Patient Renae that has been through the ENT service multiple times a year for 3 consecutive years. She came to our service with very little expectation and was thinking her pain maybe not treatable and stated “I’m questioning myself if this pain is real because no service can resolve my issue.”
Renae had chief complaint of ear stuffiness and pain that radiated from her ear to the angle of the jaw. Our clinical exam exhibited that Renae had bilateral TMJ pain confirmed by palpation, bilateral stylomandibular ligament insertion tendonosis and a diurnal and nocturnal bruxing issue.
Renae was treated with a series of bilateral stylomandibular ligament insertion injections, bilateral temporal tendon injections and bilateral suboccipital injections (that we term the “Blume”). Renae was provided with daytime and nighttime orthotics to control the bruxing habits. Within a few months, (September 24th to January 12th ) providing an injection series and orthotic daily use, Renae had her ear pain and radiating symptoms into her jaw her symptoms were almost completely resolved with a small amount of tinnitus remaining. All areas of palpation were negative.
Patient Tina had 7 years of right sided ear pain that was becoming bilateral and finally (mis)diagnosed as trigeminal neuralgia (one of the common diagnosis’s we see is Trigeminal neuralgia), which becomes the default diagnosis for facial pain with an unclear etiology. Tina had an extracted upper right molar and a root canal on the adjacent tooth. Tina’s clinical exam showed positive bilateral stylomandibular insertion tendonosis (Ernest Syndrome), which was treated with stylo injection series from June to September. Orthotics to control bruxing habits and reduced her a pain from a right sided facial pain from a 10 (June), to a 0.5 by September. Tina refused medication that would very likely had reduced her symptoms to a zero.
Patient Rose had been seen by neurology for 17 years in a attempt to control her migraine issue. She was referred our service with a chief complaint of she a 14 day headache that had been continuous. We treated Rose with bilateral suboccipital injections (Blume), and daytime/nighttime orthotics. Rose has had no significant headache at last report (6 months). Most cases do not improve that quickly but it can happen.
We met patient Tami in 2009 in Allentown. Today she would have been diagnosed with Peripheral Traumatic Trigeminal Neuropathy.[15-17] Then it was called atypical facial pain with early signs of Complex Regional Pain Syndrome. We were unsuccessful for Tami and referred to Pain Management. After failing multiple medications including IV ketamine and a failed implanted suboccipital stimulator, Tami wound up with an intra-thecal baclofen pump. This took her 10 of 10 pain down to 5-6 of 10 and she was grateful. (This case began with a wisdom tooth extraction and 3 subsequent surgeries in the same site in an attempt to relieve pain. We will be writing this up as the 14th case of CRPS in the trigeminal distribution.)
Unfortunately, last year someone extracted 2 more teeth in the same quadrant and triggered a relapse. She was referred back to us for injection therapy in an attempt to control the pain. We were able to increase the interval to two weeks over the last 3 months with the severe pain beginning to return on day13-14. Unfortunately her baclofen dose had to be decreased because urinary retention was affecting her kidneys. Pain management recently asked us to see Tami weekly, because this time around our injection therapy is the only thing that successfully manages Tami’s pain. We already have two cases of PTTN in Wilkes-Barre, thankfully less severe. Fortunately, our experience with Tami and the recent literature have enabled us to quickly recognize and diagnose PTTN. Currently, these cases remain difficult to manage.
Patient Carlos was hit in the head with a golf club on the right side on the head above and in front of his ear (frontal parietal suture line). He had been treated by neurology with multiple medications for his right-sided headache for five years. The proper diagnosis was auriculotemporal neuralgia.  Carlos was treated with a series of auriculotemporal nerve blocks with anesthetic and corticosteroids. Also, daytime/nighttime orthotics. Carlos was almost pain free in three months with our treatment.
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