Facial Pain Secondary to Occult Head and Neck Tumors

Abstract

Objectives: 1) Review the natural history of occult head and neck malignancy presenting with facial pain. 2) Evaluate the risk factors, diagnostic workup, and management of facial pain in the setting of occult malignancy. Methods: A retrospective chart review was conducted of all patients who presented to a tertiary care center between 1980 and 2010 with the chief complaint of facial pain and a delayed diagnosis of a head and neck cancer. Clinical, radiographic, and pathologic data were reviewed. Results: Thirty-eight patients met inclusion criteria. Initial diagnoses consisted of trigeminal neuralgia, herpetic neuralgia, temporo-mandibular joint disorder, and atypical facial pain. Average delay to diagnosis was 18.4 months (1.9 - 76.8 mo). Twenty-two patients had negative magnetic resonance imaging or computed tomography imaging between onset of symptoms and tumor diagnosis, with an average of 1.05 non-diagnostic scans per patient. Tumor etiologies included squamous cell carcinoma (39.5%), adenocarcinoma (10.5%), adenoid cystic carcinoma (7.9%), and acinic cell carcinoma (7.9%). Primary intervention consisted of surgical tumor removal (66%); chemotherapy, radiation therapy, or both (26%); gamma knife (5%); and conservative therapy (3%). Thirty-two out of the 33 patients (97.0%) who underwent therapy reported partial or complete resolution of their facial pain. Conclusions: Occult tumors of the head and neck may present as symptomatic facial pain in the absence of other clinical or radiographic findings and should be considered in the workup of facial pain. Therapeutic and palliative interventions often result in marked improvement of pain symptoms.