Differential Diagnosis Challenges of Facial Pain (Clinical Case)

Abstract

Annotation. The diagnosis of facial pain falls within the realm of professional competence for dentists, orthopedic dentists, ophthalmologists, otolaryngologists, neurosurgeons, neurologists, and physiotherapists. The complex and highly subjective nature of clinical symptoms often poses challenges for practitioners across these specialties. Consequently, a patient with facial pain may undergo multiple consultations with different specialists before a definitive diagnosis is established and effective treatment is provided. The aim of this study is to demonstrate a developed routing protocol for a patient with atypical facial pain through a clinical case. The stages of interdisciplinary simultaneous consultation, a comprehensive approach to diagnosis and treatment of patients with facial pain, and differential diagnosis are considered using the example of a clinical case of a 15-year-old female patient K., who presented to a dental surgeon with complaints of constant facial pain and a preliminary diagnosis of “Temporomandibular joint dysfunction. Impacted wisdom teeth 38 and 28”. The pain was constant, dull, deep, and piercing. She experienced decreased sensitivity in the lower lip and the anterior half of the tongue on the left side, as well as stuffiness and ringing in the left ear. Consultations with a neurologist and an orthopedic dentist were conducted, which led to the prescription of additional diagnostic methods: needle electromyography and magnetic resonance imaging of the brain. The article assesses the relevance and effectiveness of a multidisciplinary approach to the comprehensive diagnosis of facial pain syndrome, including a thorough history-taking by a dental practitioner, conclusions of a neurologist, and the results of additional diagnostic methods. Based on the electromyographic signs, the trigeminal nerve damage was detected, and a voluminous brain tumor causing compression of the trigeminal nerve and its peripheral endings was visualized on magnetic resonance tomography. Following the consultation with the dental surgeon, the patient was referred for further treatment to the A.P. Romodanov Neurosurgery Institute of the National Academy of Medical Sciences of Ukraine. Thus, interdisciplinary consultation is recognized as the basis for the comprehensive management of patients with atypical facial pain, requiring the involvement of a primary care physician - a dentist, who develops a routing protocol for timely diagnosis and effective treatment of these kind of patients.