Search Results (399)

Background: Vascular adverse events (VAEs) related to facial filler injections are rare but potentially severe complications. Doppler ultrasound has emerged as an adjunct imaging tool for evaluating vascular compromise; however, Doppler findings in facial VAEs remain insufficiently characterized. Objectives: To characterize Doppler ultrasound findings associated with filler-related facial VAEs and to assess whether Doppler patterns differ according to prior hyaluronidase administration. Methods: This international multicenter retrospective observational study included 100 patients with clinically diagnosed facial VAEs following filler injections between May 2022 and April 2025. Doppler ultrasound findings were analyzed, including absent flow in perforators and major arteries, compensatory flow, abnormal waveforms, increased peak systolic velocity (PSV), and absence of Doppler abnormalities. Patients were categorized according to hyaluronidase administration prior to ultrasound evaluation. Descriptive statistics and comparative analyses were performed. Results: One hundred patients (median age, 38 years; IQR: 30–50; 88 women) were evaluated. The most frequent Doppler ultrasound findings were absent flow in perforators (42%) and major arteries (35%), followed by compensatory flow (26%), string sign (18%), flow diversion (16%), and increased peak systolic velocity (16%). No Doppler abnormalities were observed in 12% of cases, while tardus–parvus (9%) and staccato waveform (8%) were less frequent. Doppler ultrasound findings did not differ significantly between patients who received hyaluronidase before imaging and those who did not (all p > 0.05). The dose of hyaluronidase varied substantially. Livedo reticularis, blanching, and pain were the most common clinical findings. Central facial arterial territories, particularly the perioral, nasolabial fold, nasal, and glabellar regions, were most commonly involved. Conclusions: Filler-related facial VAEs show recognizable Doppler ultrasound patterns, and the identification of these patterns may improve localization of vascular occlusion and support ultrasound-guided hyaluronidase administration, potentially enabling more targeted delivery with lower doses. Full article

Background: Pain assessment in critically ill, mechanically ventilated pediatric patients is highly complex owing to communication barriers and the frequent use of sedation. A standardized, rapid, and objective tool such as the Behavioral Pain Scale (BPS) is urgently needed in Japanese pediatric intensive care units (PICUs), particularly in mixed adult–pediatric settings, to ensure consistent, multidisciplinary assessment. This study aimed to evaluate the clinical applicability, validity, and reliability of the Japanese version of the BPS in critically ill mechanically ventilated pediatric patients. Methods: This single-center, prospective cross-sectional observational study was conducted between October 2021 and March 2023. The final analysis included 70 observations from 37 pediatric patients who needed mechanical ventilation (MV). Concurrent and convergent validity were assessed using Spearman’s rank correlation coefficients (ρ) between the BPS; the Face, Legs, Activity, Cry, Consolability (FLACC) scale; and the COMFORT-Behavior (COMFORT-B) scale. Interrater reliability was evaluated using intraclass correlation coefficients (ICCs) and weighted kappa values among the three independent observers. The sample size (52 observations) was calculated based on the kappa coefficient estimation. The impact of sedation depth (assessed using the Richmond Agitation–Sedation Scale [RASS]) and the observers’ prior clinical experience with the evaluations were also analyzed. Results: Concurrent and convergent validity were high, showing strong correlations with the FLACC (ρ = 0.49–0.91) and COMFORT-B (ρ = 0.69–0.87) scales. The total BPS score showed moderate interrater reliability (ICC = 0.66, 95% CI = 0.55–0.76; weighted κ = 0.63–0.71). However, deep sedation (defined as a median RASS score ≤ −4 across observers), present in 68.6% of the observations, caused a pronounced floor effect that suppressed behavioral responses, even during painful procedures. Consequently, the reliability of fine motor subscales like “upper limb movement” (κ = 0.08) was slight and for “facial expression” (κ = 0.38), it was fair. Furthermore, the correlation strength with the FLACC scale varied significantly with observer experience, with the strongest correlation (ρ = 0.91) achieved by the observer with extensive adult ICU experience. Conclusions: As an initial validation, the Japanese version of the BPS has demonstrated acceptable validity and moderate reliability in mechanically ventilated pediatric patients. However, its clinical application requires careful interpretation because of the pronounced floor effect under deep sedation. Furthermore, accurate assessment depends heavily on specific training and familiarity with the adult-derived scale. With adequate training, the BPS has the potential to serve as an alternative tool and a valuable common multidisciplinary language in mixed intensive care settings. Future research should investigate whether implementing this tool improves multidisciplinary communication and clinical outcomes. Full article

