Conditions: Facial Pain
Determining the cause of the facial pain is essential for treating it effectively. Causes of facial pain are many. Choose the subject below you are interested in expanding.
Facial pain
The skin and bones of the face and much of the sensation within the mouth and nose provide sensory feedback to the brain through the left and right trigeminal nerves. Determining the cause of the facial pain is essential for treating it effectively. Causes of facial pain are many, including sinusitis, various headache syndromes (such as trigeminal neuralgia, cluster headache, migraine), dental problems, jaw joint problems (temporomandibular disorders), giant cell arteritis, trauma, dermatologic conditions, and others. Making the correct diagnosis requires a physician evaluation for history and physical exam and potentially imaging (CT, MRI, dental x-rays) and/or nasal endoscopy.
sinus infection (sinusitis)
Infections in the sinuses frequently account for pain in the face or even elsewhere in the head, such as pain at the top of the scalp. Correctly diagnosing a sinus infection largely depends on a supportive history that may include sinus or head pain, facial pressure, runny nose, poor sense of smell, and difficulty breathing nasally. If the diagnosis is in doubt, nasal endoscopy or imaging (such as a CT scan most commonly) may be undertaken to confirm or refute this diagnosis.
headache syndromes
Headaches may occur on their own (called primary) as well as a result from another condition (secondary). Primary headaches include cluster headaches, migraine, new daily persistent headaches, and tension headaches. Secondary headaches may arise from disease of blood vessels in the brain, head injury, high blood pressure, infection, medications, sinus infection, trauma, or a tumor. Investigation in the form of a history, physical exam, and often some additional procedures such as imaging are needed to identify the cause and help define treatment options. Neurologists, dentists, otolaryngologists, and spine specialists may be involved depending on the situation.
neurogenic causes
All pain is transmitted to the brain through nerves but the term neurogenic pain refers to when the nerves themselves are faulty and the nerves are wrongfully sending pain signals to the brain. A common example of neurogenic facial pain is trigeminal neuralgia, in which the trigeminal nerve is signaling facial pain to the brain when the face tissues themselves are healthy. Another example is nerve pain that persists after dental work, when the tooth is healed, but the nerve serving it remains irritated.
dental causes
Pain resulting from a problem with teeth is very common and represents a large portion of all facial pain. The cause is readily identified when one’s dental health is poor, pain is localized to one or more teeth, and when there is swelling around the affected tooth or teeth. Chronic facial pain may be related to the teeth, but may be more difficult to diagnose as such. When a dental cause of pain is suspected, evaluation is best performed by a dentist.
temporomandibular joint
The lower jaw (mandible) moves on a joint immediately in front of each ear. The joint itself, muscles around it, and the nerves serving it are all components of the family of temporomandibular disorders. TMD affects up to 15% of adults, with a peak incidence at 20 to 40 years of age. Common symptoms include jaw pain or dysfunction, earache, headache, and facial pain. Many causes contribute to temporomandibular disorders, including diet, clenching, maloclusion (teeth coming together improperly), trauma, as well as social and emotional factors. Initial diagnosis is usually based on history and physical examination. Diagnostic imaging may be beneficial. Most patients improve with a combination of noninvasive therapies, including patient education, self-care, cognitive behavior therapy, pharmacotherapy, physical therapy, and occlusal devices. Nonsteroidal anti-inflammatory drugs and muscle relaxants are recommended initially, and benzodiazepines or antidepressants may be added for chronic cases. Commonly, referral to a dentist or oral and maxillofacial surgeon is valuable for further evaluation and management.
• Animated video explaining the temporomandibular joint and associated problems.
giant cell arteritis (temporal arteritis)
Giant cell arteritis, also known as temporal arteritis, is a long-term disease process without a known cause in which large and medium sized blood vessels become inflamed and narrowed. This narrowing can become severe and lead to major problems such as blindness. Therefore, early diagnosis is essential so that treatment can get underway. Diagnosis is suspected when an individual over the age of 50 develops severe pain in the temple or, less commonly, develops muscle fatigue in the tongue and mouth requiring resting breaks during a meal. A current or prior diagnosis of polymyalgia rheumatica increases the likelihood of giant cell arteritis. Unusual arm muscle fatigue is another indicator. Diagnosis is typically confirmed by surgically sampling a portion of the temporal artery, but advancements in MRI and MR angiography, computed tomography angiography, PET scan, and ultrasonography may also be used. Once the diagnosis is made, steroids are the mainstay of therapy, though other medical treatments (immune system modulators, for example) may be chosen.
Swelling of the parotid salivary gland.
other infections
Salivary glands, skin, eyes and eyelids also become painful as a result of infection, and the location of the pain and swelling are helpful in making the diagnosis. Most infections causing facial pain develop fairly rapidly (over a few days) and are associated with redness, swelling, and warmth. The causes include bacteria, viruses, and sometimes fungal organisms.
A swelling of the parotid salivary gland due to a tumor.
tumors (neoplasms)
Tumors may arise in the skin, lymph nodes, salivary glands, or any type of tissue. Pain does not alway accompany a tumor, but it can. The quality and duration of pain as well as any associated findings like a mass may suggest a tumor growth and direct additional studies such as imaging or biopsy.