phenylephrine-hydrochloride and Facial-Pain

The diagnosis "sinus headache" has been reclassified as "headache attributed to disorder of the nose or paranasal sinuses" by the International Headache Society, but the term is still commonly used by patients and primary care doctors alike. Rhinologic symptoms and headache disorders are common, and they may coexist without a causative relationship. Patients may undergo unnecessary medical interventions because of inadequate understanding of the classifications and management of various headache disorders. Otolaryngologists frequently treat patients with these complaints, and a systematic approach to the differential diagnosis and utilization of a multidisciplinary approach are critical in providing optimal patient care.

Topics: Diagnosis, Differential; Endoscopy; Facial Pain; Headache; Humans; Nose; Otolaryngology; Sinusitis; Tomography, X-Ray Computed; Unnecessary Procedures

Chronic rhinosinusitis (CRS) has been defined as inflammation of the paranasal sinuses lasting at least 12 weeks with corresponding 2 or more "cardinal symptoms" that include: (1) nasal obstruction; (2) thick nasal discharge; (3) facial pain/pressure; and (4) reduction or loss of sense of smell. Although prior studies have investigated symptoms of CRS after sinus surgery, none have compared the outcomes of these specific symptoms to ongoing medical therapy.. Patients with CRS were prospectively enrolled into a multi-institutional, comparative effectiveness, cohort study. Subjects elected either continued medical management or endoscopic sinus surgery (ESS). Baseline characteristics and objective clinical findings were collected. Cardinal symptoms of CRS were operationalized by 4 questions on the 22-item Sino-Nasal Outcome Test (SNOT-22). Symptom improvement was evaluated in subjects with at least 6-month follow-up.. A total of 342 subjects were enrolled, with 69 (20.2%) electing continued medical management, whereas 273 (79.8%) elected ESS. Subjects electing surgical therapy were more likely to have a higher baseline aggregate SNOT-22 score (44.3 (18.9) vs 53.6 (18.8); p < 0.001). All subjects improved across all cardinal symptoms; however, subjects undergoing ESS were significantly more likely (p ≤ 0.013) to experience improvement in thick nasal discharge (odds ratio [OR] = 4.36), facial pain/pressure (OR = 3.56), and blockage/congestion of nose (OR = 2.76). Subjects with nasal polyposis were significantly more likely to report complete resolution of smell/taste following ESS compare to medical management (23.8% vs 4.0%; p = 0.026).. Across a large population, surgical management is more effective at resolving the cardinal symptoms of CRS than ongoing medical management with the exception of sense of smell/taste.

Topics: Adrenal Cortex Hormones; Adult; Anti-Bacterial Agents; Canada; Chronic Disease; Cohort Studies; Endoscopy; Facial Pain; Female; Follow-Up Studies; Humans; Male; Middle Aged; Mucus; Nasal Obstruction; Nose; Olfaction Disorders; Prospective Studies; Quality of Life; Rhinitis; Severity of Illness Index; Sinusitis; Surveys and Questionnaires; United States

Objective of this study was to test whether there is a difference between chronic rhinosinusitis patients with (CRSwNP) and without (CRSsNP) nasal polyps in the association of extent of disease on CT scans with symptom severity and health-related quality-of-life (HRQL) impairment. Data sets from 271 chronic rhinosinusitis (CRS) patients who completed the Sino-Nasal Outcome Test 22 (SNOT-22) and visual analog scale (VAS) scores were subjected to principal component analysis (PCA) to identify a symptom components related to CRS. After controlling for demographics, medical therapy, and comorbidities, the association between symptom components/items excluded from PCA and Lund-Mackay score (LMS) was evaluated. No association was found between the total SNOT-22 score and LMS in CRS patients. There was an independent association between a higher "nasal" symptom component derived from SNOT-22 PCA and LMS in patients with CRSwNP (p < 0.001), but not in CRSsNP patients, with a statistically significant difference between two patient subsets (p = 0.003). In patients with CRSsNP, higher (worse) SNOT-22 "facial pain" was associated with lower LMS (p = 0.022), although the estimated change in LMS was modest. Considering VAS PCA components, higher "nasal" symptoms were associated with higher LMS in CRSwNP patients (p < 0.001) but not in CRSsNP, with a statistically significant difference between CRS groups (p = 0.024). A higher "pain" PCA component was associated with lower LMS in CRSsNP patients (p = 0.019). This study found significant differences in the relationship between symptom burden and CT scores between CRS phenotypes and no association between HRQL impairment and CT scores.

