OBJECTIVE: To develop a clinical automated diagnostic system for temporomandibular disorders (TMD) based on the diagnostic criteria for TMD (DC/TMD) to assist dentists in making rapid and accurate clinical diagnosis of TMD. METHODS: Clinical and imaging data of 354 patients, who visited the Center for TMD & Orofacial Pain at Peking University Hospital of Stomatology from September 2023 to January 2024, were retrospectively collected. The study developed a clinical automated diagnostic system for TMD using the DC/TMD, built on the. NET Framework platform with branching statements as its internal structure. Further validation of the system on consistency and diagnostic efficacy compared with DC/TMD were also explored. Diagnostic efficacy of the TMD clinical automated diagnostic system for degenerative joint diseases, disc displacement with reduction, disc displacements without reduction with limited mouth opening and disc displacement without reduction without limited mouth opening was evaluated and compared with a specialist in the field of TMD. Accuracy, precision, specificity and the Kappa value were assessed between the TMD clinical automated diagnostic system and the specialist. RESULTS: Diagnoses for various TMD subtypes, including pain-related TMD (arthralgia, myalgia, headache attributed to TMD) and intra-articular TMD (disc displacement with reduction, disc displacement with reduction with intermittent locking, disc displacement without reduction with limited opening, disc displacement without reduction without limited opening, degenerative joint disease and subluxation), using the TMD clinical automated diagnostic system were completely identical to those obtained by the TMD specialist based on DC/TMD. Both the system and the expert showed low sensitivity for diagnosing degenerative joint disease (0.24 and 0.37, respectively), but high specificity (0.96). Both methods achieved high accuracy (> 0.9) for diagnosing disc displacements with reduction and disc displacements without reduction with limited mouth opening. The sensitivity for diagnosing disc displacement without reduction without limited mouth opening was only 0.59 using the automated system, lower than the expert (0.87), while both had high specificity (0.92). The Kappa values for most TMD subtypes were close to 1, except the disc displacement without reduction without limited mouth opening, which had a Kappa value of 0.68. CONCLUSION This study developed and validated a reliable clinical automated diagnostic system for TMD based on DC/TMD. The system is designed to facilitate the rapid and accurate diagnosis and classification of TMD, and is expected to be an important tool in clinical scenarios.
Humans ; Temporomandibular Joint Disorders/diagnosis* ; Retrospective Studies ; Male ; Female ; Adult ; Middle Aged ; Facial Pain/diagnosis* ; Diagnosis, Computer-Assisted/methods* ; Sensitivity and Specificity ; Young Adult

Objective: To screen the physical, psychological and behavioral factors related to patients with temporomandibular disorders (TMD) by using Axis Ⅱ assessment instruments of diagnostic criteria for TMD(DC/TMD). And to provide a reference to establish personalized diagnosis and treatment plans for TMD patients so as to prevent TMD and reduce predisposing factors. Methods: A total of 141 TMD patients, who were admitted in the Department of Oral and Maxillofacial Surgery in School and Hospital of Stomatology, Wuhan University from October 2018 to February 2021 were selected. There were 121 females and 20 males, with an average age of 30 years. A total of 90 healthy people were included as controls. A full-time psychologist conducted relevant questionnaire surveys. The questionnaires include general clinical survey forms and TMD symptom questionnaire. In addition, Axis Ⅱ assessment instruments include graded chronic pain scale, jaw functional limitation scale, oral behaviors checklist, patient health questionnaire-9 (depression), generalized anxiety disorder scale, patient health questionnaire-15 (physical symptoms), etc. The main observational indicators include: pain level, pain impact rates, overall classification of chronic pain, limited chewing function score, limited motor function score, limited communication function score, total jaw function restricted score, depression score, anxiety score, somatic symptom score and oral behavior score.The survey data were imported into SPSS 22.0 software for statistical analysis. Results: In the TMD group 60.3% (85/141) patients had various degrees of pain, 24.1% (34/141) of those with pain effect grades from 1 to 3 and 61.0% (86/141) showed chronic pain overall grades from Ⅰ to Ⅳ. The chewing function restricted score was 2.67(1.17, 4.25), motor function restricted score was 4.25(1.75, 6.12), communication function restricted score was 1.13(1.00, 2.25) and total jaw function restricted score was 2.56(1.47, 4.15) respectively. Patients with mild depression or above accounted for 59.6%(84/141), patients with mild anxiety or above accounted for 56.7%(80/141), 46.1%(65/141) patients had somatization symptoms. Statistical differences (P<0.05) were determined between TMD group and control group in various scores of jaw function, oral behavior grading, depression, anxiety, and physical symptoms. Physical symptoms had significantly statistical difference between different diagnostic classification(P<0.05). Meanwhile, among the different chronic pain levels in the TMD group, there were statistical differences in the various scales of mandibular dysfunction, depression, anxiety, and somatization. In the TMD group, other significant differences were noticed between males and females in terms of the average score of mouth opening, verbal and facial communication, the total score of mandibular dysfunction as well as physical symptoms (P<0.05). Conclusions: Compared with the healthy people, patients with TMD had more abnormal oral behaviors, different restriction of the mandibular functional activities. At the same time, depression, anxiety, and somatization were more serious. Patients with osteoarthritis and subluxation of temporomandibular joint were more likely to suffer physical symptoms. TMD patients suffering from pain had more severe mandibular dysfunction and symptoms of depression, anxiety, and somatization.
Adult ; Depression/diagnosis* ; Facial Pain ; Female ; Humans ; Male ; Mandible ; Somatoform Disorders ; Temporomandibular Joint Disorders/diagnosis* ; Temporomandibular Joint Dysfunction Syndrome

