chpt 18- facial pain and neuromuscular disease

Question 1

3 symptoms with dysfunction of motor nerves

Answer 1

Lack of motion
Weakness
Loss of function

Question 2

loss of sensation

Answer 2

anesthesia

Question 3

partial loss of sensation

Answer 3

hypoesthesia

Question 4

change of sensation

Answer 4

paresthesia

Question 5

increased sensation

Answer 5

hyperesthesia

Question 6

CN VII (facial nerve) is mostly ____ with some ____

Answer 6

mostly motor with some sensory

Question 7

unilateral paralysis of CN VII

Answer 7

Bell’s Palsy

Question 8

What systemic disease has a high rate of Bell’s palsy

Answer 8

Multiple Sclerosis

Question 9

75% of Bell’s palsy caused how

Answer 9

trigger event (viral infection, exposure to cold, pregnancy)

Question 10

Is it called Bell’s palsy if the the paralysis is secondary to surgical or traumatic severance of the nerve

Answer 10

no

Question 11

Syndrome that can have Bell’s Palsy associated

Answer 11

Melkesson – Rosenthal

Question 12

Demographic for Bell’s Palsy

Answer 12

middle aged

Question 13

What is usually cause of Bell’s Palsy in children

Answer 13

Secondary to viral infection, Lyme disease, or earache

Question 14

Clincial appearance of Bell’s Palsy

Answer 14

mask like appearance, inability to smile, close one eye or wink, raise one eyebrow, corner of mouth droops

Question 15

Is there a universal treatment for Bell’s Palsy

Answer 15

no

Question 16

what is the recovery rate for Bell’s Palsy

Answer 16

82% recover slowly within 6 months

Question 17

these may mimic pain of dental origin so must rule out dental inflammatory disease

Answer 17

neuralgias and headaches

Question 18

How will patients act/feel with neuralgias and headaches

Answer 18

confused, frustrated, afraid

Question 19

Called Tic douloureux, affecting the trigeminal nerve (CN V)

Answer 19

trigeminal neuralgia

Question 20

Symptoms of Tic Douloureux/ Trigeminal Neuralgia

Answer 20

extremely severe, electric shock, sharp, lancinating pain in one or more trigeminal branches

Question 21

Most common of all the neuralgias

Answer 21

tic douloureux/trigeminal neuralgia

Question 22

3 divisions of CN V

Answer 22

ophthalmic (i)
maxillary (ii)
mandibular (iii)

Question 23

trigeminal neuralgia most commonly involves which branches

Answer 23

mostly middle (maxillary) and lower (Mandibular), but can be all 3 divisions

Question 24

Criteria diagnosis of trigeminal neuralgia/tic douloureux

Answer 24

abrupt attack, initiated by a light touch and specific, constant trigger . Duration of single spasm <2 min

Question 25

Is there motor deficit in trigeminal neuralgia/tic douloureux

Answer 25

No

Question 26

What can decrease pain in trigeminal neuralgia/tic douloureux

Answer 26

Carbamazepine

Question 27

Common trigger point for trigeminal neuralgia/tic douloureux

Answer 27

nasolabial folds Vermillion border Periorbital skin

Question 28

Treatment for trigeminal neuralgia/tic douloureux

Answer 28

topical/systemic meds Decompress nerve Destroy nerve

Question 29

If paroxysmal facial pain is accompanied by excess lacrimation, conjunctival injection, and intense headache, what should be considered instead of trigeminal neuralgia/tic douloureux

