2016 Volume 9 Issue 1 Pages 47-51
Patient: A 55-year-old man had experienced stabbing pain around the right periorbital area seven years ago. After visiting the Neurosurgery clinic, he was prescribed carbamazepine for trigeminal neuralgia, and his pain was relieved. Incision and drainage were performed for implantitis at a dental office. One week following the procedure, he presented to our orofacial pain clinic with intermittent right periorbital and temporal pain accompanied by autonomic symptoms, such as redness of eye or lacrimation. At the first visit, we diagnosed possible trigeminal neuralgia, and he was prescribed carbamazepine （100 mg/day）. Magnetic resonance imaging showed neurovascular decompression at the root entry zone of the right trigeminal nerve by the superior cerebellar artery. Subsequently, the attack frequency, duration, pain intensity and autonomic symptoms reduced, and then completely disappeared after two months. After administering for seven months, carbamazepine was withdrawn. As of five months since medication withdrawal, stabbing pain around the upper eyelid has recurred with a few attacks per day without autonomic symptoms. Carbamazepine （100 mg/day） was resumed, which provided complete relief of pain for fifteen months.
Discussion: It is clinically difficult to differentiate trigeminal neuralgia from SUNCT since patients with trigeminal neuralgia may present with mild autonomic symptoms such as lacrimation and/or redness of the eye. According to ICHD3β such patients should receive both diagnoses.
Conclusions: Trigeminal neuralgia with autonomic symptoms is rare. The dentist should carefully discriminate between the two diseases/cases since there are cases where patients have facial pain with autonomic symptoms, like TACs.
