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