Sympathetic Activity-Mediated Neuropathic Facial Pain Following Simple Tooth Extraction: A Case Report

ABSTRACT

This is a report of a case of sympathetic activity-mediated neuropathic facial pain induced by a traumatic trigeminal nerve injury and by varicella zoster virus infection, following a simple tooth extraction. The patient had undergone extraction of the right lower third molar at a local dental clinic, and soon after the tooth extraction, she became aware of spontaneous pain in the right ear, right temporal region, and in the tooth socket. At our initial examination 30 days after the tooth extraction, the healing of the tooth socket was normal; however, the patient had a tingling and burning sensation (dysesthesia) and spontaneous pain of the right lower lip and the right temporal region, both of which were exacerbated by non-noxious stimuli (allodynia). The patient also showed paralysis of the marginal mandibular branch of the facial nerve, taste dysfunction, and increased varicella zoster serum titers. A diagnostic stellate ganglion block (SGB) 45 days after the tooth extraction using one percent lidocaine markedly alleviated the dysesthesia and allodynia. These symptoms are characteristic of neuropathic pain with sympathetic interaction. The patient was successfully treated with SGB and a tricyclic antidepressant.

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Notes on contributors

Atsushi Kohjitani

Dr. Atsushi Kohjitani received his D.D.S. degree in 1990 from Tokyo Medical and Dental University School of Dentistry and a Ph.D. in 1997 from Kobe University School of Medicine. He is an assistant professor in the Department of Dental Anesthesiology at Okayama University Hospital of Dentistry since 1998.

Takuya Miyawaki

Dr. Takuya Miyawaki received his D.D.S. degree in 1986 and a Ph.D. in 1995 from Okayama University Dental School. He is an associate professor in the Department of Dental Anesthesiology at Okayama University Hospital of Dentistry since 1996.

Keigo Kasuya

Dr. Keigo Kasuya received his D.D.S. degree in 1994 from Kyushu Dental College. He is a resident in the Department of Dental Anesthesiology at Okayama University Hospital of Dentistry since 1998.

Masahiko Shimada

Dr. Masahiko Shimada received his D.D.S. degree in 1980 and a Ph.D. in 1984 from Tokyo Medical and Dental University School of Dentistry. He is a professor in the Department of Dental Anesthesiology at Okayama University Hospital of Dentistry since 1993, and a professor in the same department at Okayama University Graduate School of Medicine and Dentistry since 2001.