摘要
目的探讨误诊为牙源性疼痛的三叉神经痛的临床特点,并总结鉴别诊断和治疗经验。方法对24例误诊为牙源性疼痛的三叉神经痛患者的临床资料作回顾性分析。结果本组男11例、女13例,年龄41~78岁(56.8±8.8)岁。疼痛累及三叉神经第Ⅱ支分布区者5例,第Ⅱ、Ⅲ支分布区者19例。均曾就诊于口腔科或口腔诊所并按照牙源性疼痛进行治疗,此后就诊于疼痛科、神经内科和神经外科,辅以头颅MRI特定序列影像学检查,诊断为原发性三叉神经痛22例、继发性三叉神经痛2例。20例原发性三叉神经痛接受微血管减压术,2例继发性三叉神经痛接受桥小脑角区占位切除术,患者在术后早期疼痛均有缓解。结论误诊为牙源性疼痛的三叉神经痛多累及三叉神经第Ⅱ支或第Ⅱ、Ⅲ支分布区。为鉴别牙源性疼痛与三叉神经痛,应仔细询问患者病史、了解疼痛特点,选择恰当的检查手段如头颅MRI特定序列明确诊断。对原发性三叉神经痛和继发性三叉神经痛应分别选择相应的治疗方式。
Objective To investigate the clinical characteristics,differentiation diagnosis and treatment experience of trigeminal neuralgia misdiagnosed as odontogenic pain. Methods We retrospectively analyzed the clinical data of 24 cases with trigeminal neuralgia misdiagnosed as odontogenic pain. Results Of all 105 cases of trigeminal neuralgia,24 cases（ 22. 9%） had been misdiagnosed as odontogenic pain,including 11 male（ 45. 8%） and 13 female（ 54. 2%） patients,with age of 41-78（ 56. 8 ± 8. 8） years at admission. The distribution area of pain were involved with trigeminal nerve Ⅱbranch in 5 cases（ 20. 8%） and ⅡⅢ branches in 19 cases（ 79. 2%）. All 24 cases had visited stomatology department or clinic with diagnosis of odontogenic pain and related treatment,including 8 cases with tooth extraction. Patients were diagnosed as trigeminal neuralgia after the consultation with pain department,neurology department or neurosurgery department with assistance of head MRI specific sequences. Twenty cases of primary trigeminal neuralgia received microvascular decompression and 2 cases of secondary trigeminal neuralgia received resection of cerebellopontine angle mass,with alleviation of symptom after surgery in the early period. Conclusions The trigeminal neuralgia misdiagnosed as odontogenic pain are mostly involved with trigeminal nerve Ⅱ branch or Ⅱ Ⅲ branches. To identify the odontogenic pain and trigeminal neuralgia,we should carefully ask the patients＇ medical history,understand the characteristics of pain,and then select the appropriate means of examination,such as head MRI specific sequence. For primary trigeminal neuralgia and the secondary trigeminal neuralgia,we should choose the different treatment methods.
出处
《山东医药》
CAS
北大核心
2017年第35期83-86,共4页
Shandong Medical Journal
基金
北京市215高层次卫生技术人才学术骨干项目(2014-03-061)
关键词
三叉神经痛
牙源性疼痛
微血管减压术
桥小脑角区占位切除术
trigeminal neuralgia
odontogenic pain
microvacular decompression
resection of cerebellopontine angle region
