Facial Pain – causes, diagnosis and treatment

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Facial Pain – A number of conditions are involved in the pain localized to the face. These may range from pain arising from diseases of teeth, gums, sinuses, tempro mandibular joint to vascular causes.

Common causes of facial pain are:

1. Neuritis of the cutaneous nerves of the face and scalp.

2. Arthralgia of the temporomandibular joint.

3. Trigeminal neuralgia

4. Post-herpetic neuralgia/herpes zoster.

5. Temporal arteritis

6. Miscellaneous causes.

Facial neuritis

It is a form of inflammation of the nerve of the face and scalp. It generally occurs as a complication of a septicaemic state or due to involvement by a neurotropic virus. Onset is usually acute and pain is confined to the face and scalp, occurring in paroxysms lasting for several hours and very often till the end of the day when the patient is exhausted.

The character of pain is dull aching which is intensified by exposure to cold and often occurs in the form of shooting pains in the distribution of the nerve. Sometimes the pain is so severe that the patient is unable to sleep. Physical examination shows presence of hyperalgesia in the distribution of nerves including face and scalp. Nerve trunk is tender on pressure.

Facial neuritis has to be differentiated from number of conditions which have character of facial pain. In infection of the nasal air sinuses (frontal, maxillary and sphenoidal) pain is referred to the distribution of supraorbital and infraorbital nerves. It may be at the root of the nose (ethmoiditis) or forehead or occiput (sphenoidal sinusitis). All cases of sinusitis have a preceding history of a bad cold. Presence of sinusitis can be confirmed by trans-illumination and X-ray of sinuses.

Teeth are other common source of facial pain

It may be an impacted or UN-erupted tooth or a carious tooth. Sometimes an acute inflammation or a growth in the pharynx may cause pain in the ear and face. Cases of glaucoma may sometime present with referred pain to eyes and face. Uncommonly a case of acute myocardial infarction may present with pain referred to teeth, gums, jaw and face.

Cases of facial neuritis are managed with analgesics and warmth applied to the part of the face effected. At the same time careful search be made for any septic focus or any other cause being considered responsible for the facial pain and appropriate treatment instituted. Cases of sinusitis responsible for facial pain should be treated with antibiotics, and analgesics. In cases where improvement does not occur drainage of pus from the involved sinus especially maxillary sinus is undertaken by puncture.

Cases of glaucoma have to be treated with appropriate drugs while in suspected cases of myocardial infarction electrocardiogram be recorded and if found significant treatment be given on these lines.

Myofacial pain

It is a form of dull constant pain with local tenderness of the muscles of jaw. There is often pain and difficulty in opening the mouth. This pain is related to bad and improper habits of clenching and grinding of teeth. This type of habit is present amongst hysterical persons especially women who often clench and grind their teeth.

There is no physical finding in such people except that these people have an emotionally labile personality and often suffer from depression. Treatment consists in giving them assurance, analgesics and tricyclic antidepressants.



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