Topics: Adult; Chronic Disease; Facial Pain; Female; Humans; Male; Middle Aged; Nasal Polyps; Nose; Rhinitis; Severity of Illness Index; Sinusitis; Tomography, X-Ray Computed

Topics: Cranial Sinuses; Facial Pain; Humans; Nose; Toothache

Topics: Diagnosis, Differential; Facial Pain; Female; Humans; Middle Aged; Myofascial Pain Syndromes; Nose; Pain Measurement

To assess the prevalence of periodontal disease, orofacial changes and craniofacial abnormalities in patients with thalassemia major (TM). Dental management is discussed. The sample consisted of 54 patients with TM, 31 males and 23 females aged 5.5 to 18.3 years, with the mean age (+/- SD) of 1.6 +/- 3.2 years. The sample was divided into two subgroups according to age. A similar number of unaffected control group matched by age and sex served as a control. Clinical and radiographic examinations were carried out to assess the prevalence of changes caused by this disorder. Student's t-test was used to compare the means between thalassemic group and the control group. The Chi-square test was employed to determine statistical differences in frequencies between the two groups.. Poor oral hygiene and gingivitis were observed in 61.1% and 43.0% of the thalassemic patients, respectively. The overall mean plaque score was 1.66 +/- 0.51 and gingival score 1.43 +/- 0.59. In all tested periodontal parameters, a higher frequency and severity were noted in the thalassemic patients compared with controls. More than half of the patients exhibited frontal bossing, saddle nose and to less extent maxillary protrusion; giving in severe cases (16.7%) a "chipmunk" like appearance. Dental discoloration and pallor oral mucosa were noted in 44.4% and 38.9%, respectively. Dental/jaw pain was reported by 40.0% and headache by 29.6% of the patients. Increased overjet was evident in 25.9% of the patients. The majority of the patients had thickened frontal bone (66.7%), and thinned inferior border of the mandible (64.6%). Widened dipolic spaces and spiky roots and were observed in one-third of the patients. The ramus length and width in the patients were significantly smaller than in controls (P < 0.001).. TM may particularly diagnose through orofacial abnormalities. Dentists required understanding the complications and management of the disease.

Topics: Adolescent; beta-Thalassemia; Case-Control Studies; Cephalometry; Child; Child, Preschool; Craniofacial Abnormalities; Dental Plaque Index; Facial Pain; Female; Frontal Bone; Gingivitis; Headache; Humans; Jordan; Male; Mandible; Maxilla; Nose; Oral Hygiene Index; Overbite; Periodontal Diseases; Periodontal Index; Prevalence; Tooth Discoloration; Tooth Diseases

Curcumin has diverse therapeutic effects, such as anti-inflammatory, anti-oxidant, anti-cancer, and antimicrobial activities. The vanilloid moiety of curcumin is considered important for activation of the transient receptor potential vanilloid 1 (TRPV1), which plays an important role in nociception. However, very little is known about the effects of curcumin on nociception. In the present study, we investigated whether the anti-nociceptive effects of curcumin are mediated via TRPV1 by using nociceptive behavioral studies and in vitro whole-cell patch-clamp recordings in the trigeminal system. Subcutaneous injection of capsaicin in the vibrissa pad area of rats induced thermal hyperalgesia. Intraperitoneally administered curcumin blocked capsaicin-induced thermal hyperalgesia in a dose-dependent manner. Whereas curcumin reduced capsaicin-induced currents in a dose-dependent manner in both trigeminal ganglion neurons and TRPV1-expressing HEK 293 cells, curcumin did not affect heat-induced TRPV1 currents. Taken together, our results indicate that curcumin blocks capsaicin-induced TRPV1 activation and thereby inhibits TRPV1-mediated pain hypersensitivity.

Topics: Animals; Capsaicin; Cell Line; Curcumin; Facial Pain; Hot Temperature; Humans; Hyperalgesia; Injections, Intraperitoneal; Injections, Subcutaneous; Kidney; Male; Nociceptors; Nose; Patch-Clamp Techniques; Rats; Rats, Sprague-Dawley; Trigeminal Ganglion; TRPV Cation Channels

The concept of a sinus headache is problematic from neurology, allergology, and rhinology perspectives. It may be considered the final neurological diagnosis of exclusion when criteria for other craniofacial pain syndromes are not met. The International Headache Society definition implicates the presence of acute sinusitis, but this requirement is often not met in practice or with a patient's perception of the term. Otorhinolaryngologists have a similar exasperation with this cephalgia but tend to attribute idiopathic, nonallergic rhinopathy as the cause. Allergists often see patients who claim to have a sinus headache but instead have perennial allergic rhinitis or nonallergic rhinitis. A fresh perspective is required to determine the characteristics, differential diagnosis, and veracity of the sinus headache. We recommend using the term with caution only if the clinical picture meets the criteria for acute sinusitis-induced headache.