Answer 29

SUNCT syndrome

Question 30

What does SUNCT syndrome stand for

Answer 30

``` S = Short lasting U = unilateral N = Neuralgiform headache C = conjuctival injection T = Tearing ```

Question 31

Similar to trigeminal neuralgia except that the 9th CN is affected

Answer 31

Glossopharyngeal Neuralgia

Question 32

What are the anatomical locations for Glossopharyngeal Neuralgia that is different from trigeminal neuralgia/tic douloureux

Answer 32

intra-auricular area, tonsil, base of tongue, posterior mandible, lateral wall pharynx

Question 33

If pt has neuralgia triggered by talking, chewing, or swallowing

Answer 33

Glossopharyngeal Neuralgia

Question 34

Chronic pain associated with Vericella-Zoster virus/ Shingles characterized by constant burning sensation over nerve distribution with episodic stabbing pains

Answer 34

Postherpectic Neuralgia

Question 35

Facial paralysis seen in association with herpes zoster of the face or external auditory canal also associated with facial paralysis, hearing deficits, vertigo, and other auditory and vestibular symptoms

Answer 35

Ramsay-Hunt Syndrome

Question 36

Treatment options for Ramsay Hunt syndrome

Answer 36

antiviral meds (acyclovir) Antihistamines or vasodilators Systemic corticosteroids Ocular antibiotics and artificial tears

Question 37

What is the recovery rate for Ramsay Hunt Syndrome

Answer 37

82% of pts recover completely in 6 months

Question 38

persistent maxillofacial pain that doesn’t fit any of the other patterns (diagnosis by exclusion), but need to rule out sinus problems, cracked tooth, headache, infection, ischemia, myofascial pain, typical neuralgias, TMD, trauma, or tumors

Answer 38

atypical facial pain

Question 39

Demographics for atypical facial pain

Answer 39

women> men, 40-50 y.o.

Question 40

3 treatments of atypical facial pain

Answer 40

Gabapentin (anticonvulsants) Opiod analgesics Tricyclic antidepressants

Question 41

degeneration and death of marrow and bone from a slow or abrupt decrease in marrow blood flow, will not be picked up on radiograph, only way to diagnose is to inject bone marrow with local anesthetic

Answer 41

Neuralgia – Inducing Cavitational Osteonecrosis

Question 42

Treatment for Neuralgia-Inducing Cavitational Osteonecrosis

Answer 42

Curettage

Question 43

4 types of headaches

Answer 43

Sinus Cluster Tension Migraine

Question 44

pain is behind browbone and/or cheekbones

Answer 44

sinus headache

Question 45

pain is in and around the eye

Answer 45

cluster

Question 46

pain is like a band squeezing head

Answer 46

tension

Question 47

pain, nausea, visual changes

Answer 47

migraine

Question 48

Males> females, 30-40y.o., called an alarm clock headache with vasodilation related to head trauma, abnormal hypothalamic function

Answer 48

cluster/alarm clock headache

Question 49

demographic for Cluster/alarm clock headaches

Answer 49

African-Americans, 80% smokers

Question 50

Character of Cluster headaches

Answer 50

upper face near eye, abrupt onset, no trigger zone, recurs at same time, lasts for weeks then has long remission

Question 51

What nerve and how is the Cluster headache associated

Answer 51

unilateral associated with ophthalmic division Trigeminal

Question 52

2 types of migraine (disabling unilateral headache)

Answer 52

migraine with aura | Migraine without aura

Question 53

vasospasm/vasoconstriction of cerebral arteries in response to reduced serotonin activity followed by vasodilation

Answer 53

migraine

Question 54

Demographic for migraines

Answer 54

women more effected and more severly

Question 55

Best treatment for migraines

Answer 55

recognize and avoid triggers

Question 56

4 meds for migraines

Answer 56

ergotamine Beta blockers Serotonin receptor agonists

Question 57

pain/burning sensation in mouth including gingival, unattached mucosa and tongue, found in post- menopausal women, with a strong associating with depression and anxiety. Will build in intensity and can have altered taste

Answer 57

Burning mouth syndrome

Question 58

technical name for burning mouth syndrome and is there one known cause

Answer 58

Glossopyrosis, multiple causes, multiple treatments

Question 59

Capasin treatment for Glossopyrosis

Answer 59

swish red hot sauce

Question 60

Persistent abnormal taste

Answer 60

dysgeusia

Question 61

75% of taste is

Answer 61

smell

Question 62

injury to auriculotemporal nerve leads to flushing and sweating along its distribution after gustatoary stimuli. Can occur as a result of parotidectomies

Answer 62

Frey syndrome/auriculotemporal syndrome/gustatory sweating

Question 63

autoimmune nonsupparative inflammatory destruction of joings due to cross reacting antibodies, usually have symmetrical large joints

Answer 63

Rheumatoid arthritis

Question 64

Wear and tear inflammation leading to destruction of cartilage, then bone

Answer 64

osteoarthritis/degenerative joint

Question 65

Only bone in the body that has to cross the midline and work in unison with the other side

Answer 65

mandible

Question 66

TMD is a problem of what part of masticatory system

Answer 66

entire masticatory system (teeth, jaws, joints, muscles)

Question 67

TMD that is associated with dysfunction more than pain, having a clicking, popping, disarticulation or lack of opening

Answer 67

arthrogenic disorders

Question 68

Conservative treatments of TMD

Answer 68

``` rest Heat/cold Immobilize Occlusal splint Occlusal adjustment Physical therapy ```