Main

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.