Title : Atypical facial pain – a mistaken diagnosis
Abstract:
Once diagnostic labels have been given to patients, they can be very difficult to change. Atypical Facial Pain (AFP) is a case in point. It has been defined as ‘facial pain that does not meet the criteria for other known conditions.’ The pain is unilateral, of varying duration and typically located infra-orbitally, around the mastoid process, in the external auditory meatus or in the submandibular region. In the absence of a trigger point trigeminal neuralgia can be excluded. Treatment is usually the prescription of Tegretol or antidepressants.
However, the true cause can be determined by an understanding of the:
a. Embryology of the first branchial arch.
b. Its derived motor nerve supply to all eight muscles via the mandibular division of the trigeminal nerve.
c. The physiology of occlusion and the site of proprioceptors.
d. The construction of complete dentures
e. Centric (jaw) relation and centric occlusion.
f. The pathogenesis of temporo-mandibular joint dysfunction syndrome (TMJDS).
The unilateral, episodic pain of atypical facial pain suggests that this is due to muscle spasm, the most common cause of which is temporo-mandibular dysfunction syndrome. In fact, the symptoms of AFD are due to muscle spasm in the four smaller and often forgotten muscles supplied by the motor division of the trigeminal nerve. The correct diagnosis is TMJDS. It follows that symptoms that might have formally led to a diagnosis of AFD should lead to a complete examination of both the larger four muscles of mastication and a complete examination of the occlusion including determining the occlusion at centric relation and any slides into centric occlusion followed by appropriate occlusal therapy.
