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 TM joint syndrome, sinusitis, and dental caries or abscesses. Disorders of the eye that cause face pain are included in the section on eye pain (see page 199).
FACIAL 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 Tegretol (trigeminal neuralgia)
- Temporal artery compression (migraine)
- Sedimentation rate (temporal arteritis)
- X-rays of the TM joint (TM joint syndrome)
- CT scan of the brain (tumors)
- CT scan of the sinuses (sinusitis)
- Nasopharyngoscopy
- MRI of the TM joint (TM joint syndrome)
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins
- 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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