The Epidemiology of Facial Pain

Assuming that the average age of the readership of this thesis is 35 years, and that 49% is male, given the number of theses printed (n=500) and the average life expectancy (78 years for men, 82.3 years for women), nine [95% confidence interval (95% CI): 8 - 10] readers (1.8%) will get a form of facial pain as studied in this thesis. Despite its low frequency the severity and debilitating nature of certain facial pain conditions is an important motivator for scientific research in this field. Facial pain comprises many different disease entities, which differ in aetiology, presentation, severity, frequency of occurrence and natural course of disease. In this thesis, we studied eight different forms of facial pain, including trigeminal neuralgia, postherpetic neuralgia in the facial area, cluster headache, occipital neuralgia with referred facial pain, local facial neuralgias, persistent idiopathic facial pain, glossopharyngeal neuralgia and paroxysmal hemicrania. These diseases share some clinical features and are often considered together in the differential diagnosis of a general practitioner. Facial pain conditions can be divided into primary (idiopathic) and secondary (symptomatic) facial pain based on the disease aetiology. While the aetiology of primary forms is largely unknown, secondary forms can be due to tumors, infarctions, arterio-venous malformations, multiple sclerosis and many other diseases

Beware of thermal epiglottis! A case report describing 'teapot syndrome'

Background: The type of scalding injury known as 'teapot syndrome', where hot liquid is grabbed by the child with the aim of ingestion and falls over a child causing burns on the face, upper thorax and arms, is known to cause peri-oral and facial oedema. Thermal epiglottitis following scalds to face, neck and thorax is rare and can occur even in absence of ingestion of a damaging agent or intraoral burns, Awareness of the possibility of thermal epiglottitis, also in scald burns, is imperative to ensure prompt airway protection. Case presentation: We report the case of a child with thermal epiglottitis after a scalding burn from boiling milk resulting in mixed deep burns of the face, neck and chest, but no history of ingestion. Upon presentation there was a progressive stridor and signs of respiratory distress requiring intubation. Laryngoscopy revealed epiglottis oedema, confirming the diagnosis of thermal epiglottitis. Final extubation took place 5 days after initial burn. Conclusions: Thermal epiglottitis following scalds to face, neck and thorax is rare and can occur even in absence of ingestion and intra-oral damage. Burns to the peri-oral area should raise suspicion of additional damage to oral cavity and supraglottic structures, even in absence of intra-oral injury or initial respiratory distress. Awareness of the occurrence of thermal epiglottitis in absence of intra-oral injury is important to diagnose impending upper airway obstruction requiring intubation

Sublingual sufentanil for postoperative pain relief: First clinical experiences

Background: The sublingual sufentanil tablet system (SSTS) is a novel hand-held patientcontrolled analgesia device developed for treatment of moderate-to-severe postoperative pain. Here we present the first results of its clinical use. Methods: Adult patients undergoing major surgery in five hospitals in the Netherlands received the SSTS for postoperative pain relief as part of multimodal pain management that further included paracetamol and a nonsteroidal anti-inflammatory drug (NSAID). The following variables were collected: postoperative pain scores using the 11-point numerical rating score (NRS) at rest, number of tablets used, occurrence of nausea, and patient satisfaction scores. Results: We included 280 patients in the study; the majority underwent laparoscopic abdominal (49%) or orthopedic (knee replacement) surgery (34%). The median NRS was 3.5 (interquartile range 2.3–4.0) on the day of surgery, 3.3 (2.3–4.0) on the first postoperative day, and 2.8 (2.0–4.0) on the second postoperative day; pain scores did not differ between surgery types. Mean number of tablets used was 19 (range 0–86). Nausea occurred in 34% of patients, more often in women (45% vs 19%). Overall satisfaction was high in 73% of patients. Satisfaction was correlated with pain relief (p < 0.001) and inversely correlated with occurrence of nausea (p=0.01). Discussion: In this data set obtained under real-life conditions we show that the SSTS effectively managed postoperative pain in abdominal and orthopedic surgeries. Future studies should determine patient populations that benefit most from the SSTS, assess the added values versus intravenous patient-controlled analgesia, and determine the pharmacoeconomics of the system