Facial pain

Sadly, this enthusiastic attempt at a cure was unsuccessful in clearing up the infection in Jim's sinuses.

Definition

Pain in the face, obviously.

Epidemiology

Pretty common. Specially if you get in a lot of bar brawls.

Clinical and Associated Features

Facial pain. Usually the location is a good clue - dental abscesses are more likely to hurt around the jaw, whereas giant cell arteritis is less likely on the chin.

Differential Diagnosis

• Trauma - head injuries can cause pain in the face, especially with broken cheek bones, etc.
• Sinusitis - a very sharp pain, often behind the eyes, or the cheeks.
• Dental abscess - generally accompanied with toothache.
• Temporal arteritis - An important cause that can lead to blindness and even death! Identified by the side of the head being tender to the touch.
• Trigeminal neuralgia - A sharp stabbing pain caused by the trigeminal nerve being homophobic. Can last for days, or have repeat daily episodes or the like.
• Tempero-mandibular joint disorder - Painful inflammation of the jaw joint, causing flare ups. Rarely chronic, often related to stress, many people have symptoms at some point in life.
• Glaucoma, or other eye problems - Can cause eye pain in closed angle glaucoma.

Investigations

1. If there is any trauma history, or signs of bruising, a head Xray is a good idea.
2. History is important in sorting out sinusitis and neuralgia, since often there will be past episodes.
3. Biopsy of the temporal artery is quite useful for diagnosing temporal arteritis.