Facial Pain

Question 1

Apart from trauma, facial pain in children is almost invariably due to ______

Answer 1

dental problems

Question 2

A serious problem sometimes seen in children is orbital cellulitis secondary to ______

Answer 2

ethmoiditis.

Question 3

Dental caries, impacted teeth, infected tooth sockets and dental roots can cause pain in the _____ and _______

Answer 3

maxillary and mandibular regions

Question 4

Features of dental caries

• Pain is usually confined to the affected tooth but it may be diffuse.
• Pain is almost always aggravated by thermal
changes in the mouth:
—_________—if dental pulp vital
—_______—if dental pulp is necrotic

Answer 4

cold

hot

Question 5

this is a very painful condition mainly in the lower molars unrelieved by
analgesics following a tooth extraction

Answer 5

Dry tooth socket

Question 6

This is a rapidly swelling cellulitis occurring in both the sublingual and submaxillary spaces without abscess formation, often arising from a root canal infection

Answer 6

Ludwig angina

Question 7

Infection of the paranasal sinuses may cause localised pain.

Localised tenderness and pain may be apparent with ________ and ______

Answer 7

frontal or maxillary sinusitis

Question 8

The commonest organisms of sinusitis are

Answer 8

Streptococcus pneumoniae,
Haemophilus influenzae and
Moraxella catarrhalis.

Question 9

The _______ is the one most commonly

infected sinus

Answer 9

maxillary sinus

Question 10

Causes of sinusitis

Answer 10

caused by stasis following a URTI or

acute rhinitis, or due to dental root infection

Question 11

A simple way to assess the presence or absence of fluid in the frontal sinus, and in the maxillary sinus (in particular), is the use of ________

Answer 11

transillumination

Question 12

Associations of chronic sinusitis

Answer 12

nasal polyps and vasomotor rhinitis, but is frequently associated with a structural abnormality of the upper
airways.

Question 13

This condition is due to abnormal movement of the mandible, especially during chewing

Answer 13

TMJ dysfunction

Question 14

MC cause of TMJ dysfunction

Answer 14

The basic cause

is dental malocclusion.

Question 15

Methods for TMJ Arthralgia

Answer 15

1. ‘Chewing’ the piece of soft wood

2. The ‘six by six’ program

Question 16

Indications of TMJ injection

Answer 16

painful rheumatoid arthritis,

osteoarthritis or TMJ dysfunction not responding to conservative measures

Question 17

What to give in TMJ injection

Answer 17

Inject a 1 mL solution of

local anaesthetic and corticosteroid in equal parts

Question 18

Lesions of the posterior third of the tongue, the oropharynx, tonsils and larynx may radiate to the region of the ear via the_______

Answer 18

tympanic branch of the ninth nerve or

the auricular branch of the tenth nerve.

Question 19

__________ a condition of often unknown cause that typically occurs in patients over the age of 50, affecting the second and third divisions of the trigeminal nerve and on the same side of the face

Answer 19

Trigeminal neuralgia (tic douloureux)

Question 20

Surgical procs for TN

Answer 20

decompression of the trigeminal nerve root

Question 21

Surgical procs for TN if severe

Answer 21

if severe, refer for neuroblative treatment, e.g.

thermocoagulation/radiofrequency neurolysis

Question 22

This is an uncommon condition of the ninth cranial nerve and branches of the vagus nerve with similar clinical features of severe, lancinating pains, particularly felt in one ear, the base of the tongue or
beneath the angle of the jaw

Answer 22

Glossopharyngeal neuralgia

Question 23

the pain is unilateral and centred around the eye with associated lacrimation and stuffiness of the nose.

Answer 23

Migrainous neuralgia (cluster headache)

Question 24

there is a unilateral facial pain that can
resemble chronic cluster headache but the duration is briefer, about 15 minutes, and it may recur many times a day even for years

Answer 24

Chronic paroxysmal hemicrania

Question 25

TX of Chronic paroxysmal hemicrania

Answer 25

It responds dramatically to

indomethacin.

Question 26

Herpes zoster may present as hyperaesthesia or a burning sensation in any division
of the fifth nerve, especially the _______

Answer 26

ophthalmic division

Question 27

This is mainly a diagnosis of exclusion whereby patients, usually middle-aged to elderly women, complain of diffuse pain in the cheek (unilateral or bilateral) without demonstrable organic disease

Answer 27

Atypical facial pain

Question 28

Characteristic of Atypical facial pain

Answer 28

The pain does not usually conform to a specific nerve distribution (although in the maxillary area), varies in intensity and duration and is not lancinating as in
trigeminal neuralgia.

Question 29

Characteristic of Atypical facial pain

Answer 29

deepseated and ‘boring’, severe, continuous and throbbing in nature.

Question 30

Tx of Atypical facial pain

Answer 30

amitriptyline 10–75 mg nocte
or
dothiepin 25–150 mg nocte
or
carbamazepine

Question 31

This may produce mild or severe unilateral or

bilateral headache. There may be ischaemic pain in the jaws when chewing

Answer 31

Temporal arteritis

Question 32

_______ is a superficial form of cellulitis
involving the face. It usually presents with the
sudden onset of butterfly erythema with a welldefined edge

Answer 32

Classical erysipelas

Question 33

Etiology of Classical erysipelas

Answer 33

Streptococcus pyogenes

Question 34

tx of Classical erysipelas

Answer 34

Treatment is by phenoxymethylpenicillin or di/flucloxacillin for 7–10 days.

Question 35

____must be excluded in the elderly with

facial pain.

Answer 35

Malignancy

Question 36

Problems from the molar teeth, especially the _______, commonly present with periauricular pain without aural disease and pain in the posterior cheek

Answer 36

third (wisdom)