FACIAL PAIN
Visualize the structures of the face in a systematic fashion to develop
a differential diagnosis of facial pain. With the skin, herpes zoster
and carbuncles come to mind. Next, the internal maxillary artery
suggests histamine cephalalgia and arteritis, just as the nerves
suggest trigeminal neuralgia, herpes zoster, and the atypical facial
neuralgias encountered in multiple sclerosis, Wallenberg syndrome, and other
central nervous system conditions. These will almost invariably be
associated with other neurologic findings. With reference to the
bones, one should recall temporomandibular joint (TMJ) syndrome, sinusitis,
and dental caries or abscesses. Disorders of the eye that cause face pain
are included in the section on eye pain .
Of course, one could apply the mnemonic VINDICATE to the differential
diagnosis and come up with an extensive list. Thus, V—Vascular
conditions suggest histamine cephalalgia; I—Inflammatory conditions
suggest herpes zoster, sinusitis, and dental abscesses; and
N—Neoplasms suggest Schmincke tumors, carcinoma of the tongue, and so
forth. This procedure, however, is more involved than is necessary.
Approach to the Diagnosis
The approach to the diagnosis of face pain includes a careful history
and physical with a good neurologic examination. The sinuses are
transilluminated, and x-rays may be performed. The teeth and occlusion are
examined carefully and possibly x-rayed. A histamine test may be indicated.
The busy physician may want to refer the patient to a neurologist
immediately, but this will obviously take away the challenge.
Other Useful Tests
-
Therapeutic trial of sumatriptan (migraine)
-
Therapeutic trial of carbamazepine (Tegretol) (trigeminal
neuralgia)
-
Temporal artery compression (migraine)
-
Sedimentation rate (temporal arteritis)
-
X-rays of the TMJ (TMJ syndrome)
-
CT scan of the brain (tumors)
-
CT scan of the sinuses (sinusitis)
-
Nasopharyngoscopy
-
Magnetic resonance imaging (MRI) of the TMJ (TMJ syndrome)
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Face swelling
Read excerpts from these other book chapters related to Face swelling:
Medical Books Excerpts
- FACE PAIN
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Facial pain
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Edema, facial
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Facial pain
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Face swelling
» Next page: FLUSHED FACE (PLETHORA) (Differential Diagnosis in Primary Care)
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