I have had continuous chronic facial pain and pressure on the right side of
my face for about 10 years now. The pain extends into my front teeth on the
right side of my face. When it first started, I visited with an ENT and had
a CT scan that showed no abnormalities. Several years later, I had another
CT scan that again showed no abnormalities. I was advised by both ENT's that
the pain was not from the sinus. I have not had a CT scan of my sinuses for
about 5 years now. I should also note that I have a severe deviated septum
from a car accident over 20 years ago. There is a deformity of the nose and
it does cause a feeling of "stuffiness" on the right side. It should be
corrected, but with this facial pain, I'm afraid of compounding the problem.
Believing that the pain was caused by a tooth, I had it extracted.
Unfortunatly, it did not resolve the problem and caused a year of dental
visits. I also have one weird symptom: if I drink a carbonated beverage, the
air bubbles which come up behind my nose causes a brief, bright pain - as if
it is touching the source of the pain. Do you have any idea's..I just have
no idea what could be the problem and would like to get relief from the
facial pain/pressure. Can chonic sinius infection exist without thick nasal
discharge? Thanks alot for any help you might shed on this difficult
problem.
>
Reply: ------------------
The anatomy of the head and neck is extremely complex. This is particularly true of the courses that nerves take in the head and neck region. Complex nerve pathways account for a relatively common phenomenon known as referred pain. A very common example of referred pain is often experienced with tonsil infections which cause pain in the ears. In some cases the pain felt in the ears may be more severe than that felt in the throat, yet an examination of the ears shows that there is no infection in the ears. This is explained by the fact that one nerve may supply branches with nerve endings to more than one general area of the head or neck. If a single nerve supplies sensation to several areas of the head and neck, and a condition which causes pain occurs in only one specific area, the pain may nevertheless be felt in any one of the areas supplied by that nerve. Similarly, pain that is felt in the face may be related to a condition located in another part of the head. It is possible that the facial pain you describe could be caused by the septal deformity you have mentioned. This would be known as a rhinogenic headache and can be caused by contact made between the septum (the center partition made of thin bone and cartilage that separates the right nasal passage from the left) and the side wall of the nasal passage known as the turbinate. When such contact is made, one may experience pain or discomfort that can be felt occasionally in the cheek. This can usually be diagnosed by locally anesthetizing the mucosal surfaces where contact is being made during an episode of headache - if the headache is rhinogenic, the anesthetic should alleviate the headache. Sinus disease certainly can cause pain in the cheek, but one would expect to see characteristic x-ray findings on a CT scan such as an obstruction near the opening of the sinus (which can produce air-pressure imbalances) or signs of infection. Sinus infections often cause dental or tooth pain because certain nerves with endings in the upper teeth travel through the sinuses. Other causes of chronic facial pain include temporomandibular joint problems (TMJ), migraine variants, inflammatory conditions, neuro-muscular conditions, or conditions which may affect the trigeminal nerve (a cranial nerve that provides sensation to much of the face and head) as well as other less common causes. It might be worthwhile to get another ENT consultation. Also, you might consider getting an opinion from a dental specialist who deals specifically with chronic facial pain, or perhaps a neurologist.
--
Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
NOTICE: OFCN is not engaged in the rendering of professional medical services. The information contained on this system or any other OFCN system should not supplant individual professional consultation. It is offered exclusively as a community education service. Advice on individual problems must be obtained directly from a professional.
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