【原】神经痛与非典型面痛、耳痛和头痛（一）

 英语晨读 ·

山东省立医院疼痛科英语晨读已经坚持10余年的时间了，每天交班前15分钟都会精选一篇英文文献进行阅读和翻译。一是可以保持工作后的英语阅读习惯，二是可以学习前沿的疼痛相关知识。我们会将晨读内容与大家分享，助力疼痛学习。

本次文献选自Cutri RM, Shakya D, Shibata SB. Neuralgia and Atypical Facial, Ear, and Head Pain. Otolaryngol Clin North Am. 2022 Jun;55(3):595-606.本次学习由谢珺田副主任医师主讲。

KEYWORDS

Temporomandibular dysfunction; Facial neuralgias; Myofascial pain dysfunction syndrome; Trigeminal nerve; Glossopharyngeal nerve; Intermedius nerve

KEY POINTS

Trigeminal neuralgia (TN) manifests in the facial region innervated by the trigeminal nerve and causes pain in the jaw, teeth, or gums.

Glossopharyngeal neuralgia (GPN) affects the glossopharyngeal nerve and causes pain in the throat, tongue, and ear canal, while geniculate neuralgia (GN) presents in the distribution of the intermedius nerve.

Myofascial Pain Dysfunction Syndrome (MPDS) is a stress-related disorder characterized by pain that is often described as dull, radiating, unilateral, and aching.

Diagnosis of MPDS requires that two of the three criteria be met: the presence of a taut band on palpation, a hypersensitive spot, and the presence of referred pain to a distant area.

Pharmacologic therapy for TN, GPN, and GN includes anticonvulsants (namely carbamazepine), analgesics, steroids, and antidepressants (TCAs). For those who failed to respond to medications, microvascular decompression is the preferred surgical treatment.

关键词：

颞下颌关节功能紊乱；面部神经痛；肌筋膜疼痛功能综合征；三叉神经；舌咽神经；中间神经

关键点：

三叉神经痛（TN）主要累及三叉神经支配的面部区域，表现为下颌、牙齿或牙龈疼痛。

舌咽神经痛（GPN）影响舌咽神经并表现为咽喉、舌部和耳道疼痛，而膝状神经痛（GN）表现为在中间神经分布区疼痛。

肌筋膜疼痛功能障碍综合征（MPDS）是一种与肌紧张相关的疾病，其特征是通常被描述为钝痛、放射痛、单侧痛和酸痛性质的疼痛。

MPDS的诊断需要满足三个标准中的两个：触诊可扪及肌束紧张、扳机点和远隔区域的牵扯性疼痛。

TN、GPN和GN的治疗药物包括抗惊厥药（如卡马西平）、镇痛药、类固醇和抗抑郁药（TCAs）。对于那些对药物无效的患者，微血管减压是首选的外科治疗方法。

INTRODUCTION

Though there have been considerable strides in the diagnosis and care of orofacial pain disorders, facial neuralgias, and myofascial pain dysfunction syndrome remain incredibly cumbersome for patients and difficult to manage for providers. Cranial neuralgias, myofascial pain syndromes, temporomandibular dysfunction (TMD), dental pain, tumors, neurovascular pain, and psychiatric diseases can all present with similar symptoms. As a result, a patient’s quest for the treatment of their orofacial pain often begins on the wrong foot, with a misdiagnosis or unnecessary procedure, which makes it all the more frustrating for them. Understanding the natural history, clinical presentation, and management of facial neuralgias and myofascial pain dysfunction syndrome can help clinicians better recognize and treat these conditions. In this article, we review updated knowledge on the pathophysiology, incidence, clinical features, diagnostic criteria, and medical management of TN, GPN, GN, and MPDS.

引文

尽管在口面部疼痛疾病的诊断和护理方面取得了相当大的进展，但面部神经痛和肌筋膜疼痛综合征依然让患者非常痛苦，让医疗人员感到诊治困难。口面部神经痛、肌筋膜疼痛综合征、颞下颌关节紊乱（TMD）、牙痛、肿瘤、神经血管疼痛和精神疾病都可能表现出类似的症状。因此，患者口面疼痛的治疗往往是从错误的角度开始的，会出现误诊或接受不必要的手术，这让他们油然而生挫败感。详细询问面部神经痛和肌筋膜疼痛综合征的病史、临床表现和诊疗经过可以帮助临床医生更好地诊断和治疗此类疾病。在本文中，我们综述了关于TN、GPN、GN和MPDS的病理生理学、发病率、临床特征、诊断标准和治疗方法的最新进展。

TRIGEMINAL NEURALGIA

The term tic douloureux, French for “painful tic,” was first put in text in 1756 by Nicholas Andre´. His documented case studies depicted patients with facial spasms that were caused by agonizing facial pain. Now referred to as trigeminal neuralgia, the condition generally presents as short episodes of lancinating, unilateral pain affecting the jaw, teeth, or gums that last for seconds to minutes at a time. The pain can be triggered easily by everyday activities such as eating or speaking and occurs due to the disruption of the trigeminal nerve.

三叉神经痛

术语tic douloureux，法语中意为“痛苦的痉挛”，由尼古拉斯·安德烈于1756年首次出现在文本中。他记录的病案描述了由痛苦的面部疼痛引起的面部痉挛患者。现在被称为三叉神经痛，这种情况通常表现为短暂的刺痛，主要累及单侧下颌、牙齿或牙龈，每次发作持续数秒至数分钟。这种疼痛易于由日常活动（如吃饭或说话）引发，可因三叉神经受累及而发病。

The trigeminal nerve possesses three branches: the ophthalmic nerve (V1), the maxillary nerve (V2), and the mandibular nerve (V3). Trigeminal neuralgia is characterized by pain in at least one of these 3 divisions. Of the three, the maxillary nerve and the mandibular nerve are most commonly affected. The ophthalmic nerve, which gives sensation to the eyes and forehead, is usually spared, and is especially rarely targeted alone. The maxillary nerve gives sensations to the roof of the mouth, the upper lip, and the cheeks, while the mandibular nerve gives sensation to the lower lip and jaw. The mandibular nerve is the only branch with motor function as well as sensory function and is most commonly associated with activities such as mastication and swallowing. The mandibular nerve is also the branch of the trigeminal nerve that most correlates with pain within trigeminal neuralgia, which explains why eating can trigger pain spells. TN is most common in elderly populations, with a general incidence rate of 4.3 per 100,000 people in the United States. The condition more commonly affects women compared to men in a 1.6:1 ratio.

三叉神经有三个分支：眼神经（V1）、上颌神经（V2）和下颌神经（V3）。三叉神经痛的特征是这三个分区中至少有一个分区中发生的疼痛发作。在这三个神经分支中，上颌神经和下颌神经最常受累。支配眼部和前额感觉的眼神经很少受累，单独发病者更为罕见。上颌神经支配口腔顶部、上唇和脸颊的躯体感觉感觉，而下颌神经支配下唇和下颌部的感觉。下颌神经是唯一同时具有运动功能和感觉功能的分支，与咀嚼和吞咽等活动密切相关。由此可以解释为什么进食会引发疼痛。TN在老年人群中最为常见，在美国的人群发病率为每10万人4.3例。与男性相比，女性发病率更高，比例为1.6:1。