Ricerc@Sapienza

Background
Tolosa–Hunt syndrome (THS) related neurological
symptoms are described in literature as “unilateral”,
“recurrent”, “episodic”, “intense”, “severe”, “lancinating” or
“stabbing” pain on the upper face and forehead and may be
misdiagnosed due to the similarity of few symptoms and a
significant number of common characteristics between both
conditions.
Aims
The aim of this brief report is to indicate some important
clinical insights related to Tolosa Hunt syndrome, and to
give a frank account on the multidisciplinary approach on
neurological-related symptomatology in maxillofacial
region.
Methods
We analysed a selection of patients with such clinical
picture. To better describe the proper management of
clinical cases, we report a 50-year-old female reporting an
history of two years of recurrent, severe stabbing pain
around the right eye, prominence of her cheek and
forehead. Her general dentist first mistakenly diagnosed
toothache and, thus, it was subsequently misdiagnosed the
trigeminal neuropathy (TN).
Results
Reported exemplificative case presented a mild ptosis,
diplopia of the right eye, corneal reflex loss, paresthesia and
hyperesthesia of upper part of left side of face. Magnetic
resonance imaging (MRI) findings were suggestive of THS.
Complete resolution of symptoms was achieved with oral
Prednisolone and constant monitoring of symptoms.
Conclusion
THS may be added to the long list of differential diagnosis of
TN and general dentist and oral surgeons should be
informed about such rare causes of facial pain through
continued medical education programs.