Migrainous neuralgia may be localized to the mouth. Episodes of pain and remission without identifiable cause and absence of relief with local anesthesia are important clues. Trigeminal neuralgia (tic douloureaux) may involve the entire branch or part of the mandibular or maxillary branches of the fifth cranial nerve and produce pain in one or a few teeth. Pain may occur spontaneously or may be triggered by touching the lip or gingiva, brushing the teeth, or chewing. Glossopharyngeal neuralgia produces similar acute neuropathic symptoms in the distribution of the ninth cranial nerve. Swallowing, sneezing, coughing, or pressure on the tragus. | Chapter 032. Oral Manifestations of Disease Part 8 Migrainous neuralgia may be localized to the mouth. Episodes of pain and remission without identifiable cause and absence of relief with local anesthesia are important clues. Trigeminal neuralgia tic douloureaux may involve the entire branch or part of the mandibular or maxillary branches of the fifth cranial nerve and produce pain in one or a few teeth. Pain may occur spontaneously or may be triggered by touching the lip or gingiva brushing the teeth or chewing. Glossopharyngeal neuralgia produces similar acute neuropathic symptoms in the distribution of the ninth cranial nerve. Swallowing sneezing coughing or pressure on the tragus of the ear triggers pain that is felt in the base of the tongue pharynx and soft palate and may be referred to the temporomandibular joint. Neuritis involving the maxillary and mandibular divisions of the trigeminal nerve . maxillary sinusitis neuroma and leukemic infiltrate is distinguished from ordinary toothache by the neuropathic quality of the pain. Occasionally phantom pain follows tooth extraction. Often the earliest symptom of Bell s palsy in the day or so before facial weakness develops is pain and hyperalgesia behind the ear and side of the face. Likewise similar symptoms may precede visible lesions of herpes zoster infecting the seventh nerve Ramsey-Hunt syndrome or trigeminal nerve. Postherpetic neuralgia may follow either condition. Coronary ischemia may produce pain exclusively in the face and jaw and like typical angina pectoris is usually reproducible with increased myocardial demand. Aching in several upper molar or premolar teeth that is unrelieved by anesthetizing the teeth may point to maxillary sinusitis. Giant cell arteritis is notorious for producing headache but it may also produce facial pain or sore throat without headache. Jaw and tongue claudication with chewing or talking is relatively common. Tongue infarction is rare. Patients with subacute thyroiditis
