J Orofac Pain
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This article reviews the utility of neurophysiological recordings and quantitative sensory testing (QST) in providing sensitive, quantitative, and objective tests for the diagnosis and localization of damage to the trigeminal nerve. Electromyography and recordings of the masseter reflex and compound muscle action potential evoked by transcranial magnetic stimulation or direct electrical stimulation of the masseteric nerve can be of value in evaluating the function of a motor neurons supplying the muscles of mastication. Orthodromic recording of the sensory action potential and trigeminal somatosensory-evoked potential recording with the near-nerve stimulation technique are sensitive tools for the investigation of trigeminal sensory Abeta afferents, whereas recordings of polysynaptic trigeminal brainstem reflexes and tactile QST are less sensitive. ⋯ In a study of the diagnostic value of neurography, blink reflex and thermal QST, and various commonly used clinical sensory tests, neurophysiologic tests and thermal QST had better sensitivity (50% to 88% vs 40% to 59%) and negative predictive values (78% to 100% vs 70% to 74%) compared to clinical examination, whereas the specificity (55% to 100%) and positive predictive values (48% to 73%) were similar. At 1 year after trigeminal nerve injury, the risk of a false negative finding with clinical sensory testing was 94%, whereas the combination of nerve conduction recordings and thermal QST increased the diagnostic yield to 100% in patients with long-standing postsurgical sensory alteration. In conclusion, clinical neurophysiological recordings and QST improve the diagnostic accuracy for trigeminal neuropathy.
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Evaluating sensory nerve damage is a challenging and often frustrating process. Diagnosis and follow-up is usually based on the patient's history and gross physical evaluation in addition to simple sensory tests such as brushing or pin prick. ⋯ In this article specific clinical uses of QST are described and its clinical applicability is demonstrated. Future studies should be directed at exploring the use of QST in the diagnosis and classification of further nerve pathologies.
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To evaluate the effect of temporomandibular arthralgia on mandibular mobility, chewing, and bite force. ⋯ These systematic findings supplement results from acute pain experiments and confirm indications from unspecified patient groups that the clinical presence of long-standing TMJ pain is associated with marked functional impairment. This impairment might be a result of reflex adaptation and long-term hypoactivity of the jaw muscles.
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To investigate changes in calcitonin gene-related peptide (CGRP)-like immunoreactivity (CGRP-LI) in the rat masseter muscle and brain after the unilateral experimental induction of masseter myositis. ⋯ The results of this study demonstrate that CGRP may play an important role both peripherally and centrally in masseter muscle myositis in association with presumed nociceptive behavior.