Alexithymia and facial emotion recognition in patients with craniofacial pain and association of alexithymia with anxiety and depression: a systematic review with meta-analysis

Background We aimed to determine the presence of alexithymia in patients with craniofacial pain (CFP) compared with asymptomatic individuals. Our secondary aims were to assess the relationship of alexithymia with anxiety and depression levels, as well as to assess the presence of facial emotion recognition deficit. Methods Medline, Scielo and Google Scholar were searched, with the last search performed in 8 September 2021. Standardized mean differences (SMDs) and 95% CIs were calculated for relevant outcomes and were pooled in a meta-analysis using the random effects model. In addition, meta-analyses of correlations and a meta-regression of alexithymia with depression and anxiety were performed. Results Regarding alexithymia, assessed through the Toronto Alexithymia Scale (TAS), the results showed significant differences, with higher values in patients compared with asymptomatic individuals, with a large clinical effect (SMD 0.46; 95% CI [0.22–0.71]; heterogeneity-Q 66.86; p < 0.001; inconsistency (I2) = 81%). We found statistically significant correlations with a small clinical effect of alexithymia with anxiety and depression. The meta-regression showed no significant association between the TAS and anxiety or depression. With respect to facial emotion recognition, the results showed statistically significant differences, with greater recognition difficulty in patients compared with asymptomatic individuals, with a large clinical effect (SMD −1.17; 95% CI [−2.01 to −0.33]; heterogeneity-Q 2.97; p = 0.080; I2 = 66%). Conclusions Patients with CFP showed alexithymia with moderate evidence. There was also moderate evidence indicating that these patients had significant deficits in facial emotion recognition compared with asymptomatic individuals. Furthermore, alexithymia showed statistically significant correlations with anxiety and depression levels.

Microvascular decompression for a unique case of glossopharyngeal neuralgia with provokable symptomatic bradycardia: 2-Dimensional operative video

Background: Glossopharyngeal neuralgia is a rare neurovascular compression syndrome that can lead to paroxysmal craniofacial pain and sometimes cardiovascular symptoms.[1,2] The characteristic pathology involves a vessel (commonly a branch/loop of PICA) compressing the nerve at the root entry/exit zone at the brainstem.[1] Microvascular decompression is a commonly used treatment approach for patients that have failed conservative measures.[2] Case Description: A 72-year-old male presented to the ED following four episodes of syncope. The patient had a multi-year history of right-sided burning/stabbing pain involving the submandibular area and posterior throat. His syncope was related to symptomatic bradycardia that would occur during episodes of pain. His pain was exacerbated by speaking and swallowing and could be triggered by placing his finger in the right external auditory meatus. Interestingly, this maneuver would also trigger his bradycardia. The patient had failed previous pharmacotherapy, and a pacemaker had been placed to protect him from periods of hypotension. MRI/MRA of the brain and cervical spine were unremarkable. Due to his profoundly symptomatic status, the patient was offered a right retrosigmoid craniotomy for microvascular decompression of the right glossopharyngeal nerve. The patient had complete resolution of his pain and bradycardia immediately post-operatively. He was discharged on the second postoperative day and his pacemaker was ultimately removed. The patient continues to be pain free and off medication. Conclusion: Here we present a video case report of microvascular decompression with favorable outcome for an interesting presentation of glossopharyngeal neuralgia. The patient gave informed consent for surgery and video recording.

Eagle’s Syndrome as a Cause of Discomfort and the Subjective Presence of a Foreign Body in the Throat

Eagle syndrome consists of symptoms resulting from the elongation and excessive calcification of the styloid process of the temporal bone and calcification of the ligaments associated with this process. The main symptoms of this syndrome are the feeling of a foreign body in the throat, dysphagia and pain localized in the temporomandibular region, neck and ear. The authors describe the case report of a previously healthy 39-year-old Caucasian male that complained of discomfort and foreign body sensation in his throat. Computed tomography (CT) showed the presence of an elongated styloid process bilaterally with clear predomination at the left side. The patient underwent laryngological and surgical consultation. Due to the lack of symptoms related to the compression of the carotid arteries, no surgery was recommended. In summary, Eagle’s syndrome is a rare condition characterized by craniofacial pain or foreign body sensation that should be considered, especially if the pain is unilateral. CT imaging in his case was a perfect tool and enabled a suitable diagnosis of this rare syndrome.

