Jawbone cavities and trigeminal and atypical facial neuralgias

By Ratner E., Person P., Kleinman D., Shlar g., Scoransky S.

Date: 01/1979
Journal: JOMS

Purpose:

Investigate association between jawbone cavities and atypical facial neuralgias

Materials/Methods:

n=38 patients diagnosed with idiopathic trigeminal neuralgia and 23 patients diagnosed with atypical neuralgia. Routine exam and radiographs revealed no pathology. Authors developed new diagnostic procedure to detect and localize pain disease. Pain localized to extraction sites. Areas were exposed, curetted, packed with tetracycline soaked gauze.

a.Divided areas of pain distribution into regions associated with teeth 1. anterrior 2. midregion (premolars) 3. posterior

b.1st area of suspected lesion is blocked with plain Carbocaine, if pain subsides the cause of pain is in area of block-after block subsides, a hypodermic needle pushed through cortical plate and Carbocaine deposited in suspected area-if pain subsides the area has been located

c.Cavity is then exposed and curetted, packed with tetracycline impregnated guaze until healthy granulation tissueis established

d.Patient is placed on 1,600,000 units of oral penicillin 1 week prior to curettage and continues this until 1 month after pain subsides

Results:

Local anesthesia at bony cavitation’s produced pain relief in most cases. Radiographs could not detect lesions until radiopaque material placed in area during curettage. Microbial analysis was positive for mixed aerobic and anaerobic flora.

-11 (29%) of Trigeminal neuralgia patients had 100% relief, 16 (42%) had 90-98% relief

-7 (30%) of Atypical facial pain patients had 100% relief, 6 (26%) had 90-95% relief

Clinical Significance:

May be something else to look for if the a patient presents with pain in an edentulous area-authors state even in cases where pain wasn’t completely eradicated it reduced the levels of medications required to control the pain.