Abstract
Patient: A 59 -year-old woman was complaining severe pain and dysesthesia in the left premolar region of the maxilla and the left trigeminal nerve branch Ⅱ region. The symptoms suddenly developed after undergoing left maxillary sinus cystectomy 3 years ago. The pain did not improve at all even after visiting various medical institutions. In addition to the appearance of paroxysmal electric shock pain that stings the left trigeminal nerve branch Ⅱ region, persistent pain with throbbing and deep continued throughout the day. At the first visit, we suspected trigeminal nerve pain although it was not typical, and prescribed carbamazepine 100mg/day. The electric shock pain diminished but persistent pain remained. MRI showed neurovascular compression of the trigeminal nerve. In addition, a trigger point with pain related to the left premolar was found in the left temporal muscle, thus the massage guidance was given and the pain was further diminished, however the discomfort and pain with allodynia persisted. After stellate gangrlion blocks （SGB） and Ⅳ magnesium（Mg）sulfate andⅣ lidocaine hydrochloride, the pain subsided within the range of self-control. Currently, the pain is controlled by the combined use of SGB and Ⅳ of Mg and lidocaine.
Discussion: The patient was diagnosed as having both trigeminal neuralgia and complex regional pain syndrome typeⅠwith sympathetically maintained pain, peripheral and central neuropathic pain, and was also concurred myofacial pain.
Conclusion: In the clinical practice of orofacial pain, there are various causes of pain. Careful diagnosis and various approaches are crucial for pain control of such patient.
