A case of vestibular schwannoma mimicking burning mouth syndrome

Background An oral burning sensation with unidentified cause in patients with preexisting psychosocial conditions is usually diagnosed as burning mouth syndrome. However, unexpected organic lesions may be detected in rare cases. Case presentation A 35-year-old woman had chief complaints of a burning sensation and numbness of the right side of the lip and tongue, as well as a dry sensation of the mouth with a taste disturbance of the right side of the tongue. The symptoms were continuous and did not show any daily fluctuations. The symptoms started without any recognizable triggering factor six months before her first visit to our clinic,. No abnormality was detected in her mouth. MRI images revealed an approximately 30 × 30 mm well-defined mass localized in the right cerebropontine angle compressing the trigeminal nerve, which was diagnosed as schwannoma of the right auditory nerve. Conclusions It is important for clinicians to consider the possibility of brain tumors in their differential diagnosis of BMS. Although it is not always easy to eliminate all diseases that may cause an oral burning sensation in patients with BMS-like symptoms, more attention and careful examination based on the patient’s psychosomatic background features and other possible causes are needed to rule out organic diseases.

A Case of Vestibular Schwannoma with Oral Burning Sensation: Surgical Complication or Burning Mouth Syndrome?

Background: Vestibular schwannoma (VS) or acoustic neuroma is a benign brain tumor. Despite improvements in surgical technique, the removal of VS is related to some complications of which the recovery is difficult and sometimes lead to permanent deficits. About 10.7% of complication of vestibular schwannoma surgery is reported to affect facial or tongue area, including numbness of pain, which is similar to a typical symptom of burning mouth syndrome (BMS). However, up to our knowledge, there is no documented case of BMS either comorbid with vestibular schwannoma or occur due to surgery complications. Clinical Presentation: A 46-year-old woman complained about left-sided facial pain, a burning sensation on the left side of her tongue and maxilla, and a spontaneous bitter taste. Four years before her first visit to our clinic, left-sided facial pain and burning sensation on the left side of the tongue suddenly became severe. She visited a neurosurgeon and VS was found in the left cerebellopontine angle. After the tumor was removed, facial pain, burning sensation of the tongue, and bitter taste improved simultaneously but quickly recurred after a while. The patient had a panic attack because of severe pain and started visiting a psychiatrist. The psychiatrist diagnosed her as having somatic symptom disorder and depression, prescribing sertraline 100 mg, zolpidem 5 mg, and lorazepam 1.0 mg and referred her to our clinic. At the first visit, no abnormal intraoral nor extraoral findings were detected. Based on the characteristics of the pain, we made a diagnose of BMS. Amitriptyline was initiated at 10 mg/day and increased to 30 m. Within 1.5 months, the pain and burning sensation of the tongue and maxilla almost remitted completely, whereas bitter taste showed moderate improvement. Conclusions: Our case suggests there might be an exceptional case in which BMS and VS can occur simultaneously. Specifically, an oral burning sensation and dysgeusia after VS surgery are not always a case of surgical complication or untreatable.

Burning mouth syndrome: An update

Background: Burning mouth syndrome (BMS) is a chronic and debilitating oral pain of the normal oral mucosa. It mainly affects women in their fifth to seventh decade. Its aetiopathogenesis remains unclear and is probably of multifactorial origin, with increasing evidence that BMS may be a neuropathic disorder. BMS is classified as an idiopathic (nociplastic) orofacial pain with or without somatosensory changes by International Classification of Orofacial Pain (ICOP 2020). The diagnosis of BMS, having excluded ‘oral burning mouth symptoms’, has evolved from basic intraoral exclusion screening to extensive clinical and laboratory investigations, which include the screening of comorbidities and other chronic pains and somatosensory testing. There is no standardised treatment in managing BMS, but a proposed combination of supportive and pharmacological treatment has been recommended. Aim: To review the current concepts of BMS definitions, classifications, aetiopathogenesis, diagnosis techniques, and evidence-based treatments in managing BMS patients. Conclusion: As BMS is a diagnosis by exclusion, thus a stratified approach is required for assessment of patients presenting BMS. A BMS diagnosis protocol is desired using a standardised screening to distinguish BMS from patient’s presenting with ‘oral burning symptoms’, and evaluation of comorbid chronic pain disorders or other medical comorbidities, which will include haematological, fungal, salivary flow, and qualitative sensory testing. Axis II and other additional quantitative sensory testing may further elucidate the causes of this condition. For future BMS prediction and prevention, will be based upon research on the relationship between other chronic pain disorders and familial history, environmental and genetic information.

Rebamipide to Manage Stomatopyrosis in Oral Submucous Fibrosis

ABSTRACT Introduction Oral submucous fibrosis (OSF) causes progressive debilitating symptoms, such as oral burning sensation (stomatopyrosis) and limited mouth opening. The standard of care (SOC) protocol includes habit cessation, intralesional steroid and hyaluronidase injections, and mouth opening exercises. The objective of the study was to evaluate efficacy of rebamipide in alleviating burning sensation of the oral mucosa in OSF in comparison with SOC intralesional steroid injections. Materials and methods Twenty OSF patients were divided into two groups [rebamipide (100 mg TID for 21 days) and betamethasone (4 mg/mL biweekly for 4 weeks)] of 10 each by random sampling. Burning sensation was assessed every week for 1 month. Burning sensation scores were analyzed using repeated measures analysis of variance (ANOVA) and paired t-test. Results Change in burning sensation score was significant (p < 0.05) in the first four visits. However, score between the 4th and 5th visit was not statistically significant (p > 0.05). Conclusion Our study has shown that rebamipide can be considered as an effective modality to manage burning sensation in patients suffering from OSF. Clinical significance Considering stomatopyrosis and trismus as a major cause for inability to eat in OSF, use of newer adjunctive modalities, such as rebamipide will ease patients suffering and also encourage them to consume food. How to cite this article Baptist J, Shakya S, Ongole R. Rebamipide to Manage Stomatopyrosis in Oral Submucous Fibrosis. J Contemp Dent Pract 2016;17(12):1009-1012.

Scombrotoxinism: Protracted Illness following Misdiagnosis in the Emergency Department

Background. Scombrotoxinism is an acute toxin-induced illness caused primarily by bacterial synthesis of histamine in decomposed fish.Case Report. Immediately after taking 2-3 bites of cooked salmon, a clerical worker developed oral burning, urticaria, and asthma. In the emergency department, she was diagnosed with “allergies”; scombrotoxinism was never considered. She then developed wide-ranging symptoms (e.g., chronic fatigue, asthma, anxiety, multiple chemical sensitivity, and paresthesiae) and saw many specialists (in pulmonology, otorhinolaryngology, allergy, toxicology, neurology, psychology, and immunology). During the next 500+ days, she had extensive testing (allergy screens, brain MRI, electroencephalogram, electromyogram, nerve conduction velocity, heavy metal screen, and blood chemistry) with essentially normal results. She filed a workers’ compensation claim since this injury occurred following a business meal. She was evaluated by a Qualified Medical Evaluator (GL) on day 504, who diagnosed scombrotoxinism.Comment. Scombrotoxinism should be considered in all patients presenting to the emergency department with “oral burning” or allergy symptoms following “fish consumption.” Initial attention to such history would have led to a correct diagnosis and averted this patient’s extended illness. Specialist referrals and tests should be ordered only if clinically indicated and not for diagnostic fishing expedition. Meticulous history is crucial in resolving clinical dilemmas.