抄録
Two case reports are presented that show neuropathic orofacial pain which was induced by cooling of oral mucous membrane in the extraction site of teeth. The first patient, a 59-year old Japanese woman, was referred for restorative dental treatment of lower anterior teeth. In addition, well-localized, transient, tingling pain was triggered in extraction site of teeth (upper right first premolar and lower right first molar) by cold food and drink. An uncomfortable sensation or pain was rarely perceived without cooling. She had had her 14 teeth extracted successively due to dental caries and periodontal disease within 10 years and complained of the pain for 5 years since she lost the teeth. Her pain was sometimes more intense at night than in the daytime, but nonsteroidal anti-inflammatory drugs (NSAIDs) were effective for a sound sleep. The second patient, a 31-year old Japanese woman, had intense, spontaneous pain in the left posterior maxilla and right and left posterior mandible. Precise examination revealed the patient had both dull organic pain due to purulent inflammation in the periapical tissues and stinging atypical pain complicated by successive extirpation of a total of 6 tooth pulps and extraction of a total of 6 molars. The latter atypical pain was triggered by cooling of oral mucous membrane in the extraction site of teeth. The former pain was relieved by endodontic treatment to remove and disinfect the contaminated root canals of teeth and periapical tissues, whereas the latter atypical pain was relieved by sympathetic blockade. These pains disappeared in 21 long months, however, frequent stellate ganglion blocks or traumatic nerve injury during needle puncture brought about Horner's syndrome.
