Management Of Facial Pain Research Articles

Development of an interdisciplinary specialist facial pain management programme.

This article aims to describe the development of a specialist chronic facial pain (CFP) management programme within an already well-established pain management service, including the content from a multidisciplinary perspective, and present preliminary descriptive 6-month outcomes from patients who have attended the programme. Authors used their clinical experience of working with people who have a diagnosis of CFP. They researched available literature, liaised with CFP support organisations and visited an existing UK-based CFP programme. Programme content was designed based on findings. The roles of pain interdisciplinary team members involved in delivering the programme are described, as well as a brief description of the structure of the programme and programme sessions provided by each discipline. Clinical outcomes from programme participants were collected at assessment, end of treatment and 6 months post-treatment, which measured relevant outcomes for a pain management programme (PMP). Outcomes from 36 participants at both end of programme and 6 months following completion of programme demonstrate promising improvements. Qualitative data from patient satisfaction questionnaires completed at the end of programme suggest that providing a CFP-specific programme was beneficial for participants, with the main critique being that the programme sessions should be longer than 45 minutes. Attending a CFP-specific programme demonstrated positive 6-month changes in relevant outcome measures for people with CFP. With a small sample size, there is a need for further research into the effectiveness. It would also be beneficial to compare outcomes from the usual PMP treatment with people who have CFP, with outcomes from a CFP-specific programme.

Therapeutic applications of botulinum neurotoxins in head and neck disorders.

ObjectiveThe aim of this article is to review the mechanism of action, physiological effects, and therapeutic applications of botulinum neurotoxins in the head and neck area.Study designAn extensive literature search was performed using keywords. The resulting articles were analyzed for relevance in four areas: overview on botulinum neurotoxins, the role of botulinum neurotoxins in the management of salivary secretory disorders, the role of botulinum neurotoxins in the management of facial pain, and the role of botulinum neurotoxins in head and neck movement disorders. Institutional review board approval was not needed due the nature of the study.ResultsBotulinum neurotoxin therapy was demonstrated to be a valuable alternative to conventional medical therapy for many conditions affecting the head and neck area in terms of morbidly, mortality, and patient satisfaction with treatment outcomes.ConclusionBotulinum neurotoxin therapy provides viable alternatives to traditional treatment modalities for some conditions affecting the head and neck region that have neurological components. This therapy can overcome some of the morbidities associated with conventional therapy. More research is needed to determine the ideal doses of botulinum neurotoxin to treat different diseases affecting the head and neck regions.

Craniofacial Pain Secondary to Occult Head and Neck Tumors

To review the natural history of occult head and neck malignancy presenting with facial pain and evaluate the risk factors, diagnostic workup, and management of facial pain in the setting of occult malignancy. Retrospective chart review. Tertiary care center. All patients presenting from 1980 to 2010 with facial pain and a delayed diagnosis of a head and neck cancer were reviewed. Thirty-eight patients were included. Onset of pain was rapid or sudden in 94.7%, intermittent in 84.2%, and sharp in 86.8%. Facial nerve weakness was present in 15.8%. Five patients had a history of locoregional skin cancer, and 14% had a history of malignancy. Average delay to diagnosis was 18.4 months. On average, the suspicious lesion was identified on the second scan (mean, 2.1; range, 1-4 scans). Diagnosis was suggested by magnetic resonance imaging in 54.8% and computed tomography in 38.7% of patients. The most common pathology was squamous cell carcinoma (39.5%), and the predominant location was the parotid gland (28.9%). Surgical resection (66%) was the most common intervention. In patients who received treatment and had clinical follow-up available for review, 97.0% (32/33) reported symptomatic improvement. In our series, sudden-onset, intermittent, sharp facial pain without resolution or improvement was associated with occult malignancy and should be considered in the differential diagnosis for facial pain. Based on the high incidence of early negative imaging, consideration should be given to repeat imaging when there is concern for malignancy. Therapeutic interventions often result in improvement of facial pain.

Facial Pain Secondary to Occult Head and Neck Tumors

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.