Background: Trigeminal neuralgia (TN) is clinically defined, but patients presenting to tertiary practice with trigeminal-region pain are often diagnostically heterogeneous and may follow prolonged medication, dental, imaging, and procedural pathways before a stable phenotype is established. We aimed to characterize diagnostic phenotypes, secondary causes, and treatment-escalation patterns in a large retrospective tertiary-center trigeminal pain cohort derived from routine free-text clinical documentation. Methods: We conducted a retrospective single-center cohort study based on a clinical dataset containing 18,007 note fragments linked to 672 unique patient records between 12 October 2010 and 21 April 2026. A rule-based natural-language-processing-assisted chart review framework was used to identify patients with trigeminal pain and to extract documentation-derived demographic features, pain distribution, secondary causes, dental pathway variables, imaging signals, medication exposure, procedures, and outcome language. Patients were grouped into primary/classical TN, secondary TN/trigeminal pain, and dental-first or mimic pathways using predefined operational criteria. Results: A total of 455 patients met criteria for the analytic trigeminal pain cohort; 311 (68.4%) carried explicit TN terminology. Mean age was 58.7 years, median age 60 years, and 267 of 428 patients with recoverable sex data (62.4%) were women. Trigeminal branch involvement could be extracted in 351 patients (77.1%), with V2 involvement documented in 256 (56.3%), V3 involvement in 218 (47.9%), and V1 involvement in 138 (30.3%). The final NLP-derived phenotypic distribution comprised 201 primary/classical TN cases (44.2%), 146 secondary TN/trigeminal pain cases (32.1%), and 108 dental-first or mimic presentations (23.7%). MRI was documented in 384 patients (84.4%), neurovascular conflict or vascular loop in 253 (55.6%), multiple-sclerosis-related disease in 69 (15.2%), and tumor-related trigeminal involvement in 84 (18.5%). Prior dental evaluation was identified in 169 patients (37.1%), and prior dental procedures in 114 (25.1%). Carbamazepine exposure was documented in 367 patients (80.7%), pregabalin in 221 (48.6%), gabapentin in 150 (33.0%), oxcarbazepine in 116 (25.5%), and phenytoin in 73 (16.0%). At least one invasive or image-guided procedure was documented in 390 patients (85.7%), including nerve blocks/injections in 355 (78.0%), radiofrequency procedures in 126 (27.7%), balloon compression in 90 (19.8%), microvascular decompression in 113 (24.8%), and stereotactic radiosurgery in 55 (12.1%). Dental-first patients were significantly more likely to have undergone prior dental procedures (65.7% vs. 3.5% in primary/classical TN and 24.7% in secondary TN; p < 0.001), whereas secondary TN/trigeminal pain was associated with higher use of radiofrequency procedures (36.3%; p = 0.017), higher use of stereotactic radiosurgery (19.9%; p = 0.002), higher recurrence documentation (70.5%; p = 0.001), and a higher rate of complete pain relief documented at last follow-up (46.6%; p = 0.004). Conclusions: In tertiary practice, trigeminal pain is substantially broader than a formal TN label. Secondary disease and dental-first pathways account for a large fraction of referrals, and management is characterized by heavy medication burden, frequent escalation, and recurrent retreatment. A structured phenotyping approach may help convert routine clinical documentation into a clinically meaningful framework for diagnostic triage and treatment selection, although imaging and outcome variables require cautious interpretation when derived from retrospective free text. Full article

Juvenile idiopathic arthritis (JIA) is the most common systemic chronic inflammatory connective tissue disease in children, characterized by joint inflammation lasting at least six months. Temporomandibular joint (TMJ) involvement can occur in conjunction with other joints and may often be asymptomatic in its early stages. Objective: This study aims to evaluate the relationship between clinical symptoms of the stomatognathic system and radiologically confirmed cone beam computed tomography (CBCT)-detected structural TMJ changes in children with JIA. The research hypothesis posits that specific clinical symptoms are more prevalent in patients with CBCT-confirmed structural TMJ changes. Methods: A cohort of children diagnosed with JIA was examined. Clinical symptoms, including facial asymmetry, limited mandibular movement, and joint and masticatory muscle pain upon palpation, were assessed. CBCT imaging was performed to assess osseous TMJ structural changes. Results: The frequency of orofacial clinical symptoms was assessed and compared between patients with and without radiological evidence of TMJ involvement. Children with CBCT-confirmed TMJ changes demonstrated significantly higher rates of facial asymmetry, reduced maximum mouth opening, mandibular deviation during opening, and limitations in lateral or protrusive movements compared with those without TMJ involvement. Pain-related symptoms (TMJ pain, muscle tenderness, and pain during movement) and joint sounds occurred at similar frequencies in both groups. Conclusions: Facial asymmetry, mandibular deviation during opening and reduced mandibular mobility are the clinical signs most strongly associated with structural TMJ involvement in JIA and should prompt targeted imaging. Pain-related symptoms show limited diagnostic value, highlighting the need for focused clinical assessment and future studies integrating CBCT and MRI to refine early screening protocols. Full article

