Facial pain

Question 1

Ddx for facial pain?

Answer 1

Sinusitis/Rhinosinusitis
Trigeminal neuralgia
Cluster headaches
Temporal arteritis

Question 2

What examinations would you do for presentation of sinusitis?

Answer 2

External inspection of nose
Anterior rhinos copy
Endoscopic examination - nasal cavity and post nasal space

Question 3

Investigations for sinusitis?

Answer 3

Allergy - skin prick test, Allergen specific IgE (RAST) test

CT scans - if concerned about malignancy

Question 4

Characteristic presentation of sinusitis?
(passmed)

Answer 4

Facial ‘fullness’ and tenderness
Nasal discharge, pyrexia or post-nasal drip leading to cough

Question 5

Characteristic presentation of trigeminal neuralgia?

(passmed)

Answer 5

• Unilateral facial pain characterised by brief electric shock-like pains.
• Abrupt in onset and termination
• May be triggered by light touch, emotion

NICE CKS: severe, unilateral, short lived, recurrent, episodic, provoked.

Question 6

Causes of trigeminal neuralgia?

Answer 6

Idiopathic
Secondary causes:
- malignancy
- AVM
- MS
- Sarcoidosis
- Lyme disease

Question 7

Management of trigeminal neuralgia?
- pharmacological
- surgical

Answer 7

Pharamacological
- carbamazepine (1st line)
- phenytoin
- lamotrigine
- gabapentin

Surgical
- microvascular decompression
- treat underlying cause and alcohol injections

Question 8

Risk factors for trigeminal neuralgia?

Answer 8

MS
Increasing age - peak 50-60yrs
Female
FHx
HTN
Stroke

Question 9

Complications of trigeminal neuralgia?

Answer 9

Impaired daily activities
Depression
Weight loss - as can’t eat!

Question 10

Characteristic facial pain caused by cluster headache?

(passmed)

Answer 10

Pain typical occurs once or twice a day, each episode lasting 15 mins - 2 hours
Clusters typically last 4-12 weeks
Intense pain around one eye
Accompanied by redness, lacrimation, lid swelling, nasal stuffiness

Question 11

Characteristic facial pain caused by GCA?

(passmed)

Answer 11

Tender around temples
Raised ESR

Question 12

What is rhinosinusitis aka sinusitis?

Answer 12

Inflammation of the nose and paranasal sinuses
Must have more than 2 symptoms - one of which must be nasal congestion or nasal discharge

Question 13

Presentation of rhinosinusitis aka sinusitis?

Answer 13

Nasal congestion
Nasal discharge
Facial painpressure
Reduced olfaction

Question 14

Investigations for rhinosinusitis aka sinusitis?

Answer 14

Clinical Dx !!

May do nasal endoscopy, sinus culture, CT sinuses with contrast.

Question 15

Differentials for rhinosinusitis aka sinusitis?

Answer 15

Allergic rhinitis
Non-allergic rhinitis
MIgraine
Adenoiditis
Facial pain - cluster headache, trigeminal neuralgia

Question 16

Management for rhinosinusitis aka sinusitis?

Answer 16

Supportive therapy
Analgesia
Decongestant
Intranasal corticosteroid
Abx if necessary

Question 17

Complications of rhinosinusitis aka sinusitis?

Answer 17

Peristent infection
Orbital cellulitis
Meningitis, encephalitis
Mucoceles
Osteomyelitis
Subperiostal abscess.