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Abstract
Misdiagnosis frequently led to treatment failure.
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Israel HA, Ward JD et al. J Oral Maxillofac Surg 2003; 61: 662–667
Some patients have orofacial pain which is difficult to diagnose, and consequently treatment may fail. Over a 2 year period, 120 patients (75% female; mean age 49 yrs) with a history of pain for a mean 6.75 yrs, and having seen on average 6 previous specialists, were seen at a New York facial pain clinic.
A single clinician from a multidisciplinary team recorded each patient's history and conducted an examination, with other clinicians present. The team immediately met in conference, made diagnoses and recommended appropriate treatment. Diagnoses included: myofascial pain (50%), atypical facial neuralgia (40%), depression (30%), TMJ synovitis (14%), TMJ osteoarthritis (12%), trigeminal neuralgia (10%) and TMJ fibrosis (2%).
In 38 patients, previous treatment had been performed: endodontics (30%), exodontia (27%), apicoectomy (12%), TMJ surgery (6%), neurolysis (5%), orthognathic surgery (3%) and debridement of bone cavities (2%). In more than half of patients, surgical treatment had clearly exacerbated pain. In 6 patients, gross misdiagnosis led to serious sequelae: in one, a parotid adenocarcinoma treated as a TMJ problem for 13 months was found to be inoperable.
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Oral and maxillofacial surgery in patients with chronic orofacial pain. Br Dent J 195, 659 (2003). https://doi.org/10.1038/sj.bdj.4810785
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DOI: https://doi.org/10.1038/sj.bdj.4810785