Not all facial pain is sinus pain – avoid misdiagnosis.

Patients seeing a Doctor about facial pain is a common presentation in clinical practice and seen by our Doctors regularly at Australian Allergy Centre with patients who are concerned about sinusitis as the cause of their facial pain.

The main thing to know is not all facial pain is sinus pain.

In most cases, the site of the pain can be identified by a good clinical history and examination, however in some cases the cause of facial pain can be quite a diagnostic challenge. In fact one of the hardest consultations a GP can manage is the disgruntled patient who is frustrated at still not having a clear diagnosis after seeing several different Doctors or other practitioners and a lot of money in the process without a satisfactory diagnosis or management plan.

The following table is a snap shot of common causes of facial pain
• Dental or oral eg. dental infections, cancer
• Facial bone disease eg. Elongated styloid process (Eagles syndrome)
• TMJ (temporomandibular joint dysfunction)
• Salivary Gland disease
• Sinus disease eg. maxillary sinusitis
• Neurological disorders eg. MS, migraines, post herpetic neuralgia, trigeminal neuralgia
• Vascular disorders eg. cranial (temporal) arteritis
• Psychogenic disorders eg. depression and anxiety

Although patients can tell you exactly where they feel the pain, the site where it comes from is often different so an understanding by well trained GP’s of the different causes of facial pain is important so you get the right tests, the right referrals and the right help quickly.

Referred pain is common in the head and neck, especially the ear which means that even an ulcer on the base tongue can cause a pain to be felt in the ear!
As Dr Tobias Pincock, ENT and Facial Plastic surgeon explains “oral and facial structures have multiple nerve connections which means that the pain can be felt in different areas to where the site of the pain might originate – we call this referred pain and this can make facial pain diagnosis challenging.”

Dental causes of pain however need to be strongly considered when a patient describes a facial pain. A recent study showed that in 87% of cases, facial pain was due to a dental cause or due to disease of the oral cavity. Usually if there is pain with a change in temperature or biting it suggests a dental cause. However, seeking a dental opinion is important when in doubt.

If you have a facial pain, then our Allergy/ENT trained GP’s are able to be consulted. Please contact our collective.care and Australian Allergy centre Doctors on 1300 MY ALLERGY or 1300 344 325. We have Doctors in Wollongong, Bella Vista and Edgecliff trained in facial pain, ENT and Allergy assessment. We are a bulk billing clinic.

Dr Suzan Bekir MBBS FRACGP is Clinical Director of Australian Allergy Centre.

references:
Quail G. Facial Pain – A diagnostic challenge. Australian Family Physician 2015; 44:901-904
Quail G. Atypical facial pain. Australian Family Physician 2005;34:641-45
Stovner LJ, Hagen K, Jensen R et al. The global burden of headache. A documentation of headache prevalence and disability worldwide. Cephalgia 2007;27:193-210.