Differential diagnosis of facial pain and guidelines for management

The diagnosis and management of facial pain below the eye can be very different dependant on whether the patient visits a dentist or medical practitioner. A structure for accurate diagnosis is proposed beginning with a very careful history. The commonest acute causes of pain are dental and these are well managed by dentists. Chronic facial pain can be unilateral or bilateral and continuous or episodic. The commonest non-dental pains are temporomandibular disorders (TMDs), especially musculoskeletal involving the muscles of mastication either unilaterally or bilaterally; they may be associated with other chronic pains. A very wide range of treatments are used but early diagnosis, reassurance and some simple physiotherapy is often effective in those with good coping strategies. Dentists will often make splints to wear at night. Neuropathic pain is usually unilateral and of the episodic type; the most easily recognized is trigeminal neuralgia. This severe electric shock like pain, provoked by light touch, responds best to carbamazepine, and neurosurgery in poorly controlled patients. Trauma, either major or because of dental procedures, results in neuropathic pain and these are then managed as for any other neuropathic pain. Red flags include giant cell arteritis which much be distinguished from temporomandibular disorders (TMD), especially in >50 yr olds, and cancer which can present as a progressive neuropathic pain. Burning mouth syndrome is rarely recognized as a neuropathic pain as it occurs principally in peri-menopausal women and is thought to be psychological. Chronic facial pain patients are best managed by a multidisciplinary team.

Review article: oral surgery and TMJ-related papers published in BJOMS in 2008 and 2009

This review summarises the 81 papers relating to oral surgery and to the temporomandibular joint (TMJ) published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) January 2008–December 2009. They include full length articles on distraction osteogenesis, imaging, extraction techniques, implants, and the management of facial pain and disorders of the TMJ including joint replacement. Many short communications were also published, but an editorial decision was taken in August 2009 to publish most of these in future in the online journal only. As BJOMS encompasses the whole remit of the specialty, and other specialist journals on oral surgery are available, it was encouraging to see that authors still choose submit their work to our journal.

O.583 Sinus floor elevation using alloplastic bone graft

This review summarises the 81 papers relating to oral surgery and to the temporomandibular joint (TMJ) published in the British Journal of Oral and Maxillofacial Surgery (BJOMS) January 2008–December 2009. They include full length articles on distraction osteogenesis, imaging, extraction techniques, implants, and the management of facial pain and disorders of the TMJ including joint replacement. Many short communications were also published, but an editorial decision was taken in August 2009 to publish most of these in future in the online journal only. As BJOMS encompasses the whole remit of the specialty, and other specialist journals on oral surgery are available, it was encouraging to see that authors still choose submit their work to our journal.

The Management of Facial Pain

Patients with facial pain are commonly referred to otolaryngologists. Unfortunately many are misdiagnosed as rhinosinusitis and as a result are treated inappropriately. Many of these patients do not actually have sinus disease and the pain could be attributed to other causes. The aim of this paper is to highlight this problem and to look at the evidence with regards to establishing a diagnosis for the patient presenting with facial pain.

Radiofrequency gasserian rhizotomy: the role of RF lesioning in the management of facial pain

Radiofrequency gasserian rhizotomy: the role of RF lesioning in the management of facial pain

Facial pain following sinonasal surgery or facial trauma.

The case notes of 22 patients who reported facial pain after sinonasal surgery or trauma out of a cohort of 973 patients seen in a rhinology clinic were reviewed retrospectively. This group included 10 patients who had undergone endoscopic sinus surgery and four who had suffered facial fractures. None of the patients reported any facial pain before surgery or trauma. In only one case was there any evidence, clinically, endoscopically, or radiologically, of any paranasal sinus disease and when this resolved with nasal medical treatment the pain remained. The treatment of these patients' facial pain centred on the use of neurological medical treatment. One third of the patients responded to low-dose amitriptyline, a further third showed some response to other pharmacological agents including carbamazepine, and the remaining third showed no response. These cases illustrate the characteristics and management of facial pain after sinonasal surgery and highlight the importance of medical neurological treatment in the absence of any objective evidence of sinus disease.

The utility of panoramic imaging of the temporomandibular joint in patients with temporomandibular disorders

Objective: The objective of this study was to evaluate the utility of panoramic imaging in assessment of patients with temporomandibular disorders (TMDs). Study Design: Fifty-five consecutive patients referred for diagnosis and management of facial pain and jaw dysfunction were included. A single examiner completed the history and clinical examination on all patients. All patients received panoramic imaging. On the basis of clinical and radiographic findings, a subset of patients received advanced imaging modalities. The panoramic radiographs were interpreted by 2 examiners; if any disagreement was noted, a third examiner interpreted the radiographs. Results: Seventy-five percent of the patients had complaints of facial pain, and 75% exhibited tenderness in masticatory muscles. Tenderness was present in TM joint regions in 62%. Altered bony anatomy was seen in 43.6% of panoramic radiographs. Panoramic imaging did not lead to changes in clinical diagnosis in any of the patients seen, although the findings on the radiographs did lead to requests for additional imaging studies in 3 cases, one of which was later referred for surgical intervention because of radiographic findings. Conclusion: Clinical findings may be of greater relevance leading to the diagnoses associated with TMD and to determination of the need for additional imaging rather than the use of panoramic imaging in all patients with facial pain and TMD.(Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:236-9)