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Chirurgia OMF

Orofacial Pain And Headache


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Orofacial Pain and Headache is a timely and comprehensive
addition to the important area of the diagnosis and treatment
of craniofacial pain. It is true to state that the diagnosis
and management of acute pain conditions are
readily achieved; this is one of the characteristic features
of the practice of dentistry. However, this is sadly not
the case for many chronic pain conditions. A patient with
chronic orofacial pain can represent a significant challenge
to the clinician, leading to repeated and usually
unsuccessful interventions. Why is this? Unfortunately,
the curriculum of most dental and medical schools has
only a limited emphasis on pain mechanisms, diagnosis
and management. Additionally, there is at present only
an incomplete understanding of the mechanisms underlying
the aetiology and pathogenesis of chronic orofacial
pain conditions. Furthermore, chronic orofacial pain can
take many forms, with a wide variety of apparently successful
treatment options; many of these do not have a
strong scientific or evidence basis. To further complicate
matters, pain is a multidimensional experience involving
physical, cognitive and emotional aspects and chronic
pain in particular recruits active involvement of these
dimensions. An important related factor is that the orofacial
region has special meaning to each of us since we
communicate with and express our feelings to others
through this body region. We recognize our acquaintances
by their facial features, and from the moment of
birth, we sustain our life through the intake of air, fluids
and foodstuffs through orofacial structures.
The trigeminal system provides most of the craniofacial
sensory innervation, and is associated with specific
physiological qualities and pain conditions. For example,
pain syndromes such as trigeminal neuralgia or migraine
are specific to the area, and trigeminal nerve injury
responses differ from those in spinal nerves. Furthermore,
the trigeminal nerve innervates anatomically
related but functionally diverse organs such as the
meninges, the craniofacial vasculature, the eyes, the ears,
the teeth, oral soft tissues, muscles and the temporomandibular
joint. In the brainstem, the trigeminal sensory
nucleus overlaps with upper cervical dermatomes. Taken
together, these features account for the complex and
extensive pain referral patterns that often make clinical
diagnosis so difficult.
The philosophy and design of this book make it a
timely and instructive addition to the pain literature.
Management of orofacial pain demands the services of
clinicians from various specialties due to the anatomical
density of the region. Based on their extensive clinical
experience and a thorough understanding of pain
mechanisms specific to the trigeminal system, the editors,
Professors Yair Sharav and Rafael Benoliel, are well
equipped to integrate knowledge across the various disciplines.
They have written the major part of this comprehensive
textbook and have successfully integrated
knowledge from the areas of headache and craniofacial
pain. In particular, they have succinctly explained common
mechanisms involved in the two regions, with
important implications for pain diagnosis and
The anatomy and neurophysiology relevant to orofacial
pain are covered in Chapter 2, and this provides a
solid basic science underpinning for subsequent chapters
that present current knowledge of aetiologic and pathophysiologic
mechanisms. The book emphasizes the four
major clinical entities of orofacial pain: acute dental
(Chapter 5), neurovascular (Chapters 9, 10), musculoskeletal
(Chapters 7, 8) and neuropathic (Chapter 11). Diagnostic
and management strategies are emphasized in
these chapters and in Chapter 1, supplemented by expert
contributions on otolaryngology and facial pain (Chapter
6) and neurosurgical procedures (Chapter 12), pharmacotherapy
for acute and chronic pain (Chapters 15, 16), complementary
and alternative medicine (Chapter 17) and
psychologically based interventions (Chapter 4). Novel
in its approach is the chapter on the occurrence of craniofacial
pain in systemically complex patients (Chapter 14).
The clinical chapters are complemented by several informative
case reports that offer insight into the complexity
of orofacial pain diagnosis and management.
As such, this book should be an invaluable resource for
dental or medical students, dental practitioners, pain specialists
from all fields and basic and clinical pain scientists
who are interested in an up-to-date and comprehensive
review of the diagnostic and management issues in the
orofacial pain field.

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