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Dental Disorders
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Sinus Disease
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TMJ dysfunction
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Cx dysfunction
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Myofascial Trigger points
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Eye disorders
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Lesions of the oropharynx/posterior 1/3 of tongue
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Trigeminal Neuralgia
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Chronic Paroxysmal hemicrania
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Carcinoma of the mouth, sinuses, nasopharynx, tonsils, tongue, larynx and parotid
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Temporal arteritis
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SOL in orbit/base of the brain
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Refer out when:
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Severe trigeminal neuralgia
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+ve neurological signs - impaired corneal reflex, sensation loss in trigeminal dermatone, facial weakness, hearing loss ipsilateral to neuralgia
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Possible need for drainage of sinusitis
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Dental infection/other dental problems
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Site
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Cause
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Pain in the Ear
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Referral from skin, teeth, tonsils, pharynx, larynx, neck
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Tenderness over maxilla
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Sinusitis, dental abscess, carcinoma
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Character
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Sharp, severe pain in divisions of the Vth nerve
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Trigeminal Neuralgia
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Dull,aching quality
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Infections of teeth, mastoid and ear
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Precipitating Factors
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Food/chewing
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Dental Abscess, salivary gland disorder, TMD, jaw claudication
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Touch of the skin
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Trigeminal Neuralgia
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Associated symptoms
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Otorrhoea/hearing loss
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ear/mastoid
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Nasal obstruction + rhinorrhoea
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Maxillary sinusitis/carcinoma of the maxillary antrum
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Proximal muscle weakness + Pain
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PMR + Temporal arteritis
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Health status & Behaviour
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Palpation of face and neck - parotid gland, eyes, regional lymph nodes, Trps + skin
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TMJ + Cx spine for joint dysfunction
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Nose, mouth, pharynx + ears
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Teeth - percussion of teeth
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Palpation of sinuses for tenderness
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CN - V, III, IX
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Rule out suspected MS + Tumour in neuralgia
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- MRI, CT
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Trauma/Dental problems
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Sinusitis - especially with bilateral mucopurulent rhirrorhoea >10 days
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Consider:
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Trigeminal neuralgia
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Herpes Zoster
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Carcinoma
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Glaucoma
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TMD
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Cx Spondylosis
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Glossitis
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