A 49-year-old male presented with horizontal binocular diplopia without facial pain or skin lesion. Limitation of medial gaze in the left eye was revealed on neurological examination, which is accompanied by peripheral facial nerve palsy ipsilaterally. The diagnosis had been made based on the diffusion restriction lesion of left pontine tegmentum. We may denominate a “seven-and-a-half syndrome” and clinician should maintain a high level of awareness of the various syndromes associated with pontine lesions.
Diagnosis ; Diffusion ; Diplopia ; Facial Nerve ; Facial Pain ; Facial Paralysis ; Humans ; Male ; Middle Aged ; Neurologic Examination ; Ocular Motility Disorders ; Paralysis ; Pontine Tegmentum ; Skin ; Telescopes

Crowned dens syndrome (CDS) is a cause of neck pain characterized by calcium deposition in the periodontoid tissues. Clinical features of the syndrome are acute onset of neck pain and headache with fever. Computed tomographic imaging is necessary for diagnosis. The prognosis of CDS is excellent. Symptoms disappear within several weeks and calcifications may be absorbed. We report a case of CDS with acute onset of severe neck pain, facial pain, and pharyngeal pain provoked by swallowing.
Calcium ; Crowns* ; Deglutition ; Diagnosis ; Facial Pain ; Fever ; Headache ; Neck Pain* ; Neck* ; Odontoid Process ; Prognosis

Acute rhinosinusitis is a common entity in children, most are due to viral infections, however up to over 80% children with rhinosinusitis are prescribed with antibiotics. Acute bacterial sinusitis should be diagnosed in when a child has 1) a severe onset with a fever over 39℃, purulent nasal discharge or facial pain for 3 to 4 days; 2) persistent illness with rhinorrhea, daytime cough or both for over 10 days with no clinical improvement; or 3) worsening course with symptoms aggravating or new onset symptoms including fever, headache, cough or rhinorrhea after clinical improvement. Radiographic imaging is not recommended for differentiation of viral and bacterial rhinosinusitis, however a contrast-enhanced computed tomography or magnetic resonance imaging may be done in cases with orbital or central nervous system complications. Antibiotics may be prescribed in cases with severe onset or worsening course. Antibiotics may be prescribed after additional observation for 3 days in children with persistent illness. Amoxicillin-clavulanate (amoxicillin 40 to 50 mg/kg/day, every 12 hours) is recommended for initial treatment and high dose amoxicillin-clavulanate (amoxicillin 90 mg/kg/day every 12 hours) may be considered in cases with severe infection, children in day care center, under 2 years of age, recent admission history, previous antibiotics within 1 month and immunocompromised children. Clinical response should be reassessed in cases of worsening or failure to improve within 72 hours of treatment.
Anti-Bacterial Agents ; Central Nervous System ; Child ; Cough ; Day Care, Medical ; Diagnosis ; Facial Pain ; Fever ; Headache Disorders, Primary ; Humans ; Magnetic Resonance Imaging ; Orbit ; Sinusitis

Polyacrylamide hydrogel is a widely used filler material in cosmetic procedures performed on the face and breasts. Recently, however, complications including inflammation, deformity, and pain have been reported. The present article addresses unregulated materials/products injected as dermal fillers. The authors report a case involving a 29-year-old woman who developed severe facial pain after undergoing a cosmetic procedure with injectable triamcinolone and hyaluronidase. Two months later, the pain spread to her upper and lower limbs, and abdomen, which eventually led to the the development and diagnosis of complex regional pain syndrome (CRPS) in the upper limbs. The authors hypothesize that CRPS in the upper limbs was responsible for the facial pain through sensitization of third-order neurons and the trigeminal nucleus caudalis extending to the upper cervical segments.
Abdomen ; Adult ; Breast ; Congenital Abnormalities ; Dermal Fillers ; Diagnosis ; Facial Neuralgia ; Facial Pain* ; Female ; Humans ; Hyaluronic Acid ; Hyaluronoglucosaminidase ; Hydrogel ; Inflammation ; Lower Extremity ; Neurons ; Triamcinolone ; Trigeminal Nuclei ; Upper Extremity*

