有患者随后均进行了磁共振成像,结果与颅内疾病一致。磁共振图像显示病例 1、2 和 4 中桥小脑角有听神经瘤,病例 3 中左侧 Meckel 腔入口附近有小脑膜瘤。病例 1、3 和 4 均进行了这些病变的切除,疼痛随后得到缓解。在进行牙科治疗之前,牙科医生不仅应关注牙科影像,还应关注患者的病史和疼痛特征。