Facial pain: Diagnosis and therapy

Abstract

Correct diagnosis facilitates treatment; it may therefore be helpful for diagnosis to classify facial pain to. According to Hapak et al. [ 1 ] facial pain can be classifi ed as musculoligamentous, dentoalveolar and neurological categories of pain origin. Temporomandibular joint disorders, facial arthromyalgia, salivary gland disease and rhinosinus- related headache are assigned to the musculoligamentous group and are mostly treated by maxillary surgeons. Bruxism, increased or reduced saliva production, local swelling, fever, pain aggravated by eye movements and other clinical signs can help to make a probable diagnosis in the fi eld of musculoligamentous disorders. Concerning the dentoalveolar group, which is extremely common, we have to consider dentinal, periodontal, pulpal, thermal sensitivity and other causes of pain. Patients suffering from dentoalveolar disorders are best referred to dentists. Pain character and duration include the whole range of possibilities and can show some degree of diagnostic overlap with trigeminal neuralgia (TN). The last, but for neurosurgeons not the least, group of facial pain is the neurological one. This includes pain caused by nerve compression (E.G. neurinoma of the fi fth nerve), cranial arteritis (temporal arteritis), Tolosa-Hunt syndrome (unspecifi c infl ammation of the cavernous sinus and adjacent neural structures of the orbit) and various neuralgias, among which the most important is TN. A sudden, intense, sharp, lancinating pain lasting from a few seconds to less than 2 min and recurring within short periods of time is characteristic for neuralgias. Given that the majority of neurosurgeons treat only TN, this chapter will deal mainly with this condition (tic douloureux): Epidemiology, natural course, diagnosis, treatment and prognosis.