ENT

1. FACIAL PAIN
Presented by:
Yash vikram singh
2013-85

2. Introduction
Facial pain is pain felt in any part of the face
including the mouth and eyes.
Although it’s normally due to an injury or a
headache, facial pain may also be the result of
a serious medical condition.
Most causes of facial pain are harmless.

3. The character of pain in face may be dull, sharp,
constant or intermittent and may vary
depending on the cause.
As the possible causes are spread over a wide
spectrum, proper medical history, clinical
examination and thorough assessment can help
in detecting the precise cause.

4. Causes
• Trigeminal neuralgia
• Migranous neuralgia
• Post herpetic neuralgia
• Psychogenic (Atypical facial pain)
• Tempomandibular arthritis
• Malocclusion

5. TRIGEMINAL
NEURALGIA

6. The
TRIGEMINAL
NERVES are
among the 12 PAIR
OF CRANIAL
NERVES that let
you feel sensations
in your face.
One nerve runs
down each side of
your head.

7. What is trigeminal neuralgia?
Trigeminal neuralgia may be caused by an artery
or blood vessel pressing on the trigeminal nerve –
the largest cranial nerve located at the base of the
brain.
The trigeminal nerve controls sensations in the
face and the muscles used in chewing, eating and
talking.

8. Each trigeminal nerve splits into three branches,
controlling the feeling for different parts of your face.
•The ophthalmic branch- It controls your eye, upper
eyelid, and forehead.
•The maxillary branch- This affects your lower eyelid,
cheek, nostril, upper lip, and upper gum.
•The mandibular branch- It runs your jaw, lower lip,
lower gum, and some muscles you use for chewing.

9. Ophthalmic
Branch
MAXILLARY BRANCH
Mandibular
Branch

10. The disorder can affect any of the three nerve
branches, meaning you could feel pain from
your forehead to your jaw.
• Usually, you’ll feel pain on only one side of
your face.
• Some people feel it on both sides.
• When that happens, it’s called bilateral
trigeminal neuralgia.

11. What causes trigeminal
neuralgia?
• The exact cause remains unknown.
• However, certain conditions such as multiple
sclerosis or a tumour pressing on the trigeminal
nerve can trigger the electric shock-like pain
associated with trigeminal neuralgia.

12. You may feel as though your pain came out of
nowhere.
Some people with this condition start out thinking they
have an abscessed tooth and go to a dentist.
You may have these symptoms:
• You have brief periods of stabbing or shooting pain.
• The pain is triggered by things such as brushing
your teeth, washing your face, shaving, or putting
on makeup.
• Even a light breeze against your face might set off
your pain.

14. • It lasts a few seconds to several minutes.
• The attacks happen several times a day or a
week, followed by periods during which you
have none at all.
These pain-free periods are known as remission.
• The pain usually affects only one side of the
face.

15. • The attacks happen more often over time, and
the pain can worsen.
• You feel the pain mostly in your cheek, jaw,
teeth, gums, and lips. The eyes and forehead
are affected less often.

16. Sudden and intense bouts of pain are signs Of
“classic” trigeminal neuralgia. If your pain is
less intense but constant -- more of an aching,
burning sensation -- you might have what’s
known as “atypical” trigeminal neuralgia.
Some people with this condition also have
anxiety because they are uncertain when the
pain will return.

17. Investigations
• X ray skull A p through orbit, lateral; view.
• MRI BRAIN
• Electrophysiological tests .

18. Treatments
Medication:
• You will be prescribed medicines that keep the nerves
from reacting to irritation. These drugs are called
anticonvulsants.
• You also may take muscle relaxants -- alone or along
with anticonvulsants.
• Typical pain medications don’t work well for people
with trigeminal neuralgia, so a tricyclic is prescribed.

19. Surgery:
• Microvascular decompression, which moves
or takes out blood vessels that are affecting
the nerve.
• Gamma knife radiosurgery, which uses
radiation focused on your trigeminal nerve.
• Rhizotomy, which destroys nerve fibers.