EXTRAORAL FACIAL PAIN - 05/09/11
Résumé |
Craniofacial pain is a common chief complaint and is among the most frustrating diagnostic and treatment challenges encountered by primary care practitioners. The extensive innervation of the facial and skull tissues, and the variety of ailments to which they are susceptible, account for the complicated array of pain entities involved. To illustrate this intricacy, craniofacial pain can originate from intraoral structures such as the teeth, periodontium, and jaws, or extraoral sites that include ligaments and muscles of the head, neck, and face; the nasal cavity and paranasal sinuses; the temporomandibular joints, the eyes and ears; blood vessels of the scalp and face, including the venous sinuses and their tributaries; dural and intracerebral arteries; and finally cranial and cervical nerves. In addition, pain can be referred, meaning the source of the pain is discrepant from the site of symptoms.9, 18, 23, 32, 38
Most of the facial pain entities manifest overlapping signs and symptoms, and many entities have an ill-defined set of signs and symptoms, which undermines the validity of present classification schemes. Finally, practitioners must also consider profound interpatient variability in pain perception and reaction thresholds, which further complicates the formidable task of identifying sources of pain and providing appropriate treatments.9, 18, 23, 32, 38
The pathophysiologies of most of the extraoral facial pain entities are ill defined, which often necessitates palliative, rather than disease-specific, treatments. This scenario of idiopathic causes and symptomatic therapies is typical of chronic pain disorders. For example, the same medications can be administered for a variety of facial pain entities, even though the proposed pathophysiologic mechanisms are dissimilar. In addition, the debilitating nature of many conditions has given rise to numerous aggressive therapies, with potentially devastating side effects. Because there are few curative therapies, chronic pain is commonplace, and with chronic pain comes a dynamic interplay between the disease and patients' psychosocial display, which can further distort the disease's presentation and complicate therapy. In such cases, therapy must be directed at improving both physiologic and psychological health.9, 18, 23, 32, 38
The goal of this article is to assist the emergency physician in the efficient development of a differential diagnosis, the delivery of appropriate and effective therapies (although often palliative), and the appropriate referral of patients who present with craniofacial pain from extraoral sources. Disease descriptions, a diagnostic work-up format, and acute management protocols are presented for the more common craniofacial pain entities. This article focuses on the healthy, adult patient population, because editorial limitations prohibit a more comprehensive review of the topic.*
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Vol 18 - N° 3
P. 577-600 - août 2000 Retour au numéro
Article précédent
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- Sanford J. Fenton, Jerry E. Bouquot, John H. Unkel
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