A 55-year-old female presents with 3-years history of severe lancinating pain extending from left ear to her maxillary area. Pain is triggered by chewing and brushing teeth. She was treated by otolaryngologist for sinus infection a year ago and undergone multiple dental work and teeth extraction with transient or no improvement. The most likely diagnosis is:
Trigeminal neuralgia or Tic Douloureux is clinically characterized by paroxysmal lancinating pain in the distribution of one or two division of trigeminal nerve. There is commonly no sensory or motor impairment on examination. The pain is triggered by ceain mild stimuli such as touching, chewing, brushing teeth, and cold breeze. If any objective neurological findings are detected, other pathologies causing compression of the nerve at its exit zone from the brainstem must be suspected. Such pathologies as AVM, tumors, and aneurysm must be ruled out by MRI. This disease is assumed to be caused by a loop of a vessel, often superior cerebellar aery or posterior inferior cerebellar aery (PICA), compressing the trigeminal nerve as it emerges from brainstem.
Maxillary sinusitis
Trigeminal neuralgia
Maxillary osteomyelitis
Gradenigo's syndrome
Cerebrovascular Diseases