Abstract
Patient: A 45-year-old man had experienced intense left facial pain at the beginning of and after meals. No apparent abnormal finding was detected by the clinical examination, panoramic radiography, CT and MRI except for tenderness of left masseter and temporal muscles, and we diagnosed trigeminal neuralgia and myofascial pain. However, neither oral administration of carbamazepine nor injection of local anesthetic to the lesion suppressed the pain. His familiar pain was reproduced just by looking at pickled plum. Moreover, sialography revealed that the duct of parotid gland was narrowed. This suggested the disturbance of natural saliva ejection caused the intense pain during the meal time.
After parotid sialography, his pain has completely disappeared.
Discussion: Trigeminal neuralgia and narrowing of parotid ducts cause transient pain in the face at the beginning of meal. Similarity in the characteristic features of these conditions sometimes makes the diagnosis challenging. Sialography is the only intervention that helps in diagnosing parotid duct stenosis, which should be considered to differentiate this condition and trigeminal neuralgia.
Conclusions: This case suggests that a disturbance of saliva ejection causes trigeminal neuralgia-like intense pain.