Background/Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterised by motor and non-motor symptoms, including pain. Temporomandibular disorder (TMD)-like pain, defined as self-reported pain modified by jaw activities, has been suggested to be more prevalent in PD, but its association with PD severity remains unclear. This study aimed to investigate the association between pain modified by jaw activities and PD severity and the temporal stability of such pain in PD. Methods: This prospective study recruited 28 individuals with PD. Motor symptom severity and disability levels were evaluated using the modified Hoehn and Yahr (mHY) staging and modified Rankin Scale (mRS), respectively. Based on the diagnostic criteria for TMD, a questionnaire assessing pain modified by jaw activities and clinical examination were utilised. Pain modified by jaw activities was reassessed at one, two, and three months. Statistical analyses included Spearman’s rank correlation test and Friedman test, with p < 0.05 considered significant. Results: The participants’ mean age was 69.2 ± 9.6 years; 53.6% were male. Eight participants reported pain modified by jaw activities. Clinical examination identified painful palpation sites in 14 participants, most commonly in the masseter muscle body. Pain modified by jaw activity count showed significant positive correlations with mHY stage (rho = 0.48, p = 0.015) and mRS score (rho = 0.41, p = 0.04). Twenty-four participants completed follow-up, with no significant changes in pain reports over three months. Conclusions: Some individuals with PD may experience persistent TMD-like pain, which is correlated with motor symptom severity and disability levels, highlighting the importance of routine TMD screening in PD. Full article

Background/Objectives: Surgical extraction of impacted mandibular third molars is frequently associated with postoperative morbidity, including swelling, trismus, and pain. However, the extent to which osteotomy contributes to these outcomes remains unclear. The aim of this study was to evaluate osteotomy as an intraoperative determinant of early postoperative morbidity following mandibular third molar extraction. Methods: This study represents a secondary analysis of data obtained from a randomized clinical trial. Patients undergoing surgical removal of impacted mandibular third molars were categorized according to whether osteotomy was required during the procedure. Postoperative outcomes included surgical duration, facial swelling (primary outcome) assessed by linear facial measurements, maximal mouth opening (trismus), postoperative pain intensity, and early soft tissue healing evaluated using the Early Healing Index. Results: Procedures involving osteotomy were associated with significantly longer surgical duration, as well as greater postoperative swelling and trismus during the early postoperative period. The most pronounced difference in swelling was observed along facial measurement line A on postoperative day 3. Multivariable analysis confirmed that osteotomy remained independently associated with increased postoperative swelling and trismus after adjustment for age, sex, and the original six-arm treatment allocation. In contrast, no statistically significant differences were found between the groups in postoperative pain intensity or early soft tissue healing. Conclusions: Osteotomy during mandibular third molar extraction is independently associated with increased early postoperative morbidity, particularly in terms of swelling and trismus. However, bone removal does not appear to negatively affect early soft tissue healing of the surgical site. Full article

