Toothache referred from auriculotemporal neuralgia: case report

Aim To present a 52‐year‐old male patient who complained of intense pain of short duration in the region of the left external ear and in the ipsilateral maxillary second molar that was relieved by blockade of the auriculotemporal nerve in the infratemporal fossa. Summary Extra‐ and intraoral physi...

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Bibliographic Details
Published in:	International endodontic journal Vol. 42; no. 9; pp. 845 - 851
Main Authors:	Murayama, R. A., Stuginski-Barbosa, J., Moraes, N. P., Speciali, J. G.
Format:	Journal Article
Language:	English
Published:	Oxford, UK Blackwell Publishing Ltd 01-09-2009
Subjects:	anaesthesia auriculotemporal neuralgia Dentistry Dexamethasone Ear, External - innervation Ear, External - physiopathology Facial Pain - etiology Facial Pain - therapy Humans Lidocaine local Male Mandibular Nerve - drug effects Mandibular Nerve - physiopathology Maxilla Middle Aged Molar Myofascial Pain Syndromes - physiopathology Myofascial Pain Syndromes - therapy Nerve Block Pain, Referred - etiology Pain, Referred - therapy toothache Toothache - complications Toothache - therapy Treatment Outcome
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Summary:	Aim To present a 52‐year‐old male patient who complained of intense pain of short duration in the region of the left external ear and in the ipsilateral maxillary second molar that was relieved by blockade of the auriculotemporal nerve in the infratemporal fossa. Summary Extra‐ and intraoral physical examination revealed a trigger point that reproduced the symptoms upon finger pressure in the ipsilateral auriculotemporal nerve and in the outer auricular pavilion. The patient’s medical history was unremarkable. The maxillary left second molar tooth was not responsive to pulp sensitivity testing and there was no pain upon percussion or palpation of the buccal sulcus. Periapical radiographs revealed a satisfactory root filling in the maxillary left second molar. On the basis of the clinical signs and symptoms, the auriculotemporal was blocked with 0.5 mL 2% lidocaine and 0.5 mL of a suspension containing dexamethasone acetate (8 mg mL−1) and dexamethasone disodium sulfate (2 mg mL−1), with full remission of pain 6 months later. The diagnosis was auriculotemporal neuralgia. Key learning point • Auriculotemporal neuralgia should be considered as a possible cause of nonodontogenic toothache and thus included in the differential diagnoses. • The blockade of the auriculotemporal nerve in the infratemporal fossa is diagnostic and therapeutic. It can be achieved with a solution of lidocaine and dexamethasone.
Bibliography:	istex:897CAB5FA62AB971A06F9D5C31B61B0603E0927B ark:/67375/WNG-K4T56TBG-V ArticleID:IEJ1599 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Case Study-2 ObjectType-Feature-4 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0143-2885 1365-2591
DOI:	10.1111/j.1365-2591.2009.01599.x