Abstract
Atypical maxillofacial pains were clinically investigated in 18 cases and obtained following results.
1. The pains submitted were composed of 7 atypical trigeminal neuralgia, 5 symptomatic trigeminal neuralgia and atypical facial pains. The patients generally had a complexed long term medical history.
2. The pains were persistent even in the atypical trigeminal neuralgia. The pains in both the atypical trigeminal neuralgia and atypical facial pain were localized at the gingival, alveolar and facial regions, while the pains in the symptomatic trigeminal neuralgia were noted at the distant regions from the pain-inducing causative place.
3. Before our clinic, healthy teeth were irrationally treated when the pain occurred at the alveolar region. Contrarily, the causative teeth or odontogenic lesions were overlooked when the pain were widely and distantly distributed.
4. Peripheral nerve block with bupivacaine was very effective for the atypical trigeminal neuralgia, therefore, local anesthetic block seems an useful approach which should be tried before alcohol block.
5. Most atypical facial pains were associated psychogenic distress.
These results indicate that not only the usual diagnostic procedures, but some other approaches such as psychogenic evaluation, pain threshold and nerve block test are essential for early correct diagnosis in the atypical orofacial pains.
