The differential diagnostics of pain syndrome in the maxillofacial area. Analysis of a clinical case

Abstract

The purpose of the study was to demonstrate the main stages of a complex examination and differential diagnosis of atypical facial pain on the example of a case from clinical practice. In modern conditions, the diagnosis and effective treatment of pain in the maxillofacial area is based on a multidisciplinary approach. Often, the causes of pain in the face, jaws and tongue are different. The variety of causes, complex and multi component diagnostic protocols (and as a result, a high risk of diagnostic mistakes)—all that requires deep knowledge of the anatomy, physiology and pathophysiology of the maxillofacial area, without which it is impossible to understand the diagnosis of the above-mentioned diseases. Based on the subjective characteristics of the pain syndrome and neurological symptoms, it is not always possible to reliably establish the etiology of facial pain. It is quite risky to draw final diagnostic conclusions even with relatively high efficiency of prescribed medicine therapy, since the syndromological approach to the treatment of such patients widely used in practice is palliative in nature and does not contain requirements for a clear assessment of the etiological factor. In the case of persistent facial pain, it is important to perform special studies to verify and evaluate the structural changes involved in the process of changing anatomical formations. The presence of objective symptoms is an important criterion in the topical diagnosis of facial prosopalgia. A clinical case of prosopalgia in a 35-year-old female patient with symptoms of trigeminal neuralgia is presented. The patient marked the positive effects from the use of non-steroidal anti-inflammatory drugs (nimesulide and ibuprofen) and antiseizure medications (carbamazepine). A thorough examination of the patient's dental status made it possible to verify the diagnosis—follicular cyst of the left upper jaw from the retained and dislocated 28th tooth, orofacial pain associated with diseases of dento-alveolar and accompanying structures. The surgical treatment made it possible to successfully cure the patient.

Differential diagnosis of pain in the maxillofacial area is a difficult task for both dentists and neurologists. Usually, such patients do not apply immediately after the problem arises but after some time, so additional signs of sensory, motor and trophic disorders may be detected in their status. There are often cases when the same etiological factor may cause different clinical symptoms, on the other side, a similar clinical complex is able to develop under the influence of different causes.