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Face / Other
The face, nose and sinus structures are predominantly supplied with sensation from a nerve coming through the skull base called the "trigeminal nerve". It consists of three branches, upper (ophthalmic), middle (maxillary) and lower (mandibular). It is the fifth cranial nerve and these branches are known as V1, V2 and V3! Pathology involving one of these branches can cause pain in the distribution of other branches or in more remote areas according to connections of the trigeminal nerve with other nerves in the skull. This is called "referred neuralgia". An understanding of the anatomy and function of this nerve and its connections is necessary to explain and diagnose headache causing conditions in this region.
The following conditions are representative but not all inclusive.
Facial Cellulitis (skin infection)
Infections generally due to staph or strep causing inflammation, redness, swelling and pain in skin which can spread to involve adjacent areas or spreads internally to cause brain abscess, meningitis and death (severe skin infections can cause serious complications !!)
Aggressive treatment with antibiotics often by intravenous therapy and attention to the causative lesion (eg abscess or boil) and predisposing conditions (eg poorly controlled diabetes)
Tumours
Benign and malignant
Primary (arising locally) or secondary (spreading from other sites in the body)
These tumours cause pain predominantly from involvement of branches of the trigeminal nerve or involvement of blood vessels
Temporal Arteritis
Autoimmune inflammation of the artery of the "temple region". Often presents with frontal and temporal headache. Common in the elderly and can be diagnosed on basis of blood tests and artery biopsy. May involve the artery of the eye and cause blindness. Treated with steroids and immune suppression.
Trigeminal Neuralgia
A syndrome consisting of recurrent excruciating shooting or stabbing pains of brief duration involving any part of the face supplied sensation by the trigeminal nerve. Also called tic douloureux
Classification:
Idiopathic (ie, no cause found)
Central Lesions
Primary & Secondary causes
Demyelination (breakdown of the lining of nerve fibres in the brain)
Cerebrovascular Disease
Key Words: sinus pains, sinus, sinusitis, rhinosinusitis, rhinitis, tumours, infections, sinus infection, sinus headaches, nose pains, nose, trigemminal neuralgias, temporal arteritis, facial cellulitis, ent specialist, ent surgeon, ear nose throat specialists,
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Post-herpetic Neuralgia (Herpes zoster infection = "shingles")</p> <p><strong>Dental Neuralgia</strong> (toothache)</p> <p>Temporomandibular (Jaw) Joint Dysfunction (abnormal jaw joint function due to bite abnormalities, previous trauma to the jaw, arthritis of the jaw joint and muscle tension imbalance of the muscles attached to the jaw)</p> <p><strong>Migraine</strong></p> <p>A well known condition consisting of headache, nausea, vomiting, photophobia, lasting generally less than one day and often preceded by an aura (well recognised neurologic disturbance such as a visual disturbance lasting < one hour).</p> <p>A subject in itself !!</p> <p>Refer to other contributions at this site dedicated to Migraine and it's causes.</p> <p><strong>Migrainous Neuralgia</strong></p> <p>Also called cluster headaches</p> <p>Commoner in men, related to migraine</p> <p>Attacks occur in clusters lasting 1-3 months with symptom free periods in between</p> <p>Pain starting in early morning behind one eye (always the same), becoming red and teary. Builds quickly to crescendo and lasts 1-2 hours.</p> <p>Alcohol can precipitate.</p> <p>Requires specialist assessment and medications.</p> <p><strong>Tension Headache</strong></p> <p>Headache, often frontal and occipital of a mild nature caused by stress and increased muscle tension</p> <p>Treated by simple analgesics and recognition and management of underlying stress</p> <p><strong>Sluder's Neuralgia</strong> (Vidian Neuralgia)</p> <p>Intractable pain in the region of the nose, eye, cheek and lower jaw</p> <p>A controversial diagnosis, A type of trigeminal neuralgia, A type of migrainous neuralgia</p> <p><strong>Atypical Facial Pain</strong></p> <p>Pain which does not fit any typical description of pain syndromes as detailed above</p> <p>Many patients are stressed,anxious or depressed => psychologic</p> <p>Commoner in females. Managed with repeated strong reassurance</p> <p><strong>Ear, Nose and Throat Problems may contribute to Headaches and Migraines so it is important to have them professionally addressed. It is also important to investigate for other potential causes, as many cases of Headaches and Migraines have more than one ingredient.</strong></p> <p>See Treatments Section (Ear,Nose,Throat)</p> <p><strong>Author:</strong></p> <address>Mr Anthony J. Guiney MBBS FRACS</address><address>Ear, Nose, Throat, Head & Neck Surgeon</address>"</p>"</p>"