Background and Objectives: Frontal bone osteomas are benign tumors characterized by the abnormal proliferation of bone. Though typically asymptomatic, these masses often produce visible forehead deformity and may cause localized discomfort. Endoscopic resection has emerged as an optimal technique for appropriately selected frontal osteomas because it enables complete excision while minimizing visible scarring and risk of neurovascular injury. This case series reviews the senior author’s patient outcomes and complications using a scalp-based, endoscopic-assisted surgical approach for frontal bone osteoma excision. Materials and Methods: A review was conducted of all patients (n = 22) who underwent endoscopic-assisted frontal bone osteoma excision performed by a single surgeon between February 2019 and December 2025. All procedures involved endoscopic visualization through remote scalp incisions, osteoma excision, and frontal bone contouring. Patient demographics, presenting symptoms, CT imaging findings, operative details, histopathology results, and postoperative outcomes were recorded. Results: Twenty-two patients underwent endoscopic-assisted excision of frontal bone osteomas performed by the senior author (NT). The primary concern prompting surgical intervention was aesthetic deformity, with localized pain reported in some cases. For all patients, CT imaging was obtained preoperatively to evaluate lesion size and anatomical relationships to nearby facial structures. Histopathology confirmed cortical bone consistent with osteoma in all cases. Postoperative swelling and ecchymosis were common in the first week but resolved spontaneously. No contour irregularities, fluid collections, residual bone, or sensory deficits were observed. Some alopecia was noted in the first three patients, prompting the senior author to modify the technique. All patients healed with small, flat, well-concealed scars adjacent to the hairline. Conclusions: This single-surgeon experience demonstrates that endoscopic-assisted excision of frontal bone osteomas is a safe and effective technique that permits complete excision with excellent aesthetic outcomes and minimal morbidity. The operative framework presented in this study, including surgical planning, technique steps, and postoperative management, supports endoscopic resection as an ideal alternative to traditional direct approaches for frontal bone osteomas. Full article

Background: Post-stroke neuropathic pain, particularly central post-stroke pain and facial pain syndromes, continues to be challenging to manage with conventional pharmacological approaches. While botulinum toxin A (BoNT-A) is well established for treating spasticity after stroke, its use in the management of central neuropathic pain remains less well established. Methods: This report presents two cases of patients with refractory neuropathic pain following ischemic cerebrovascular accidents who achieved significant pain relief through subcutaneous botulinum toxin administration, after failure of multiple conventional and intramuscular BoNT-A approaches. Results: Case 1 involves a 66-year-old patient with 18 years of post-stroke hemicorporeal pain who responded dramatically to subcutaneous BoNT-A injections after extensive prior treatment failures. Case 2 describes a 54-year-old with trigeminal-region and mandibular pain following ICA dissection who achieved complete pain resolution at facial sites with subcutaneous administration of BoNT-A. Conclusions: These cases demonstrate the potential efficacy of subcutaneous botulinum toxin for managing post-stroke neuropathic pain in selected patients and suggest a mechanism of action related to peripheral pain sensitization rather than motor denervation. Our findings support further investigation of subcutaneous administration techniques for pain management in specialized centers. Full article

Objectives: Ensuring an effective triage to treat patients with chest pain in emergency settings is critical, but it can often be challenging, particularly when patients wear face masks or are unable to clearly communicate their pain. To address this limitation, this study presents a real-time facial expression–based system for chest pain intensity assessment as an initial step toward realizing intelligent emergency triage. The proposed system integrates deep learning with real-time video analysis to provide objective and rapid pain level recognition. Methods: A YOLOv12-based facial expression recognition model was trained using annotated facial images of patients experiencing chest pain, and the model categorizes pain into three intensity levels: no pain, slight pain, and moderate to severe pain. Multiple YOLOv12 variants were systematically evaluated to identify an optimal configuration for potential clinical use. The developed system supports two operational modes: real-time recognition, which analyzes continuous video streams and delivers immediate visual feedback through an interactive interface, and a manual upload mode for offline video analysis, review of results, and playback. Additional usability features, including error prompts and data reset functions, were implemented to enhance system stability and user experience. Results: Among the evaluated models, the YOLOv12-L model achieved the best performance with an accuracy of 98.81%, sensitivity of 98.76%, specificity of 98.79%, precision of 98.04%, and an F1-score of 98.41%, demonstrating stable and accurate recognition. The proposed system is designed to support the triage process of assessing patients with chest pain, particularly in cases where patients wear masks or cannot clearly express their pain. By providing real-time and objective pain intensity assessment, the system shows potential to assist healthcare professionals in identifying patients who may require priority attention and to serve as a supportive tool for emergency triage workflows. Conclusions: Future work will incorporate edge computing with a lightweight model to enable real-time pain assessment in ambulances, facilitating faster intervention and treatment. Full article

