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Research Article| Volume 48, ISSUE 1, P3-20, July 1979

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Jawbone cavities and trigeminal and atypical facial neuralgias

  • Eugene J. Ratner
    Correspondence
    Reprint requests to: Dr. Eugene J. Ratner Facial Pain Clinic V.A. Extended Care Center St. Albans, N.Y. 11425
    Affiliations
    Maxillofacial Pain Clinic, Research Laboratory for Oral Tissue Metabolism, Brooklyn, N. Y., USA

    Dental Service, Veterans Administration Hospital, Brooklyn, N. Y., USA

    Department of Oral Medicine and Oral Pathology, Harvard School of Dental Medicine, Boston, Mass. USA

    Forsyth Dental Center Boston, Mass. USA
    Search for articles by this author
  • Philip Person
    Affiliations
    Maxillofacial Pain Clinic, Research Laboratory for Oral Tissue Metabolism, Brooklyn, N. Y., USA

    Dental Service, Veterans Administration Hospital, Brooklyn, N. Y., USA

    Department of Oral Medicine and Oral Pathology, Harvard School of Dental Medicine, Boston, Mass. USA

    Forsyth Dental Center Boston, Mass. USA
    Search for articles by this author
  • Daniel J. Kleinman
    Affiliations
    Maxillofacial Pain Clinic, Research Laboratory for Oral Tissue Metabolism, Brooklyn, N. Y., USA

    Dental Service, Veterans Administration Hospital, Brooklyn, N. Y., USA

    Department of Oral Medicine and Oral Pathology, Harvard School of Dental Medicine, Boston, Mass. USA

    Forsyth Dental Center Boston, Mass. USA
    Search for articles by this author
  • Gerald Shklar
    Affiliations
    Maxillofacial Pain Clinic, Research Laboratory for Oral Tissue Metabolism, Brooklyn, N. Y., USA

    Dental Service, Veterans Administration Hospital, Brooklyn, N. Y., USA

    Department of Oral Medicine and Oral Pathology, Harvard School of Dental Medicine, Boston, Mass. USA

    Forsyth Dental Center Boston, Mass. USA
    Search for articles by this author
  • Sigmund S. Socransky
    Affiliations
    Maxillofacial Pain Clinic, Research Laboratory for Oral Tissue Metabolism, Brooklyn, N. Y., USA

    Dental Service, Veterans Administration Hospital, Brooklyn, N. Y., USA

    Department of Oral Medicine and Oral Pathology, Harvard School of Dental Medicine, Boston, Mass. USA

    Forsyth Dental Center Boston, Mass. USA
    Search for articles by this author
DOI:https://doi.org/10.1016/0030-4220(79)90229-9
Jawbone cavities and trigeminal and atypical facial neuralgias
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      Abstract

      The possible role of dental and oral disease in the etiology of idiopathic trigeminal and atypical facial neuralgias has been examined. Among thirty-eight patients with idiopathic trigeminal neuralgia and twenty-three patients with atypical facial neuralgia, there was in nearly all instances a close relationship between pain experienced and the existence of cavities in alveolar bone and jawbone of the patients. The cavities were at the sites of previous tooth extractions and, although at times more than 1 cm. in a given diameter, were usually not detectable by x-rays. A new method for their detection and localization was developed empirically, based on the observation that peripheral infiltration of local anesthetic into or very close to the bone cavity rapidly abolished trigger and pain perception by patients during persistence of the anesthetic action. Histopathologic examination of bone removed from cavities by curettage revealed, in both idiopathic trigeminal and atypical facial neuralgias, a similar pattern characterized by a highly vascular abnormal healing response of bone. Some lesions presented a mild chronic inflammatory (lymphocytic) infiltration. Preliminary microbiologic studies of material from the walls of the cavities showed the existence within them of a complex, mixed polymicrobial aerobic and anaerobic flora. Treatment consisted of vigorous curettage of the bone cavities, repeated if necessary, plus administration of antibiotics to induce healing and filling-in of the cavities by new bone. Responses of patients to the above treatment consisted of marked to complete pain remissions, the longest of which has been for 9 years. Complete healing leads to complete and persistent pain remissions. It was concluded that in both idiopathic trigeminal and atypical facial neuralgias, dental and oral pathoses may be major etiologic factors.
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      Article info

      Footnotes

      ☆This study was supported by Project 7347-01 and Medical Investigatorship 36a to Philip Person, from the Office of Medical Research, Veterans Administration, Washington, D. C.

      Identification

      DOI: https://doi.org/10.1016/0030-4220(79)90229-9

      Copyright

      © 1979 Published by Elsevier Inc.

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