Dental Abscess
S&S |
Severe/throbbing toothache - radiates to maxilla/mandibular area |
Swollen lymphnodes |
Fever |
Sensitivity to temperatures/pressures |
Swelling in the face |
Bad taste/odour in the mouth |
Management
Referral to dentist/GP |
Antibiotics + Root canal procedure |
Acute/Chronic Sinusitis
Acute S&S |
Chronic |
Maxillary sinus most infected |
Vague Facial Pain |
Localised tenderness - Sphenoidal/ethmoidal causes constant pain behind the eye/nose + nasal blockage |
Offensive postnasal drip |
Facial Pain |
Nasal Obstruction |
Toothache |
Toothache |
HA |
Malaise |
Purulent postnasal Drip |
Halitosis |
Nasal Discharge + obstruction |
Symptoms >90 days |
Rhinorrhoea |
Cough which is worse at night |
Prolonged Fever |
Epistaxis |
Symptoms <90 days |
Examination
Palpation for Tenderness |
Frontal - upward beneath medial side of the supraorbital ridge |
Maxillary - against anterior wall, below infraorbital margin |
Ethmoid - medially against the medial wall of the orbit |
Management
Acute |
Chronic |
Refer to GP |
Refer to GP |
Antibiotics Nasal corticosteroids |
Advice on avoidance of Triggers |
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Long term Antibiotics |
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Nasal Irrigation |
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Intranasal corticosteroids |
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Underwater diving avoidance |
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Stop smoking |
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Good dental hygiene is key |
Refer IMMEDIATELY TO HOSPITAL IF:
- Orbital involvement
- S&S of meningitis
- Severe systemic infection
- Intraorbital/periorbital complications - oedema, cellulitis, displaced eyeball, diplopia, opthalmoplegia/affected visual acuity
- Neurological signs
- Severe Frontal HA
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Facial Nerves Distribution
Trigeminal Neuralgia
S&S |
Unilateral, severe, searing jabs of pain |
Usually in V2, V3 divisions |
Variable Frequency - Spontaneous onset + offset |
Talking, chewing, touching area, cold weather/wind |
No relieving factors |
Sensitive areas: upper + lower lip, nasolabial fold/upper eyelid |
Normal Neurological Exam |
Management
Drugs: Carbamazepine |
Surgery (If blood vessel is pressing on nerve) |
Capsaicin cream |
CBT/Pain management |
Glossopharyngeal Neuralgia (Rare)
S&S |
Severe lacinating pain in back of throat |
Radiates to ear canal + neck |
Triggered by swallowing, coughing, talking |
Management
Specialist Referral - GP, Dentist, Neurologist, Neurosurgeon |
MRI to rule out blood vessel disorders/causes, Tumours of throat/neck |
Drugs: Carbamazepine, gabapentin, liquid xlyocaine - regular blood tests needed |
Herpes Zoster
S&S |
Radicular Pain + hyperaestheisa in Trigeminal division (Usually V1) - stinging, tingling, burning |
Unilateral patchy rash in one or more dermatomes |
Intense erythema + papules in infected area (can be present on cornea) |
Regional lymphademopathy |
Crusting of scabs - 10-14 days afterwards |
Fever + Malaise |
HA |
Management
IMPORTANT TO TREAT WITHIN 2-3 DAYS - INCREASED RISK OF POST-HERPETIC NEURALGIA |
Referral to GP |
Analgesics - Calamine, Opoids for severe pain, Lidocaine, Gabapentin |
Antivirals - Aciclovir,valaciclovir, famciclovir |
Atypical Facial Pain (AFP)
S&S |
Moderate - Severe pain which is poorly localised - Maxilla/mandibular area |
Chronic - gradual increase of pain |
Middle aged women most affected |
Radiates in anatomically impossible ways |
Association with depression/anxiety |
No aggravating/relieving factors |
Does NOT wake patient up from sleep |
A DIAGNOSIS OF EXCLUSION - RULE OUT OTHER CAUSES OF FACIAL PAIN |
Management
Analgesics |
Antidepressants |
Muscle Relaxants |
Anticonvulsants |
Surgery ONLY TEMPORARY RELIEF |
Refer to GP for specialist |
CBT = fear avoidance |
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