Cross-Cultural Adaption and Psychometric Evaluation of the German Craniofacial Pain and Disability Inventory (CF-PDI)

BACKGROUND: The Craniofacial Pain and Disability Inventory (CF-PDI) is a cross-culturally adapted instrument designed from a biopsychosocial perspective to measure pain, disability, and function in orofacial head and neck pain with shown psychometric properties; however, the German cross-cultural adaption is lacking. OBJECTIVES: To carry out a transcultural translation of CF-PDI into German and assess its psychometric properties in patients with painful temporomandibular disorders (TMD) with respect to construct and clinical validity, internal consistency and reproducibility. STUDY DESIGN: Multicenter, prospective, cross-sectional design. SETTING: Patients (n = 398) were recruited from dental and physical therapy clinics in middle and south Germany. METHODS: Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). We investigated know-group validity by means of the scale’s potential to discriminate between affected and unaffected subjects. Multiple linear regression analysis was used to estimate convergent validity. We tested test-retest reliability by the intraclass correlation coefficient and the Internal consistency by Cronbach’s alpha, or each dimension separately, and the total score. Multiple linear regression analysis was used to estimate convergent validity. RESULTS: Two hundred forty-six heterogeneous chronic craniofacial pain patients and 152 patients without complaints were recruited from the middle and south of Germany. The German version CF-PDI-G presents 21 items, 4 factors, and adequate psychometric properties. The test-retest reliability and internal consistency of the CF-PDI-G were both excellent for the entire instrument and also for all sub-scales (intraclass correlation coefficient [ICC] > 0.90) except for the comorbidities and interference with work which was acceptable (ICC = 0.69). Standard error of the measurement (SEM) and minimal detectable change values are sufficiently low. Assessment of clinical validity shows good potential of discrimination and classification into categories “no,” “mild,” “moderate,” and “severe.” The multiple linear regression model showed a strong association between neck disability index, Visual Analog Scale, and anamnestic questionnaire (supporting the scale’s convergent validity). LIMITATIONS: Our sample has a higher prevalence of women and the sample was not recruited consecutively, which may lead to a biased estimation of psychometric properties. CONCLUSIONS: The CF-PDI-G represents valid and reliable instrument to assess pain and disability in patients with orofacial pain and headache suitable for research and clinical practice. KEY WORDS: Craniofacial pain, cross-cultural, disability, German version, headache, neck pain, psychometric validation, questionnaire, reliability, temporomandibular disorders

Gnathology, Occlusion, Oral Surgery and Other Sections in CRANIO® Journal

CRANIO®: the Journal of Craniomandibular and Sleep Practice (further CRANIO®) is a 40-year-old multidisciplinary peer-reviewed publication devoted to temporoma ndibular and sleep disorders.1 Formerly (from the launch in 1982 to 1985), it was named Journal of Craniomandibular Practice. 1 The 2019 impact factor of the CRANIO® became 1.173. This unique bi-monthly journal holds seventy-sixth from 141 positions in the category Dentistry (miscellaneous) and sixty-sixth from 107 positions in the category Otorhinolaryngology.2 As our team works deeply in the multidisciplinary Center which includes gnathologist, orthodontist, general dentists, and oral-maxillofacial surgeons the articles from the sections of the CRANIO® like “Gnathology,” “Occlusion,” “Craniofacial Pain,” “Sleep,” and “Oral Surgery” stick our great interest and passion.3,4 Looking through the CRANIO`s portfolio of issues, many head and neck practitioners, academia workers and even other journals can absorb a lot of progressive developments. Moreover, the profound analysis of that beautiful publication is definitely indicated and we will apply our efforts to highlight that research in the future issues of the Journal of Diagnostics and Treatment of Oral and Maxillofacial Pathology.

COMPARISON OF KINESIO TAPING AND MANUAL THERAPY IN TREATMENT OF PATIENTS WITH BRUXISM USING SHEARWAVE ULTRASONOGRAPHY-A RANDOMIZED CLINICAL TRIAL

Background: Bruxism is significantly associated with craniofacial pain, feeling of stiffness or fatigue of the jaw and neck pain. Various physiotherapeutic strategies are used in the treatment of bruxism, however, it is not clear which method leads to greater decrease in pain. Objective: The aim of this study is to compare the effects of two physiotherapy methods (manual therapy (MT) and Kinesio taping with manual therapy (KTMT)) in patients with bruxism. Methods: Patients were randomized into MT or KTMT groups. Evaluations were performed at baseline and following four weeks of physiotherapy. Muscle thickness and stiffness were assessed via shearwave ultrasonography; pain thresholds were evaluated using algometer. Sleep quality was assessed using Pittsburgh Sleep Quality Index and Quality of life was assessed with Likert scales regarding the associated symptoms. Results: Significant improvements were found in muscle stiffness, pain threshold, sleep quality, quality of life (p<0.05) in both MT and KTMT group. Pain in bilateral temporalis and right occipital region of the trapezius muscle decreased more in the KTMT group compared to the MT group (p<0.05). No significant differences in muscle thickness (p>0.05) were found in either of the groups. Conclusion: Both MT and KTMT methods were effective in the treatment of bruxism. KT used in conjunction with MT has additionally decreased jaw pain and temporal region pain when compared to MT intervention only. Therefore, if jaw pain is the primary complaint of a patient, our results recommend including KT application in the physiotherapeutic treatment program.