Topics: Diagnosis, Differential; Facial Neuralgia; Facial Pain; Headache; Humans; Neurology; Nose; Otolaryngology; Rhinitis, Allergic, Perennial; Sinusitis

In the last few years an increase has been observed in the incidence of fungal sinusitis in immunocompetent subjects. We present a case of mycotic sinusitis in a 12-year-old patient, in which there were several aspects that could have made the diagnosis more difficult, thus delaying her definitive treatment. This case illustrates how to arrive at a correct diagnosis of this pathology. It must be based on the histological and radiological studies, but always without forgetting a key aspect as it is a suspected diagnosis. The treatment of fungal sinusitis is surgical, and currently, endoscopic sinus surgery is the choice. We describe the clinical characteristics of this pathology and the diagnostic methods required.

Topics: Aspergillosis; Child; Facial Pain; Female; Humans; Maxillary Sinusitis; Nose; Olfaction Disorders; Suppuration

Topics: Facial Pain; Headache; Humans; Mouth; Nose; Skull

Topics: Adult; Biopsy; Carcinoma; Combined Modality Therapy; Endoscopy; Epistaxis; Facial Pain; Humans; Laryngoscopy; Male; Nasal Obstruction; Nose; Paranasal Sinus Neoplasms; Pharynx; Pressure

An association between nasal septal mucosal contact points and facial pain has often been quoted, but may be coincidental. CT scans of 100 consecutive rhinology patients were examined for contact points, and the sinuses were scored according to the Lund-Mackay system. The patients' nasal symptoms were recorded using validated questions. Contact of the nasal septum with the lateral nasal structures was identified in 55 patients. The presence of contact was significantly (P < 0.01) associated with nasal blockage and reduction of smell, but there was no association with facial pain. The median Lund-Mackay score for scans with contact was significantly greater than the score for scans without contact. Whereas the results of the study support the hypothesis that nasal contact may impede ventilation and drainage of the paranasal sinuses, the study finds no evidence to support the concept that contact points cause facial pain or headaches.

Topics: Facial Pain; Headache; Health Surveys; Humans; Nose; Nose Diseases; Olfaction Disorders; Tomography, X-Ray Computed

Topics: Acute Disease; Adult; Cerebral Infarction; Diagnosis, Differential; Disease Progression; Eye; Facial Pain; Female; Humans; Hypesthesia; Lateral Medullary Syndrome; Magnetic Resonance Imaging; Male; Middle Aged; Nose; Paresis; Pons

Studies in anaesthetized animals have indicated that noxious stimulation may produce marked blood flow changes in various orofacial structures, but the influence of painful stimulation on the blood flow regulation of the orofacial area of humans has been studied only to a limited extent. The purpose of this investigation was to study whether there are differences in temporal and spatial patterns of pain-induced vasoactive reflexes between various orofacial regions and hand in healthy human volunteers. Dynamic changes in blood flow in various orofacial regions elicited by painful stimulation of the tooth and finger were measured by means of Laser Doppler imaging (LDI) and computer-assisted infrared thermography (IRT). Blood flow of the finger was recorded by laser Doppler flowmetry (LDF) and plethysmography (PLET). During both stimulus paradigms there was a transient elevation in heart rate (HR) and blood pressure (BP). At the same time there was a significant blood flow decrease in the finger (LDF, PLET) and in the nose (LDI, IRT). In contrast to tooth stimulation, finger stimulation caused a more marked blood flow reduction in the finger. Only high intensity tooth stimulation, but not finger stimulation, caused a long-lasting vasodilatation both in lower and upper lip. The blood flow changes in the lips were not correlated with changes in systemic blood pressure or heart rate. In the cheek, there were no marked flow changes during either finger or tooth stimulation. These data indicate that painful tooth (regional) stimulation, but not finger (remote) stimulation, can induce a long-lasting vasodilatation in parts of orofacial tissues which cannot be explained by changes in central cardiovascular parameters. This tooth-stimulation-induced blood flow increase supports the hypothesis of a special vasodilator reflex mechanism in the orofacial area. Furthermore, tooth-stimulation-induced vasoconstriction in the nose and dilatation in the lips indicate that separate vasoactive reflex mechanisms may exist for different orofacial regions.

