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Correspondence to: Michele Gomes a partir de Nascimento R. Artur Coutinho, 143 - santo Amaro 50100-280 Recife, PE, Brasil. E-mail: michelepmpe
BACKGROUND and OBJECTIVES:
Auriculotemporal neuralgia is an unusual condition. Symptoms ~ ~ brief significant pain attacks, specifically in the temporal region. Return many guindaste neuralgias estão related come nervous compression, they may be existing without i can identify etiologic factors. This estude aimed at describing a case of major auriculotemporal neuralgia and respective therapeutic approach.
Male patient, 72 years old, presented for assistance reporting serious pain in left temporal region, defined as shock e of very short duration. After clinical evaluation and imaging exams, no decorrer significant alters were detected. Patient has actually satisfactorily comment to carbamazepine.
This case mostra that auriculotemporal neuralgia has actually clinical presentation o mesmo, semelhante to various other neuralgias. Diagnosis is primarily derived by pain features evaluation e exclusion of possible secondary causes.
Keywords:Auriculotemporal nerve; Auriculotemporal neuralgia; Neuropathic pain
JUSTIFICATIVA E OBJETIVOS:
A neuralgia dá aurículotemporal denominações uma condição rara. Os sintomas consistem em ataque de dor intensa, de curta duração, sobretudo na área temporal. Apesar muitos casos de neuralgias cranianas sejam relacionados à compressão nervosa, podem acontecer sem grupo etiológicos identificáveis. Ministérios objetivo disto estudo aquisição descrever um circunstancias de neuralgia auriculotemporal primário e respectiva conduta terapêutica.
RELATO a partir de CASO:
Paciente do gênero masculino, 72 anos, compareceu para participação relatando agonizante intensa em área temporal esquerda, descrita como choque, de curtíssima duração. Depois de avaliação clínica e exames de imagens, que foram detectadas alterações significativas. O doentes respondeu de forma satisfatória à carbamazepina.
O caso descrito mostra que der aurículotemporal possui apresentações clínica semelhante àquela de outras neuralgias. Ministérios diagnóstico denominações obtido predomínio pela análise das propriedades da agonizante e exclusão de possíveis causas secundárias.
Descritores:Dor neuropática; nervos aurículotemporal; Neuralgia do aurículotemporal
Neuropathic pain outcomes from der primary nervous system injury or disorder, triggered by local trauma or systemic diseases e affecting peripheral or centro nervous structures. Considering a symptom, orofacial neuropathic pain might be classified in two categories: episodic or continuous. Episodic neuropathic pain is characterized by ache paroxysms described as electric shock or twinge, o mesmo, semelhante to what happens with trigeminal neuralgia (TN)11 Benoliel R, Eliav E. Neuropathic orofacial pain. Boca Maxillofac Surg Clin phia băc Am. 2008;20(2):237-54.. Pains paroxysms ser estar in normal followed through remission periods, known as refractory periods. Pain may be share in main (classic) or secondary (symptomatic) and the difference in between them is important para adequate diagnosis and management. While ns vast bulk of patients have actually brief, severe and paroxysmal pain, constant pain may also be present22 Speciali JG, Gonçalves DA. Auriculotemporal neuralgia. Curr pains Headache Rep. 2005;9(4):277-80.,33 Gadient PM, smith JH. Ns neuralgias: diagnosis and management. Curr Neurol Neurosci Rep. 2014;14(7):459.. Most common neuralgias ~ ~ trigeminal, post-herpetic, glossopharyngeal e occipital. Much less frequent are supraorbital e intermediate nerve neuralgia. These disorders may underlie infectious and/or inflammation neurologic diseases, in addition to other primary headaches33 Gadient PM, blacksmith JH. Ns neuralgias: diagnosis e management. Curr Neurol Neurosci Rep. 2014;14(7):459..
The auriculotemporal nerve (n.AT) is naquela sensory branch originating em ~ mandibular nerve traseira trunk. As result of its pathway, over there is significant risk ao compression and irritation. Its nervous root form a short trunk, which gives several branches and innervates temporomandibular share (TMJ), temporal region, pinna e external acoustic meatus. It conducts sympathetic fibers to ns scalp and parasympathetic yarn to ns parotid gland44 Janis JE, Hatef DA, Ducic I, Ahmad J, Wong C, Hoxworth RE, et al. Anatomia of the auriculotemporal nerve: variations in its partnership to the área de superfície temporal artery and implications para the treatment of migraine headaches. Plast Reconstr Surg. 2010;125(5):1422-8.. Anatomic relationship between n.AT and masticatory muscles, TMJ e surrounding vessels in the infra temporal fossa region, creates favorable conditions porque o compressive syndromes55 Komarnitki I, Andrzejczak-Sobocinska A, Tomczyk J, Deszczynska K, Ciszek B. Clinical anatomia of the auriculotemporal nerve in the área of the infratemporal fossa. Folia Morphol. 2012;71(3):187-93.,66 dia GJ, Koh JM, Cornwall J. The origin of ns auriculotemporal nerve and its connection to ns middle meningeal artery. Anat Sci Int. 2015;90(4):216-21..
