Facial Pain

There are multiple potential aetiologies

ASSESSMENT OPTIONS – consider:

• Sinusitis – very unlikely in absence of other nasal/sinus symptoms e.g. nasal obstruction and purulent nasal discharge.  
• Dental – neuralgia or temporo-mandibular  dysfunction – refer Maxfax.
• Migraine
• Trigeminal neuralgia
• Atypical facial neuralgia – an un-named neuralgia, may have history of previous surgery or trauma close to site of pain
• Atypical neuralgias sometimes linked with mental health problems and then it can be difficult to determine which is the primary problem and which is secondary.

REFERRAL INDICATIONS TO ENT

• If pain linked to nasal/sinus symptoms (nasal obstruction and purulent nasal discharge) AND sinusitis treatment (6 weeks oral doxycycline 100mg od or 6 weeks clarithromycin 250mg bd) has failed.
• Otherwise consider dental, maxillo-facial or neurology opinions
• For management of difficult pain problems consider Pain Clinic.

INVESTIGATION PRIOR TO REFERRAL

• Consider CT scan if facial swelling is present and the clinical picture is NOT one of a simple acute sinusitis.
• Plain facial X-ray is not indicated

 

RED FLAGS

Facial pain associated with:

• persistent bleeding/crusting with nasal obstruction
• persistent clear watery discharge (csf leak, presents like a dripping tap from tip of nose)
• bulging eye, partial loss of vision, painful eye movements or double vision.