Facial Pain

Question 1

In patients with sinusitis, which side of face is typically more affected?

When is painful typically experienced most?

Answer 1

Right side of face affected more than left

Pain experienced mostly during the day - lying down can sooth pain.

Question 2

How does trigeminal neuralgia present?

What causes it? and What side of face is more affected?

How is it treated?

Answer 2

Electric shock-like pain lasting up to 2 minutes
-VERY PAINFUL

Cause is unknown - right side of face affected more

Short-term treatment with anaesthetic and anticonvulsant carbamazepine (Tegretol)

Question 3

Hepatic and post-hepatic neuralgia - what causes this?

How does it present?

How is it managed?

Answer 3

Caused - Herpes Varicella-Zoster virus lies latent in the sensory nerve ganglion after chicken pox

Presentation: burning sensation

Management: Difficult to treat as pain does not respond to treatment - can be totally resistant to drugs

Question 4

Temporal arteritis:

1. What is it?
2. How does it present?
3. How is it managed?

Answer 4

1. Affects the walls of arteries
2. Presents as deep throbbing, persistent headache - pain localised to temporal and frontal regions can be tender to touch e.g. hair brushing
3. Usually self-limiting, high dose systemic steroids

Question 5

Migraines

1. What are migraines?
2. What can cause a migraine?
3. How are they treated?

Answer 5

1. Migraines are severe throbbing headaches which can last hours to days
   -can make patients feel nauseous and vomit
2. Stress, family history and chocolate can cause a migraine
3. Pain relief and bed rest in dark room to treat

Question 6

Referred pain: Angina

1. What is angina?
2. How does it present?
3. How is it managed?

Answer 6

1. Angina = ischaemia of cardiac muscle
2. Presents as chest and jaw pain
3. Managed by GTN spray or tablets

Question 7

Myocardial Infarction:

1. What is it?
2. How does it present?
3. How is it managed?

Answer 7

1. Ischaemia of cardiac muscle
   - leading to muscle necrosis and cardiac arrest
2. Presentation = intense chest pain which radiates down left arm and up to left side of jaw
3. Management = BLS and CPR

Question 8

Atypical facial pain:

1. What is it?
2. How does it present?
3. How is it treated?

Answer 8

1. Facial pain linked to extreme personal stress, bereavement, dental treatment
2. Presentation = constant dull or burning pain - nothing makes it better or worse
   -poorly localised
   -rarely woken from sleep
   -symptoms unrelated to anatomical disruption of nerves
3. Treatment = NSAIDs, Antidepressants

Question 9

Burning Mouth syndrome:

1. How and where does this present?
2. How is it treated?
3. How should be tested for is patient complains of burning mouth?

Answer 9

1. Most commonly affects tongue, hard palate or lips
   -Chronic, burning sensation
   -relieved by eating or drinking
   -can be psychological
2. Find possible trigger and remove, Antidepressant
3. Test for diabetes and haematic deficiencies - may be difficult to tolerate dentures

Question 10

List 5 organic conditions which can present with burning mouth?

Answer 10

1. Geographic tongue
2. Lichen planus
3. Candidosis
4. Glossitis
5. Xerostomia

Question 11

List 5 common signs of TMJDS:

Answer 11

1. Clicking joint (crepitus) and locking
2. Limited mouth opening
3. Tenderness of masticatory muscles
4. Tenderness of cervico-cranial muscles
5. Overall TMJ PAIN

Question 12

What is a significant risk factor of TMJDS?

Answer 12

Psoriasis

Question 13

List 5 causes of TMJDS:

Answer 13

1. Clenching
2. Grinding
3. Occlusion
4. Stress
5. Joint/bone problems i.e. arthritis

Question 14

List 4 ways in which to manage TMJDS:

Answer 14

1. Physical therapy - bite guard
2. Neurochemical e.g. amitriptyline
3. Acupuncture
4. Cognitive therapy