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Causes of Facial Pain Cheat Sheet by

Common causes of facial pain presenting in clinics

Dental Abscess

S&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

Management

Referral to dentist/GP
Antibi­otics + Root canal procedure

Sinuses

- Sinuses of the skull

Acute/­Chronic Sinusitis

Acute 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

Examin­ation

Palpation 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

Management

Acute
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 Neuralgia

S&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

Management

Drugs: 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

Mana­gem­ent

Specialist 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 Zoster

S&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

Mana­gem­ent

IMPO­RTANT 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

Mana­gem­ent

Analgesics
Antide­pre­ssants
Muscle Relaxants
Antico­nvu­lsants
Surgery ONLY TEMPORARY RELIEF
Refer to GP for specialist
CBT = fear avoidance
   
 

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