BACKGROUND: Trigeminal neuralgia (TN) is characterized by severe and often relentless pain in the trigeminal nerve distribution. It is primarily a diagnosis of exclusion, highlighting the importance of a thorough workup to rule out treatable or secondary causes of atypical facial pain.

CASE REPORT: An 89-year-old woman experienced 2 years of relentless odontogenic pain that had been misdiagnosed as TN. She was referred to endodonticsfor a cone-beam computed Tomography (CBCT) scan. CBCT led to the diagnosis of an abscess and nerve impingement due to an old crown post. Following tooth extraction, abscess drainage, and antibiotic therapy, the patient had resolution of her pain.

CONCLUSIONS: This case highlights the importance of CBCT in the diagnostic workup of orofacial pain in suspected cases of TN, particularly when prior dental consultations and evaluations of past treatments have not identified a definitive cause.

KEYWORDS: Trigeminal neuralgia, case report, cone-beam computed tomography, odontogenic pain, orofacial pain