Common Causes of Facial pain
Dental Disorders |
Sinus Disease |
TMJ dysfunction |
Cx dysfunction |
Myofascial Trigger points |
Eye disorders |
Lesions of the oropharynx/posterior 1/3 of tongue |
Trigeminal Neuralgia |
Chronic Paroxysmal hemicrania |
Serious disorders
Carcinoma of the mouth, sinuses, nasopharynx, tonsils, tongue, larynx and parotid |
Temporal arteritis |
SOL in orbit/base of the brain |
Refer
Refer out when: |
Severe trigeminal neuralgia |
+ve neurological signs - impaired corneal reflex, sensation loss in trigeminal dermatone, facial weakness, hearing loss ipsilateral to neuralgia |
Possible need for drainage of sinusitis |
Dental infection/other dental problems |
Pain Analysis
Site |
Cause |
Pain in the Ear |
Referral from skin, teeth, tonsils, pharynx, larynx, neck |
Tenderness over maxilla |
Sinusitis, dental abscess, carcinoma |
Character |
Sharp, severe pain in divisions of the Vth nerve |
Trigeminal Neuralgia |
Dull,aching quality |
Infections of teeth, mastoid and ear |
Precipitating Factors |
Food/chewing |
Dental Abscess, salivary gland disorder, TMD, jaw claudication |
Touch of the skin |
Trigeminal Neuralgia |
Associated symptoms |
Otorrhoea/hearing loss |
ear/mastoid |
Nasal obstruction + rhinorrhoea |
Maxillary sinusitis/carcinoma of the maxillary antrum |
Proximal muscle weakness + Pain |
PMR + Temporal arteritis |
Examinations
Health status & Behaviour |
Palpation of face and neck - parotid gland, eyes, regional lymph nodes, Trps + skin |
TMJ + Cx spine for joint dysfunction |
Nose, mouth, pharynx + ears |
Teeth - percussion of teeth |
Palpation of sinuses for tenderness |
CN - V, III, IX |
Investigations
Rule out suspected MS + Tumour in neuralgia |
- MRI, CT |
Facial pain in Children
Trauma/Dental problems |
Sinusitis - especially with bilateral mucopurulent rhirrorhoea >10 days |
Facial Pain in the Elderly
Consider: |
Trigeminal neuralgia |
Herpes Zoster |
Carcinoma |
Glaucoma |
TMD |
Cx Spondylosis |
Glossitis |
|
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