Facial Pain—Atraumatic
Facial pain occurring in the absence of trauma may be caused by a variety of disorders, many of which may be associated with referred pain, thereby making accurate localization of the source difficult. For this reason, a careful examination of the face, orbits, eyes, oral and nasal cavities, auditory canals, and temporomandibular joints is an essential aspect of the evaluation of these patients.
COMMON CAUSES OF ATRAUMATIC FACIAL PAIN
Dental caries
Dental or gingival abscess*
Sinusitis
Preorbital and orbital cellulitis*
Facial or cutaneous abscess or infection
LESS COMMON CAUSES OF ATRAUMATIC FACIAL PAIN
Trigeminal neuralgia (tic douloureux)*
Parotitis*
Salivary duct stone—parotid and submandibular
Herpes zoster
Acute dystonic reaction
Temporomandibular joint syndrome*
Temporomandibular joint dislocation*
Malignant parotid tumors
Lymphadenopathy (pretragal or inframandibular)
Tetanus
HISTORY
A history of carious dentition in association with a gnawing, intolerable pain in the jaw or infraorbital region is seen in patients with gingival or dental abscesses. Pressurelike pain or aching in the area of the frontal sinuses, supraorbital ridge, or infraorbital area in association with fever, nasal congestion, postnasal discharge, or a recent upper respiratory tract infection suggests acute or chronic sinusitis. Redness, swelling, and pain around the eye are suggestive of periorbital cellulitis. The rapid onset of parotid or submandibular area swelling and pain, often occurring in association with meals, is characteristic of obstruction of the salivary duct as a result of stone. Trigeminal neuralgia produces excruciating, lancinating facial pain that occurs in unexpected paroxysms,
is initiated by the tactile stimulation of a “trigger point” or simply by chewing or smiling. Temporomandibular joint dysfunction produces pain related to chewing or jaw movement and is most commonly seen in women between the ages of 20 and 40 years; patients may have a history of recent injury to the jaw, recent dental work, or long-standing malocclusion. Facial paralysis associated with facial pain may be noted in patients with malignant parotid tumors. Dislocation of the temporomandibular joint causes sudden local pain and spasm and inability to close the mouth. Acute dystonic reactions to the phenothiazines and antipsychotic medications may closely simulate a number of otherwise perplexing facial and ocular presentations and must be considered. Acute suppurative parotitis usually occurs in the elderly or chronically debilitated patient and causes the rapid onset of fever, chills, and parotid swelling and pain, often involving the entire lateral face.
is initiated by the tactile stimulation of a “trigger point” or simply by chewing or smiling. Temporomandibular joint dysfunction produces pain related to chewing or jaw movement and is most commonly seen in women between the ages of 20 and 40 years; patients may have a history of recent injury to the jaw, recent dental work, or long-standing malocclusion. Facial paralysis associated with facial pain may be noted in patients with malignant parotid tumors. Dislocation of the temporomandibular joint causes sudden local pain and spasm and inability to close the mouth. Acute dystonic reactions to the phenothiazines and antipsychotic medications may closely simulate a number of otherwise perplexing facial and ocular presentations and must be considered. Acute suppurative parotitis usually occurs in the elderly or chronically debilitated patient and causes the rapid onset of fever, chills, and parotid swelling and pain, often involving the entire lateral face.