Impacted mandibular third-molar surgery commonly causes early postoperative pain, swelling, and trismus. This randomized, controlled, three-arm parallel trial evaluated whether intra-alveolar corticosteroid delivery via an absorbable gelatin sponge improves postoperative recovery compared with a saline control. Fifty-five patients were assessed for eligibility; 37 healthy adults (18–35 years) undergoing standardized mandibular third-molar extraction were randomized to dexamethasone 8 mg (Decort^®), methylprednisolone 40 mg (Prednol^®), or control (saline), all applied intra-alveolarly using a gelatin sponge carrier. Doses were selected using standard systemic glucocorticoid equivalence tables as a pragmatic potency reference, acknowledging unknown intra-alveolar pharmacokinetics/bioavailability. The prespecified primary endpoint (used for sample size planning) was postoperative Day 1 VAS pain; key secondary endpoints were Day 1 analgesic consumption and Day 3 facial swelling. Pain (VAS), analgesic use, trismus, and facial swelling (tragus–pogonion, tragus–labial commissure, and angulus–canthus distances) were assessed on postoperative Days 1, 2, 3, and 7 by a blinded evaluator. Two participants in the methylprednisolone group did not attend postoperative visits. To address potential attrition bias, an Intention-to-Treat (ITT) sensitivity analysis using conservative control-median imputation was performed alongside the available-case analyses. A global False Discovery Rate (FDR) correction was also applied to control for multiplicity. In both analyses, the steroid groups showed lower Day 1 pain scores than the control group. Methylprednisolone was associated with lower Day 3 swelling values than control for the tragus–pogonion and angulus–canthus measurements. These findings should be interpreted as preliminary, given the small sample size, linear swelling measurements, and lack of blinding verification. Full article

Pain is a profoundly stressful experience that significantly impacts an individual’s daily life. In many situations, people can express the intensity of pain via some observable physical actions like crying or shouting. However, in cases where the patient is non-communicative, they cannot convey their feelings through these actions. In both scenarios, automatically monitoring pain intensity using technology presents a considerable challenge. In the literature, researchers have presented numerous techniques for automatic pain monitoring using multiple approaches. This technological survey paper aims to provide an overview of current advancements in the field of automatic pain monitoring. In this paper, we present a taxonomy that summarizes our survey on the utilization of technology areas for monitoring pain automatically. Those technologies are based on Internet of Things (IoT), computer vision, and multimodal techniques. These technologies utilize various modalities, including physiological signals, facial expressions, vocalizations, and behavioral patterns, to detect and quantify pain. The paper discusses the advantages and limitations of each modality, as well as the challenges faced in developing accurate and reliable pain monitoring systems. Additionally, the paper surveys the current state of research in this field, including the development of machine learning algorithms and wearable devices for pain monitoring. Overall, this paper provides a comprehensive overview of the current state of automatic pain monitoring technology and highlights areas for future research and development. This paper also creates a keyword map that will serve as a valuable resource for researchers, enabling them to refine their investigations by identifying frequently used terms and emerging trends within each domain. Full article

Background: Central compartment atopic disease (CCAD) is a recently developed terminology used to describe a specific phenotype of chronic rhinosinusitis (CRS). The aim of this study is to provide a thorough analysis of the clinical and radiological characteristics by assessing the prevalence of symptoms, asthma, allergy, aeroallergen sensitization and radiological sinus involvement. Methods: The authors searched for articles on PubMed, Cochrane, and Embase databases. A review of the articles was carried out following PRISMA guidelines; all articles were assessed for quality according to NICE criteria. Afterwards, the meta-analysis was performed with STATA 18SE software. Studies were also assessed for heterogeneity and risk of publication bias. Mean Lund-Mackay (LMK) score of patients with and without CCAD was compared. Results: A total of 16 studies were included, including 1254 patients with CRS; 537 of these were diagnosed with CCAD. The most prevalent symptoms were obstruction at 78% and congestion at 70%, followed by rhinorrhea at 66%, hyposmia at 54%, and facial pain at 24%. Dust mite at 71% was the most prevalent sensitization. Overall, the prevalence of asthma in patients with CCAD was 26%, prevalence of allergy was 67%. The mean difference in LMK scores was −3.38 in CCAD. Conclusions: Patients frequently present with nasal obstruction and congestion; the most common allergen sensitization is to dust mites. Findings on allergy and asthma prevalence support the “Unified Airway Disease” concept and emphasize the importance of a multidisciplinary approach to managing this phenotype. CCAD patients usually do not develop very high LMK scores; high scores may rule out this diagnosis. PROSPERO registration number: CRD420261361696. Full article

