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Facial Pain Cheat Sheet by

Facial Pain General notes

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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