Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: Myofascial pain is a common cause for chronic orofacial pain. Since orofacial pain can have multiple sources of origin and a wide range of etiologies, making an accurate diagnosis can often be very challenging. Considering the high prevalence of the myofascial component in persistent orofacial pain, trigger point injections using a small volume of local anesthetic can be extremely useful in solving the diagnostic mystery.
CASE REPORT: A 60-year-old female patient presented with episodic lancinating pain in the left buccal mucosa, between the cheek and gingiva of the premolar and first molar teeth. Her pain started 15 days after extraction of the first molar tooth 4 months prior. On ultrasound evaluation of the painful area, 2 trigger areas were identified in the region of the buccinator and risorius muscles through elicitation of a deep tenderness and reproduction of the patient’s symptoms. These trigger areas were injected with 5 mL of 0.5% lignocaine (2.5 mL at each site) using a 26-gauge needle, following which the patient reported more than 70% reduction in her pain score. Subsequently she was discharged after educating her on stretching exercises for orofacial muscles.
CONCLUSION: The presence of a tender area in the orofacial muscles, which on manual compression produces deep tenderness and reproduction of the patient’s symptoms, should prompt the clinician to proceed with trigger point injections. Considering that the procedure is safe, minimally invasive, and a diagnostic as well as a therapeutic modality, it should be considered early in selected patients with chronic orofacial pain who otherwise pose a diagnostic dilemma.
KEY WORDS: Chronic orofacial pain, myofascial pain syndrome, trigger point injection