Facial Pain And Sensory Loss

Sensory trigeminal neuropathy:

Progressive, painless loss of trigeminal sensation. Normally unilateral and without trigeminal motor weakness, the sensory loss may affect one or all trigeminal divisions. This condition is often associated with established connective tissue disease (scleroderma, Sjogren's syndrome and mixed connective tissue disease (MCTD)). Diagnosis requires exclusion of intracranial granuloma and tumour compressing the trigeminal nerve -meningioma, schwannoma, epidermoid - by contrast enhanced MRI.

Mental neuropathy (numb chin syndrome):

Caused by a lesion of the mandibular nerve or inferior alveolar or mental branches, usually the result of metastatic compression of the nerve within the mandible. Bone scans or an enhanced CT/MRI combined with image-guided aspiration is diagnostic.

Infraorbital neuropathy (numb cheek syndrome) has similar etiology. Gradenigo's syndrome:

Lesions located at the petrous-temporal bone apex (osteitis or meningitis associated with otitis media) irritate the ophthalmic division of the trigeminal and abducens (VI) nerve. Forehead pain is accompanied by ipsilateral lateral rectus palsy and a Horner's syndrome if sympathetic fibres are also involved. Tumours and trauma can also produce this syndrome.

Neuropathic Keratitis

Corneal anaesthesia from a central or peripheral V nerve lesion may lead to a neuropathic keratitis. The corneal surface becomes hazy, ulcerated and infected and blindness may follow.

Patients with absent corneal sensation should wear a protective shield, attached to the side of spectacles, when out of doors.

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