Auriculotemporal neuralgia (NAT) is an uncommon condition. In a tertiary center, reported frequency era just 0.4%77 Murayama RA, Stuginski-Barbosa J, morares NP, Speciali JG. Toothache referred from auriculotemporal neuralgia: instance report. Int Endod J. 2009;42(9):845-51.. It appears to be much more prevalent in middle-aged females. Symptoms ~ ~ excruciating pain attacks, specifically in ns temporal region. Pain in TMJ, parotid and ear, com irradiation come temporal region is additionally described e may it is in relieved through auriculotemporal nerve anesthetic block88 Stuginski-Barbosa J, Murayama RA, Conti PC, Speciali JG. Refractory face pain attributed come auriculotemporal neuralgia. J Headache Pain. 2012;13(5):415-7.,99 Levin M. Nerve block in ns treatment that headache. Neurotherapeutics. 2010;7(2):197-203.. Return not having actually its very own classification, a name epicranial neuralgias has actually been suggested, including neuralgias of other peripheral branches1010 The internacional Classification the Headache Disorders, 3rd ed. (beta version). Cephalalgia. 2013;33(9):629-808.,1111 Olesen J, Marie-Germaine B. The internacional Classification the Headache Disorders second ed. ICHD-ll. Headache. 2004;48(5):691-3., such as supraorbital, supratrochlear, nasal, greater e lesser occipital nerves1212 Pareja JA, Pareja J, Yangüela J. Nummular headache, trochleitis, supraorbital neuralgia, and other epicranial headaches and neuralgias: a epicranias. J Headache Pain. 2003;4(3):125-31..
Although many craniana neuralgias ser estar primary, other etiologic components may be involved. Refractory situations or com paresthesia might indicate a presence of expansive injuries. Although mechanisms of such conditions are not completely explained, non-odontogenic toothache77 Murayama RA, Stuginski-Barbosa J, moraes NP, Speciali JG. Toothache referred a partir de auriculotemporal neuralgia: situation report. Int Endod J. 2009;42(9):845-51., refractory face pain88 Stuginski-Barbosa J, Murayama RA, Conti PC, Speciali JG. Refractory facial pain attributed to auriculotemporal neuralgia. J Headache Pain. 2012;13(5):415-7., as well as NAT secondary to synovial cyst in ns condyle1313 Ansari H, Robertson CE, roadway JI, Viozzi CF, Garza I. Auriculotemporal neuralgia second to TMJ synovial cyst: naquela rare presentation of der rare entity. Headache. 2013;53(10):1662-5. Ser estar reported by ns literature.
This aprender aimed at reporting der case of NAT where underlying secondary factors were no found, e which has favorably comment to low dose that carbamazepine.
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Male patient, 72 year old, who came for assistente complaining of serious left temporal an ar pain, explained as shock. First crisis had been 5 years ago com spontaneous remission. Two months back pain reappeared, com very brief duration, com several episodes varying a partir de 1 to 2 minutes. These episodes were repetitive three to 4 times naquela day e did no wake up patience at night. At physical evaluation, no decorrer pain trigger-zone was found. Patient had controlled diabetes and referred having been it is registered to prostatectomy as result of cancer. Mind magnetic resonance era normal. Panoramic X-rays that jaws e computerized tomography that temporomandibular joints had not shown far-ranging changes (Figures 1, 2 e 3). Diagnostic hypothesis foi ~ NAT. Carbamazepine (200mg) ser estar prescribed during the first two days, continuing com 400mg para the adhering to 15 days. In the o primeiro dia week using ns drug, patient foi ~ revaluated and reported lower frequency the shocks (2 come 3 per day), i beg your pardon he defined as "pinching". In ns following week, patience referred symptoms remission. Maintenance dose the 200mg foi ~ then kept and 4 months later on there has been bruta symptoms control.