急性牙髓炎误诊为三叉神经痛临床分析

Clinical Analysis of Acute Pulpitis Misdiagnosed as Trigeminal Neuralgia

目的探讨急性牙髓炎和三叉神经痛的临床特点、鉴别诊断要点及误诊原因、防范措施。方法回顾性分析2019年10月—2021年12月收治的就诊初期曾误诊为三叉神经痛的急性牙髓炎14例的临床资料。结果本组均有颌面部疼痛症状,其中额颞部突发性偏头痛且稍按压疼痛难忍10例;发作性颌面部剧烈疼痛,并可蔓延至颞枕部,伴或不伴眼部爆裂样痛3例;双侧颞部疼痛,可蔓延至额部,不敢张口咀嚼1例。14例就诊初期皆诊断为三叉神经痛,予相应治疗后效果不佳转我院,误诊时间7 d~1个月;后均经详细口腔检查和相关医技检查等确诊急性牙髓炎,病因:龋齿9例,牙隐裂3例,髓石压迫2例,皆行根管治疗,疼痛均好转或消失;随访6个月无复发。结论急性牙髓炎可误诊为三叉神经痛。临床医师需加强对急性牙髓炎和三叉神经痛临床特点的认识,仔细询问病史,细致口腔检查,根据疼痛特点认真鉴别诊断,必要时行牙髓活力检查、X线全口曲面体层检查等,以减少或避免误诊误治。

Objective To explore the clinical characteristics and differential diagnosis of acute pulpitis and trigeminal neuralgia,as well as causes of misdiagnosis and preventive measures.Methods The clinical data of 14 patients with acute pulpitis misdiagnosed as trigeminal neuralgia at the initial stage of treatment from October 2019 to December 2021 were retrospectively analyzed.Results All patients had maxillofacial pain symptoms,including 10 patients with sudden migraine in the frontotemporal region and intolerable pain caused by slight pressing,3 patients with paroxysmal severe maxillofacial pain,which could spread to the temporo-occipital region,with or without eye burst pain,and 1 patient who had bilateral temporal pain which could spread to the forehead,and had difficulty in opening his mouth to chew.All 14 patients were diagnosed with trigeminal neuralgia at the initial stage of treatment,and were transferred to our hospital with poor results after corresponding treatment.The duration of misdiagnosis was 7 d to 1 month.All patients were diagnosed as acute pulpitis by detailed oral examination and relevant medical technical examination.The causes were caries in 9 cases,cracked teeth in 3 cases,and pulp stone compression in 2 cases.All patients were treated with root canal therapy,and the pain improved or disappeared.There was no recurrence after 6-month follow-up.Conclusion Acute pulpitis can be misdiagnosed as trigeminal neuralgia.It is necessary to strengthen the understanding of the clinical characteristics of acute pulpitis and trigeminal neuralgia,carefully inquire the clinical history,carefully examine the oral cavity,carefully differentiate and diagnose according to the characteristics of pain,and perform pulp vitality examination and panoramic X-ray,when necessary to reduce or avoid misdiagnosis and mistreatment.