Orofacial neuralgia associated with a middle cerebral artery aneurysm

Abstract

Chronic orofacial pain of neuropathic origin can present diagnostic and management dilemmas to dental practitioners and also affect the patient's quality of life. Intracranial aneurysms are a potential cause of stroke, with associated sub‐arachnoid haemorrhage leading to high rates of mortality and morbidity. A patient who had been previously managed for symptoms of temporomandibular joint disorder (TMD) presented with sharp, shooting pain of moderate intensity. It was precipitated by swallowing, and radiated to the right throat, posterior border of the mandible, ear and temporomandibular joint. Clinical and radiological investigations excluded odontogenic pain, TMD and other more common causes of facial pain. Magnetic resonance imaging revealed a 7 mm × 6 mm aneurysm in the right middle cerebral artery which was subsequently surgically clipped. Interestingly the facial pain resolved after this procedure. Compression of the insular region of the brain innervated by the trigeminal, glossopharyngeal and vagus nerves provides a plausible explanation for the pain. This is the first case of facial neuralgia associated with an aneurysm in the middle cerebral artery as far as we are aware, and it emphasizes the importance of a multidisciplinary approach in the diagnosis and management of unusual cases of chronic orofacial pain.

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