Topics: Adult; Blood Pressure; Dental Pulp; Electric Stimulation; Facial Pain; Female; Fingers; Heart Rate; Humans; Laser-Doppler Flowmetry; Lip; Male; Nose; Reflex; Regional Blood Flow; Vasoconstriction; Vasodilation

The ophthalmic, or first division (V1) of the trigeminal nerve, is the smallest of the three divisions and is purely sensory or afferent in function. It supplies sensory branches to the ciliary body, the cornea, and the iris; to the lacrimal gland and conjunctiva; to portions of the mucous membrane of the nasal cavity, sphenoidal sinus, and frontal sinus; to the skin of the eyebrow, eyelids, forehead, and nose; and to the tentorium cerebelli, dura mater, and the posterior area of the falx cerebri. At first glance, one might not expect one interested in the diagnosis and treatment of orofacial pain and temporomandibular joint disorders to have a need to be concerned with the ophthalmic division. Although much of this division's influence is dedicated to structures within the orbit, nose, and cranium, still, the ophthalmic division may be afflicted with a lesion or structural disorder which can cause all sorts of orofacial pain. Ignorance of this or any portion of the trigeminal nerve will lead to diagnostic and therapeutic failures. In this, the second of four (4) articles concerning the trigeminal nerve, the first division of this vast cranial nerve will be described in detail.

Topics: Ciliary Body; Conjunctiva; Cornea; Cranial Nerve Diseases; Dura Mater; Eyebrows; Eyelids; Facial Pain; Forehead; Frontal Sinus; Humans; Iris; Lacrimal Apparatus; Mucous Membrane; Nasal Cavity; Neurons, Afferent; Nose; Ophthalmic Nerve; Sphenoid Sinus; Trigeminal Nerve

The maxillary nerve gives sensory innervation to all structures in and around the maxillary bone and the midfacial region including the skin of the midfacial regions, the lower eyelid, side of nose, and upper lip; the mucous membrane of the nasopharynx, maxillary sinus, soft palate, palatine tonsil, roof of the mouth, the maxillary gingivae, and maxillary teeth. This vast and complex division of the trigeminal nerve is intimately associated with many sources of orofacial pain, often mimicking maxillary sinus and/or temporomandibular joint involvement. For those who choose to treat patients suffering with orofacial pain and temporomandibular disorders, knowledge of this nerve must be second nature. Just providing the difficult services of a general dental practice should be stimulus enough to understand this trigeminal division, but if one hopes to correctly diagnose and treat orofacial pain disorders, dedication to understanding this nerve cannot be overstated. In this, the third of a four part series of articles concerning the trigeminal nerve, the second or maxillary division will be described and discussed in detail.

Topics: Cranial Nerve Diseases; Eyelids; Facial Pain; Gingiva; Humans; Lip; Maxilla; Maxillary Nerve; Maxillary Sinus; Nasopharynx; Neurons, Afferent; Nose; Palate, Hard; Palate, Soft; Palatine Tonsil; Skin; Temporomandibular Joint Disorders; Tooth; Trigeminal Nerve

A case of chronic facial pain and headache is presented. This was found to be due to two pieces of windscreen-glass lodged in the superior meatus of the patient's nose since a road-traffic-accident 14 years earlier. Despite being reported as normal, review of previous X-rays of her sinuses showed that the glass was visible. The importance of carefully assessing the intranasal area on sinus-views is illustrated.

Topics: Accidents, Traffic; Adult; Chronic Disease; Facial Pain; Female; Foreign Bodies; Glass; Humans; Nose; Radiography; Time Factors

Topics: Aged; Ethanol; Facial Pain; Female; Follow-Up Studies; Glycerol; Humans; Injections; Necrosis; Nose; Trigeminal Ganglion; Trigeminal Neuralgia

Individuals commonly report a multitude of factors or triggers as the cause for the onset of a headache or facial pain. The challenge has always been to understand the many triggers, the diverse symptoms, the chronological characteristics, and the variability of location associated with headache and facial pain. Part I of this article presents theories and hypotheses proposing that the etiology of the final common pathway of headache and facial pain is from pain signals generated within the skull's joints. The model proposes to explain the variability in the triggers, symptoms, chronological aspects, and location known to be associated with headache and facial pain. The evidence to support these theories is clinical and anecdotal at this time. These theories need controlled investigation. A review of the anatomy of the skull's joints is provided. Part II of this article is a step-by-step description of the use of a nasal balloon device for the treatment of skull joint dysfunction. A review of the history and use of this and other methods of skull joint treatment is provided.

Topics: Air Pressure; Chiropractic; Cranial Sutures; Facial Pain; Headache; Humans; Nose

Pain about the bridge of the nose is often a diagnostic dilemma. There is an important recognizable subgroup who may, as a consequence of involvement of the external nasal nerve in nasal injury, exhibit neuralgic pain after a latent interval. Temporary relief by anaesthesia can be achieved and cure is possible by division of the anterior ethmoidal nerve. This rare cause of facial pain is presented using two illustrative cases.

Topics: Denervation; Ethmoid Sinus; Facial Neuralgia; Facial Pain; Female; Humans; Middle Aged; