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Facial pain

  • Common ddx

    • sinusitis (sinus tenderness)
    • dental cavities
    • TMJ syndrome (associated with jaw opening)
    • shingles
    • otitis
    • cellulitis (erythema, warmth)
    • trauma
  • Serious ddx

    • erysipelas (fever, erythema, edema)
    • nasopharyngeal cancer
    • acoustic neuroma
    • trigeminal neuralgia (episodic intense pain)
  • Labs

    • imaging of sinuses: Panorex, xray, or CT
    • trial of sumatriptan if suspect migraine or cluster HA
    • trial of carbamazepine if suspect trigeminal neuralgia
  • Other ddx

    • cluster headache (rhinorrhea, lacrimation)
  • HPI

    • onset
    • triggering event
    • quality
    • severity
    • alleviates
    • pain aggravation with: lying down, bending over, jaw opening, teeth clenching, ear tugging
  • ROS

    • fever, rash
    • facial trauma
    • lacrimation
    • otalgia, hearing loss, tinnitus, vertigo
    • congestion, rhinorrhea
  • PMH

  • FH

  • SH

  • Meds

  • Allergies

  • Px

    • vitals
    • gen impression
    • inspection and palpation of painful area (erythema, discharge, tenderness, mass)
    • facial rash
    • nasal, oral cavity, gums and dentition: inflammation, mass, injuries, cavities
    • ear-tugging
    • otoscope
    • TMJ test

  • Print | Citations

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