Chronic idiopathic facial pain is the diagnosis given to a group of orofacial pain of psychogenic origin which includes atypical facial pain, facial-arthromyalgia, atypical odontalgia and oral dysaesthesia. Despite various biochemical findings, the condition remains poorly understood, but we have begun to understand the nature of these patients. This review discusses the possible aetiology of the disease through various biochemical and clinical findings. The contribution of behavioural and psychological factors to the clinical course of the disease are described. The type of adverse life events that predispose people to the disease and their potency are briefly mentioned. The current diagnostic approach for the disease is also mentioned. Treatment includes antidepressant medication, physiotherapy, bite-guards and analgesics. The problems encountered in the long-term management and outcome studies of these patients include drop-outs, non-compliance and denial.
The standard procedure for alveolar cleft closure in cleft lip and palate patients is by alveolar bone grafting (ABG) where the residual opening of oronasal fistula in the palate is also closed simultaneously. Occasionally there is a situation of soft tissue inadequacy and attempt to close the fistula at the same procedure as ABG may compromise the result of the bone graft itself. An unforeseen leakage at the closure may cause graft infection leading to failure. This article reports on a technique where alveolar bone grafting was done without closure of residual palatal fistula to provide adequate soft tissue coverage for the grafted bone. This may reduce the risk of leakage at the oral mucosal coverage of the graft . The residual palatal fistula will be closed at later stage by muco-palatal flap or tongue flap. We reported on a case of a failed ABG which was reconstructed using this technique. Various other techniques to ensure success of ABG were also discussed. Conclusion: The alveolar bone grafting without closure of oro-nasal fistula reduced the risk of failure of ABG in a wide alveolar cleft.
Mental nerve neuropathy is an important presenting complaint that may be encountered by dental surgeons in their daily practise. There are various pathological processes that could bring about this symptom, ranging. from simple dental cause to vague, life threatening diseases. We present three cases of mental paraesthesia of different aetiologies. A literature review on mental nerve neuropathy related to malignancies and infection is discussed. The importance of a thorough chair side history taking, clinical examination and relevant investigations are emphasised in a suggested clinical approach to obtaining the diagnosis of a numb chin.
Aneurysmal bone cyst is a rare non-epithelialized pseudocyst of the jaws. Jaffe and Lichtenstein in 1942 were the first to recognize aneurysmal bone cyst as a distinct clinical and pathological entity while Bernier and Bhaskar in 1958 were the first to describe the presence of this lesion in the jaws. A case of aneursymal bone cyst in the maxilla is presented and the literature reviewed.
Differential diagnosis of orofacial pain is crucial, as the course of each process and its clinical management varies markedly. A case is illustrated here of trigeminal neuralgia in a 49-year-old Indian female whose complaint was initially diagnosed as dental pain leading to sequential extractions of her right mandibular and maxillary molars but with no pain abatement. Subsequent neurological assessment diagnosed her complaint as trigeminal neuralgia but pain remained poorly controlled even with high doses of carbamazepine and gabapentin. A dental referral and orthopantomographic examination revealed multifocal sclerotic masses in her jaws, suggestive of florid cemento-osseous dysplasia (FCOD). Right mandibular incisional biopsy confirmed the diagnosis. A decision was made to curette the right mandibular masses and lateralised the right inferior dental nerve. Follow-up disclosed considerable pain reduction. This case raises the issue as to whether the sclerotic bone masses in FCOD may have caused nerve compression which
aggravated her neuralgic pain.