Abstract

Background: Trigeminal neuralgia (TN) is a chronic neuropathic pain disorder characterized by recurrent episodes of severe, unilateral facial pain along the distribution of the trigeminal nerve. Owing to its resemblance to odontogenic pain, TN is frequently misdiagnosed, resulting in unnecessary dental interventions and delayed treatment.

Case Presentation: A 20-year-old female reported with severe pain in the upper right posterior maxillary region for three years. The pain persisted despite extraction of the maxillary right third molar and previous pharmacological management. Clinical examination revealed trigger zones over the right cheek and upper lip, with a Visual Analog Scale (VAS) score of 9/10. Based on the patient’s history and characteristic clinical findings, a diagnosis of right-sided trigeminal neuralgia was established.

Management and Outcome: Initial treatment with carbamazepine and pregabalin showed minimal improvement. Subsequently, the treatment regimen was modified to include a higher dose of carbamazepine along with gabapentin, amitriptyline, and methylcobalamin. Following three months of therapy, the patient demonstrated significant symptomatic improvement, with the VAS score decreasing from 9/10 to 4/10 and a marked enhancement in quality of life.

Conclusion: This case highlights the importance of considering trigeminal neuralgia in the differential diagnosis of persistent facial and dental pain, particularly when symptoms persist after dental treatment. Early recognition, identification of trigger zones, and appropriate pharmacological management can lead to substantial pain reduction and improved patient outcomes.