facial pain

Introduction

most non-traumatic causes of facial pain have a clear tender focus or skin abnormality which may point to conditions such as:
- sinusitis
- odontogenic sinusitis
- Periorbital and orbital cellulitis
- cellulitis
- skin abscess
- dental abscess
- acute dental pain / dental abscess
- eye conditions
- ear pain
- herpes zoster (shingles)
- mumps
- TMJ pain
- Ludwig's angina - floor of mouth infection - acute swollen floor of mouth / bull neck
- iatrogenic post-injection “post-traumatic neuropathy”
- rarely neoplasia
other conditions are less clear by examination alone and include:
- migraine - often causing unilateral retro-orbital pains
- cluster headaches
- giant cell temporal arteritis
- trigeminal neuralgia
  - TN1 is characterized by intensely sharp, throbbing, sporadic, burning or shock-like pain around the eyes, lips, nose, jaw, forehead and scalp
  - TN2 pain often is present as a constant, burning, aching
  - in younger patients in particular it can be due to:
    - multiple sclerosis (MS)
    - acoustic neuroma
    - rarely, other neural tumours such as:
      - schwannoma
        
        may be genetic - neurofibromatosis type 2 (NF2), schwannomatosis (2.4-5% of patients with a schwannoma), and Carney Complex
- trigeminal neuropathic pain (TNP)
  - constant, dull and burning but can have triggered sharp pains
- trigeminal autonomic cephalalgia (TAC)]
- temporal tendinitis
- Ernest syndrome (injury of the stylomandibular ligament)
- occipital neuralgia
- post-herpetic neuralgia
- glossopharyngeal neuralgia
  - acute intense attacks of extreme pain in the back of the throat, tongue or ear
- referred pain to jaw: