Facial Pain1

8/9/2019 Facial Pain1

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Extra trigeminal pain from other oro-facio-cranial structures travel in 7th,9th & 10th & upper cranial roots.

It is not possible to discuss all theparameter of the subject ofheadache & facial pain but adiagnostic evaluation & otolaryngologyproblem as etiological factor has beenstressed.


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H eadacheThe term headache means headacheabove the eyebrow level

It is usually a benign symptom butoccasionally it is a manifestation ofserious illness such as brain tumorsubarachnoid-hemorrhage ,,meningitis or giant cell arteritis.


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Classification of H eadache1.Migrane - Rec. attack of headache usuallyunilateral females are more affected

Migraine without aura

Migraine with aura, Retinal migraine2. Tension type headache - usually suboccipital,pt. complaints of tightness pressure orcontraction.

3. Cluster headache & Ch. Paroxysmalhemicrania


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4. H eadache associated head trauma: -Acute post traumatic headache & Chronic

post traumatic headache5. H eadache or facial pain associated withdisorders of facial or cranial structure

-cranial level-eye,

-ear

-nose&sinuses

-Teeth jaw &related structures

-TM joint diseases


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6. H eadache associated with vasculardisorder:

-Acute ischemic cardiovascular disorder-Intracranial hematoma

-Subarachnoid hemorrhage

7. H eadache associated with nonvascularintracranial disorder

-H igh or Low CSF pressure-Intracranial Infection

- Intra cranial neoplasm associated with otherintracranial disorder

-


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8. H eadache associated with substancedependence or their withdrawal

9. H eadache associated with noncephalicinfection - Viral infection

-Bacterial infection

-Other infection10. H eadache associated with metabolicdisorder - H ypoxia

-H ypercapnia-Mixed hypoxia & hypercapnia-H ypoglycemia-Dialysis

-Other metabolic abnormality


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11.Cranial neuralgias, nerve trunk pain-Trigeminal (tic doloreux)-Glossopharyngeal-Central

12. H eadache no classifiable13 Psychogenic headache


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Evaluation of H eadacheA complete medical history review is essential

1. Age & Sex2. Onset, duration, intensity, quality & frequency

of headache3. Time relation in headache4. Location of headache5. H/ o any head trauma / hypertension

/allergy

/use of drug6 Aggravating and relieving factors

7 Associated symptoms


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Family history

-emotional disturbances-sociological factor

complete ENT examination : PNS,

throatcomplete neurological examinationCVS examinationH

ead & neck examinationocular & dental exam.Assessment of personality profileradiological assessment


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*

About 50 % patients presenting toENT specialists with symptoms ofsinusitis complain of severeheadache.

* 70% patients with chronic sinusitisrequiring surgery have headache


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ENT Causes of H eadache

Acute Sinusitis+ve h/ o URIAs an exacerbation of nasal allergy / vasomotor rhinitisLocal pain and tenderness overaffected sinus

NOSE- turbinate engorgement , mucosal

edema , nasal polyp or generalizededemanasal congestion, purulent nasaldischarge


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Frontal sinus - Pain in frontal regions, painincreased by bending forwardMaxillary sinus - Pain & tenderness onrelated to maxilla.

Ethmoid Sinus- pain between the eyes

Diagnosis Plain sinus radiograph can

diagnose acute maxillary and frontal sinusitisbut often fails to diagnose ethmoid orsphenoidal sinusitisCT PNS Coronal cuts- highly sensitive


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Nasal endoscopy-permits direct visualizationof nasal passage and sinus drainage areas.

This procedure is complementary to CT or

MRI scan.


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Management of Acutesinusitis

Antibiotics (gatifloxacin ,cipro.Augmentin),Antihistaminic & decongestants-systemic as well as localAnalgesicsMucolytics


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Management of chronicsinusitis

Conservative managementSurgical management- FESS (if pat.does not respond to 6 weeks ofconservative management)


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Septal deviation / spurAgger nasi cells(prominent )

Uncinate process{.medially/ lateraly bentcontacting middle

turbinatepeumatized}


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Anatomic variations in thenose and paranasal sinuses

Agger nasi cells

prominent


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Anatomical variatons ofmiddle turbinate

Paradoxicallycurved middleturbinate


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Anatomicalvariatons of middleturbinate[concha bullosa(pneumatizedmiddleturbinate)


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ea ac e t ntracran acomplication of csom or

sinusitis

MeningitisExtra dural abscessSub dural abscess

Brain abscessLateral sinus thrombsis


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Tempromandibulardisorder

Pain from TMJ.and associatedmusculature and ligaments refferedto headDental causes-carioustooth,periapical abscess ,dental

abscess


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Facial PainGlassopharyngeal Neuralgia -unilateral throat & ear Pain agravatedby eating swellowing and coldstimulationSphenopalatine neuralgia - pain inorbital area cheek roof of the mouth,

root of the nose and upper jaw &teeth.


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Trigeminal NeuralgiaCharacterised byParoxysmal sharp

excruciating painalong thedistribution ofTrigeminal nerve onone half of theface


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Medical treatment of

Trigeminal neuralgiaCarbamazepinePhenytoin sodium

GabapentineT CAD


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Micro vasculardecompression


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Surgical Treatment ofTN

MVD


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Facial PainDental Cause: Periapical abscess, periodontitis

Acute pulpitis TMJ disfunctions Orthopath


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Eagle syndrome - due to elongatedstyloid process, unilateral pharyngeal

pain. Digital palpation of in stonsilarfosa causes painCostent or TM joint syndrome -

trismus & pain in the ear, main wallnose & eyes may be associated withthe crepitation of TM joint.


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H eadache symptom thatsuggest a serious underlying

Worse headache everFirst severe headacheSubacute worsening over days or weekAbnormal neurological examinationFever or unexplained systemic signVomiting preceds headacheDistrubs sleep or presents immediately uponawakeningKnown systemic illnessOnset after age 55


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Thank you


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Anatomic variations in thenose and paranasal sinusesSeptal deviation / spurAgger nasi cells (prominent )

Uncinate process{.medially/ lateraly bentcontacting middle turbinatepeumatized}


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Anatomical variatons of middle turbinate

[concha bullosa (pneumatizedmiddleturbinate)

Anatomical variatons of middle turbinate

Ethmoid bullalarge filling middle meatusAnterior growth,overlaping hiatus

semilunaris/or protruding through middlemeatus


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Trotters triadPtrygopalatine fossa syndromeFoixs syndromeTolosahunt syndrome


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Vascular Pain;

(Migrane, cluster headache, temporalarteritis, Chronic paroxysmalhemicrania, )

post herpetic neuralgia

Central pain (SOL) carotidynia Causalgia Myofacial pain Tension H eadache Atypical facial pain Glossdynia

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Facial Pain1