Vitamin D plays an important role in bone metabolism and may influence postoperative healing processes. This study evaluated the association between preoperative serum vitamin D levels and recovery after mandibular third molar extraction. This secondary exploratory analysis included 122 healthy patients undergoing surgical extraction of an impacted mandibular third molar, of whom 98 had complete datasets for clinical and radiographic evaluation. Postoperative outcomes included pain intensity, facial swelling, trismus, early soft tissue healing assessed with the Wachtel Early Healing Index, and bone regeneration evaluated four months after surgery using CBCT-based fractal dimension analysis. Serum vitamin D levels were not significantly associated with postoperative pain, trismus, or early soft tissue healing. A weak correlation was observed between lower vitamin D levels and greater swelling along the tragus–pogonion line on postoperative day 1 (ρ = −0.21, p = 0.035), with no significant associations at later time points. Fractal dimension analysis did not demonstrate significant differences between groups. Within the limitations of this secondary exploratory analysis, vitamin D levels showed limited and inconsistent associations with postoperative outcomes, and their clinical relevance remains uncertain. Full article

Background/Objectives: Postoperative pain pharmacology is complex. We investigated the sensitivity of analgesic-like effects induced by morphine, ibuprofen, and their combination to peripheral opioid antagonism in a mouse laparotomy model. Methods: Mechanical hypersensitivity was assessed using von Frey filaments, and ongoing pain (abdominal licking and facial expressions) was evaluated using artificial intelligence algorithms. We tested the sensitivity of the analgesic treatments to the opioid antagonist naloxone or its peripherally restricted analog, naloxone methiodide. We also tested the effects of neutrophil depletion using an anti-Ly6G antibody. Gastrointestinal transit and pupillary diameter were measured to assess non-analgesic opioid effects. Results: Morphine reversed all pain-related behaviors; its effect on mechanical hypersensitivity was reversed by peripheral opioid antagonism, whereas its effects on ongoing pain were not. Ibuprofen reduced mechanical hypersensitivity and facial expressions but failed to alter licking. Interestingly, the ibuprofen effect on mechanical hypersensitivity depended on peripheral opioid receptors and neutrophils at the injury site. The morphine–ibuprofen combination produced synergistic analgesia across all endpoints without enhancing opioid-induced gastrointestinal inhibition or mydriasis. Peripheral opioid antagonism reversed the effect of the combination on mechanical hypersensitivity and facial expressions but not on licking. Conclusions: Our results replicate the key clinical phenomena relevant to the postoperative pain context, including the potentiation of morphine analgesia by ibuprofen without the exacerbation of adverse effects. Our results suggest that drug effects on different postoperative pain measures rely on distinct neurobiological mechanisms and are not interchangeable. Therefore, the use of a battery of complementary pain endpoints in preclinical pharmacology studies is advisable. Full article

Background: Trigeminal neuralgia (TN) is a severe neuropathic pain disorder primarily diagnosed on clinical grounds, and objective molecular biomarkers that could support diagnosis remain limited. Increasing evidence suggests that inflammation–apoptosis interactions contribute to TN pathophysiology. Methods: In this exploratory prospective case–control study, circulating apoptosis-related microRNAs (miRNAs) were analyzed in 30 patients with idiopathic TN and 20 healthy controls. Plasma miRNA expression levels were quantified using quantitative real-time polymerase chain reaction. Diagnostic performance of individual miRNAs was assessed using receiver operating characteristic (ROC) curve analysis. A multivariable logistic regression model integrating multiple miRNAs was constructed to evaluate combined diagnostic performance, with internal validation performed using five-fold cross-validation. Results: Circulating miRNA expression profiles differed between TN patients and controls. Among individual markers, hsa-miR-183-5p demonstrated the highest diagnostic accuracy (AUC = 0.72), followed by hsa-miR-23a-3p (AUC = 0.65). hsa-miR-223-3p showed reversed directionality (AUC = 0.28), consistent with lower expression in TN and high specificity but low sensitivity at the optimal threshold. The combined miRNA panel achieved an apparent AUC of 0.86, with a mean cross-validated AUC of 0.84 ± 0.12, suggesting improved discrimination over single miRNAs but with variability consistent with the limited sample size. Conclusions: Apoptosis-related circulating miRNAs exhibit distinct expression patterns in idiopathic TN. While individual miRNAs show modest diagnostic performance, integration into a multi-miRNA panel improved discrimination between TN patients and healthy controls in this pilot dataset. These findings support the potential of apoptosis-based miRNA signatures as candidate minimally invasive biomarkers for TN, warranting further validation in larger, independent cohorts, ideally including clinically relevant disease-control facial pain conditions. Full article