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Sato J, Saitoh T et al. Oral Surg 2004; 97: 18–22

In this study, 61 patients (mean age 59 yrs) with sharp shooting pains in the mouth and face but no other neurological symptoms were interviewed and examined. All were provisionally diagnosed with trigeminal neuralgia (TN) and prescribed carbamazepine (CBZ). Further examination included MRI and CT scans for intracranial lesions and the final diagnosis was made by agreement between a maxillofacial surgeon and a neurosurgeon.

The final diagnosis was TN in 50 cases (7 were symptomatic of tumours), atypical pain in 6, pulpitis in 2, sinusitis in 2 and trigeminal neuritis in one. CBZ was effective in 45 TN patients, and also in 5 without TN, perhaps because CBZ inhibits nociceptive transmission. Trigger zones were present in 30 patients with TN and 1 with sinusitis. No atypical facial pain patients had a trigger zone. The authors recommend thorough examination of these patients, not least because they may have intracranial tumours.