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------=_NextPart_01C77481.94CE4DE0 Content-Location: file:///C:/E6732D95/OrofacialPain-DrChiu_files/master06.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C77481.94CE4DE0 Content-Location: file:///C:/E6732D95/OrofacialPain-DrChiu_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C77481.94CE4DE0 Content-Location: file:///C:/E6732D95/OrofacialPain-DrChiu_files/slide0001.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Problem Based Workshop in Pain Management 2007
Problem Based Workshop in Pain = Management 2007
Dr. Ken Chiu =
Oral & Maxillofacial Surgery, HKU
28 January 2007
=
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Orofacial Pain
ØNon-neurological causes:
Ø
<= span style=3D'font-size:75%'>ØDental causes
Ø
<= span style=3D'font-size:75%'>ØTemporomandibular joint pain
Ø
<= span style=3D'font-size:75%'>ØENT causes
&Osla= sh;<= span style=3D'font-size:75%'>ØEye disorders
Ø
= <= span style=3D'font-size:75%'>ØOther surgical causes
&Osla= sh;
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oSiKo0iK12MmpzAnKqBcI4MFUQAdzmEIqkU5ksETJlCDladcabcEp7ABG1CGBDQax1CKw0iMxWiM x4iMyaiMy8iMzeiMTQFmpwAny5U2UYAey5EXQfArtAhzE8F8Z7hcMLAEuzgIF3ABncgx+jERz8iO 7eiO7wiP8SiP88iM0TgIQBASFIYeCiRJHbERGZFfFkER99Z8IBaO43gKFmAB6Hgx+uEt9AiRESmR E0lakRVpkcoFSyKhQhSGiKLgVeXxMGaXCGUojgg5CBzAAQzJA/3RkBfpki8JkzEpkzOZXLAkBuPy iexxOUfmiSVJjqKYLCy5kjRJlEVplEeJlEmplEvJlE1JQoEAADs= ------=_NextPart_01C77481.94CE4DE0 Content-Location: file:///C:/E6732D95/OrofacialPain-DrChiu_files/slide0018.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Problem Based Workshop in Pain Management 2007
Orofacial Pain
ØNon-neurological causes:
Ø
ØDental causes – dental caries, pulpitis, cracked tooth, periodontitis, pericoronitis, dentoalveolar abscess
ØTemporomandibular joint pain – myofascial pain, disc displacement, arthritis
<= span style=3D'font-size:75%'>ØENT causes – Sinusitis; dental in origin= is possible
ØEye disorders – acute glaucoma, refracto= ry errors, heterophoria or heterotropia
Øsquamous cell carcinoma/salivary gland tumour = in the jaw and sinus, cranial base or intracranial lesions
Hetero= phoria: A tendency for deviation of the eyes from parallelism, prevented by binocular vision= .
Origin= : hetero-+ G. Phora, movement
Hetero= tropia =3D strabismus: A deviation of the eye which the patient cannot overcome. The= visual axes assume a position relative to each other different from that require= d by the physiological conditions. The various forms of strabismus are spoken = of as tropias, their direction being indicated by the appropriate prefix, as cyclo tropia, esotropia, exotropia, hypertropia and hypotropia. Also call= ed cast, heterotropia, manifest deviation and squint.
Origin= : Gr. Strabismos =3D a squinting
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Orofacial Pain
ØNeurological causes:
ØTension headache
ØMigraine
ØTrigeminal neuralgia and= other neuralgias
ØCluster headache
ØAtypical facial pain = ;
Ø<= /span> =
= ØPsychological causes
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Clinical Features
ØDental cause
Ødental car= ies: poorly localized, sensitivity provoked by heat/cold/s= weets
Øpulpitis: =
(1)reversible: sharp, intermittent pain of sh= ort duration, = provoked by heat/cold/sweets/biting.
(2)irreversible: continuous severe, excruciat= ing, unbearable pain, lasting for hours, tooth tender to percuss= ion.
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Clinical Features
ØDental cause
Øcracked tooth: poorly localized episodic dull pain, sharp pain of= short duration can be provoked by chewing, hypersensitivity to cold
Øperiodontitis: dull pain, poorly localized pain, inflamed swollen g= um, loose tooth, tender to percussion, bad breath
<= span style=3D'mso-special-format:bullet;color:#99FF99;mso-color-index:6;positio= n: absolute;left:-6.08%;font-family:Wingdings;font-size:80%'>Ø<= /span>
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Clinical Features
ØDental cause
Øpericoronitis: aching pain, inflammat= ion and gum swelling around = erupting wisdom tooth; may also have trismus and systemic symptoms
Ødentoalveolar abscess: aching pain, i= ntra- and/or extra-oral swelli= ng, with or without systemic symptoms
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Clinical Features
ØTemporomandibular joint pain
Ødull aching pain around = ear and/or jaw muscles, lasting for weeks
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.22em'>Øaggravated by chewing, clenching
Øclicking or crepitation = of joint, jaw locking , limited mouth opening
<= span class=3DBB style=3D'position:absolute;left:-4.29%;top:.22em'>Øtender TMJ and masticato= ry muscles
Ø
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Clinical Features
ØSinusitis
Ømoderate pain which is u= sually pressure in character, nasal obstruction, rhinorrhoea, can be association with URI
<= span class=3DBB style=3D'position:absolute;left:-4.0%;top:.22em'>Øpain usually lasts for f= ew days to weeks
Ømay be aggravated by head movements or Valsalva manoeuvre
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Clinical Features
ØSinusitis
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.22em'>Øtenderness of maxilla= 3;
Ølook for dental causes, = usually in the maxillary premolars or molars Øpain relieved by antibio= tics and nasal decongestants
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.22em'>Øabnormal endoscopic exam= ination
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Clinical Features
ØNeoplasms
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.22em'>ØUlceration, swelling in = the jaw
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.22em'>ØCervical lymphadenopathy=
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.22em'>ØOther neurological defic= its
<= span style=3D'visibility:hidden'>Ø
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Investigations
ØVitality test of teeth
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.22em'>ØCold/heat test
<= span class=3DBB style=3D'position:absolute;left:-4.43%;top:.22em'>ØElectric pulp test
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Investigations
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------=_NextPart_01C77481.94CE4DE0 Content-Location: file:///C:/E6732D95/OrofacialPain-DrChiu_files/slide0014.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Problem Based Workshop in Pain Management 2007
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