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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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