Dental AbscessS&S | Severe/throbbing toothache - radiates to maxilla/mandibular area | Swollen lymphnodes | Fever | Sensitivity to temperatures/pressures | Swelling in the face | Bad taste/odour in the mouth |
ManagementReferral to dentist/GP | Antibiotics + Root canal procedure |
Acute/Chronic SinusitisAcute S&S | Chronic | Maxillary sinus most infected | Vague Facial Pain | Localised tenderness - Sphenoidal/ethmoidal causes constant pain behind the eye/nose + nasal blockage | Offensive postnasal drip | Facial Pain | Nasal Obstruction | Toothache | Toothache | HA | Malaise | Purulent postnasal Drip | Halitosis | Nasal Discharge + obstruction | Symptoms >90 days | Rhinorrhoea | Cough which is worse at night | Prolonged Fever | Epistaxis | Symptoms <90 days |
ExaminationPalpation for Tenderness | Frontal - upward beneath medial side of the supraorbital ridge | Maxillary - against anterior wall, below infraorbital margin | Ethmoid - medially against the medial wall of the orbit |
ManagementAcute | Chronic | Refer to GP | Refer to GP | Antibiotics Nasal corticosteroids | Advice on avoidance of Triggers | | | Long term Antibiotics | | | Nasal Irrigation | | | Intranasal corticosteroids | | | Underwater diving avoidance | | | Stop smoking | | | Good dental hygiene is key |
Refer IMMEDIATELY TO HOSPITAL IF:
- Orbital involvement
- S&S of meningitis
- Severe systemic infection
- Intraorbital/periorbital complications - oedema, cellulitis, displaced eyeball, diplopia, opthalmoplegia/affected visual acuity
- Neurological signs
- Severe Frontal HA | | Facial Nerves Distribution
Trigeminal NeuralgiaS&S | Unilateral, severe, searing jabs of pain | Usually in V2, V3 divisions | Variable Frequency - Spontaneous onset + offset | Talking, chewing, touching area, cold weather/wind | No relieving factors | Sensitive areas: upper + lower lip, nasolabial fold/upper eyelid | Normal Neurological Exam |
ManagementDrugs: Carbamazepine | Surgery (If blood vessel is pressing on nerve) | Capsaicin cream | CBT/Pain management |
Glossopharyngeal Neuralgia (Rare)S&S | Severe lacinating pain in back of throat | Radiates to ear canal + neck | Triggered by swallowing, coughing, talking |
ManagementSpecialist Referral - GP, Dentist, Neurologist, Neurosurgeon | MRI to rule out blood vessel disorders/causes, Tumours of throat/neck | Drugs: Carbamazepine, gabapentin, liquid xlyocaine - regular blood tests needed |
Herpes ZosterS&S | Radicular Pain + hyperaestheisa in Trigeminal division (Usually V1) - stinging, tingling, burning | Unilateral patchy rash in one or more dermatomes | Intense erythema + papules in infected area (can be present on cornea) | Regional lymphademopathy | Crusting of scabs - 10-14 days afterwards | Fever + Malaise | HA |
ManagementIMPORTANT TO TREAT WITHIN 2-3 DAYS - INCREASED RISK OF POST-HERPETIC NEURALGIA | Referral to GP | Analgesics - Calamine, Opoids for severe pain, Lidocaine, Gabapentin | Antivirals - Aciclovir,valaciclovir, famciclovir |
Atypical Facial Pain (AFP)S&S | Moderate - Severe pain which is poorly localised - Maxilla/mandibular area | Chronic - gradual increase of pain | Middle aged women most affected | Radiates in anatomically impossible ways | Association with depression/anxiety | No aggravating/relieving factors | Does NOT wake patient up from sleep | A DIAGNOSIS OF EXCLUSION - RULE OUT OTHER CAUSES OF FACIAL PAIN |
ManagementAnalgesics | Antidepressants | Muscle Relaxants | Anticonvulsants | Surgery ONLY TEMPORARY RELIEF | Refer to GP for specialist | CBT = fear avoidance |
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