Atypical facial pain (AFP) is a type of facial pain which does not fulfill any other diagnosis. It has several features such as no objective signs, no obvious explanation of the cause and poor response to treatments. We report a case of a female patient with AFP on the left maxillary area. The pain was increased by cold innocuous stimulation and thermography showed that the temperature on the painful area was significantly decreased. The pain was successfully alleviated by stellate ganglion block (SGB). Therefore, SGB can be effectively used to treat AFP.
Diagnosis ; Facial Pain* ; Female ; Humans ; Stellate Ganglion* ; Thermography

Rhinogenic headache may be defined as a headache directly caused by pathology within the nose or paranasal sinuses. Rhinogenic headache is a controversial, but distinct type of headache that has received an increased amount of attention in the literature over the past twenty years. The International Classification of Headache Disorders, 3rd edition has been released by the 'International Headache Society' in May 2013. As this version is based on a large body of research on headache, in contrast to previous editions that were mostly based on opinion of experts, it is being considered as a major step forward in the diagnosis and management of headache. The International Headache Society presented the diagnostic criteria of rhinogenic headache divided into three types: Headache Attributed to Acute Rhinosinusitis, Headache Attributed to Chronic or Recurring Rhinosinusitis, Headache Attributed to Disorder of the Nasal Mucosa, Turbinates or Septum. We herein present the salient features of the new classification, which are likely to be of interest to the rhinologist. In addition, I review the evidence that intranasal mucosal contact points cause facial pain or headache and present the important points to consider in diagnosis and treatment of mucosal contact point headache.
Classification* ; Diagnosis ; Facial Pain ; Headache Disorders* ; Headache* ; Nasal Mucosa ; Nose ; Paranasal Sinuses ; Pathology ; Turbinates

BACKGROUND AND OBJECTIVES: Vertigo is an illusion of environmental movement due to various causes, thus it is hard for medical doctors to determine the exact kind of dizziness in the final diagnosis. Recently, cervical vertigo was reported from several vertigo cases. Cervical vertigo is defined as sensation of rotation, resulting from an alteration of the neck proprioceptive afferents of the upper cervical spine. The aim of our study is to document the clinical features and the treatment outcomes in vertigo patients with myofascial pain syndrome (MPS). SUBJECTS AND METHOD: A total of 488 patients, excluding 18 patients who received other diagnosis, were examined to investigate the reasons for dizziness. We evaluated 34 patients, who were diagnosed with cervical vertigo by questionnaire after MPS treatments. Clinical evaluations for cervical vertigo were performed on all subjects, and vestibular function tests were also performed in patients with vertigo symptoms. All patients received a total of 4 treatments including trigger point injection, physical therapy or medication, and then followed up, respectively. The symptom changes of dizziness, patient satisfaction and cervical pain were checked before and treatment 1, 2, 4 times by Visual Analogue Scale (VAS) score. RESULTS: There were significant improvement in the VAS score of dizziness, patient satisfaction and cervical pain after treatment for MPS. CONCLUSION: Treatment for MPS could improve dizziness in cervical vertigo with MPS patients, but further study is needed to clearly confirm the cervical vertigo with MPS for improving patient's quality of life.
Diagnosis* ; Dizziness ; Facial Neuralgia ; Humans ; Illusions ; Myofascial Pain Syndromes ; Neck ; Neck Pain ; Patient Satisfaction ; Quality of Life ; Surveys and Questionnaires ; Sensation ; Spine ; Trigger Points ; Vertigo* ; Vestibular Function Tests

The maxillary sinus is the largest paranasal sinuses. Foreign bodies of nosal sinus can caused by car accidents, firearm attacks, or iatrogeniccause. We reported two rare cases of foreign body of pulp needle and loach. The clinical manifestations might include facial numbness, facial paresthesia, swelling, nasal congestion, facial pain, eye discomfort, limited mouth opening and relapse and etc. Both CT scan and the medical history were helpful in diagnosis. Functional endoscopic surgery would be the first choice of treatment.
Chronic Disease ; Endoscopy ; Facial Pain ; Foreign Bodies ; diagnosis ; Humans ; Maxillary Sinus ; pathology ; Paranasal Sinus Diseases ; etiology ; pathology ; Paresthesia ; Tomography, X-Ray Computed