\u200bOrofacial pain is very common in Primary Care, with reported prevalences in surveys of up to a quarter of the population. There are many causes, and the majority relate to neurological, dental or musculoskeletal causes. The key to diagnosis and management is the history and investigations rarely add value. <\/p>\n\n\n\n
Sinus pain is constant and ALWAYS associated with nasal symptoms and does not generally cause facial swelling. If there is visible facial swelling referral for iv antibiotics should be considered. Sinus pain is only significant if it lasts longer than a week.<\/p>\n\n\n\n
Migraine can be associated with a runny or blocked nose or a swollen or red face \u2013 those symptoms are episodic but can last up to 4 days. They can also be associated with midfacial segment pain and cluster headaches. The BMJ has a very useful open-access infographic about orofacial pain<\/a>.<\/p>\n\n\n\n Orofacial pain is commonly misattributed to rhinosinusitis but is not a hallmark feature of the condition: further investigation (CT or endoscopy) will only confirm the diagnosis in about 10%. <\/p>\n\n\n\n Sinonasal Cancers<\/strong><\/span><\/p>\n\n\n\n The Scottish Referral Guidelines for Suspected Cancer<\/a> emphasise that sinonasal cancers are rare, whilst benign rhinosinusitis symptoms are common. The associated clinical features include progressive or new unilateral nasal obstruction in association with one or more of proptosis, epistaxis, dental pain or loosening dentures, cranial nerve palsy or nasal (not facial) pain.<\/p>\n\n\n\n Chronic Facial Pain<\/strong><\/span><\/p>\n\n\n\n This is pain lasting more than 12 weeks, and most relates to non-ENT conditions. In addition to migraine, the commonest causes are:<\/p>\n\n\n\n The Patient Information Leaflet<\/a><\/span> gives further detail. <\/p>\n\n\n\n Diagnoses associated with nasal blockage or congestion:<\/strong><\/span><\/p>\n\n\n\n RefHelp has further detail on headache management<\/span><\/a>.<\/p>\n\n\n\n No nasal blockage or congestion<\/strong><\/span>:<\/p>\n\n\n\n Management of chronic facial pain depends on the diagnosis. Patient understanding is key and the facial pain patient leaflet<\/a><\/span> gives more detail.<\/p>\n\n\n\n C.M. & A.H. – 10-2-26<\/strong><\/p>\n\n\n\n Please see ENT indications<\/a> and neurological indications<\/a>.<\/p>\n\n\n\n Chronic orofacial pain, even with symptoms of nasal congestion or blockage, is more likely to be migrainous, and that diagnosis should be considered first.<\/p>\n\n\n\n Where rhinosinusitis is suspected, please optimise primary care management<\/a> before considering referral.<\/p>\n<\/div><\/div>\n\n\n\n <\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":" Orofacial pain is very common in Primary Care, with reported prevalences in surveys of up to a quarter of the population. There are many causes, and the majority relate to neurological, dental or musculoskeletal causes. The key to diagnosis and management is the history and investigations rarely add value. Sinus pain is constant and ALWAYS<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":4183,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[152],"class_list":["post-3922","page","type-page","status-publish","hentry","category-facial-pain-ent"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" Facial Pain (ENT)<\/a>","rttpg_excerpt":"Orofacial pain is very common in Primary Care, with reported prevalences in surveys of up to a quarter of the population. There are many causes, and the majority relate to neurological, dental or musculoskeletal causes. The key to diagnosis and management is the history and investigations rarely add value. Sinus pain is constant and ALWAYS","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3922","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3922"}],"version-history":[{"count":13,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3922\/revisions"}],"predecessor-version":[{"id":26714,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3922\/revisions\/26714"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4183"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3922"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3922"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n
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Who to Refer:<\/h4>\n\n\n\n
Who not to Refer:<\/h4>\n\n\n\n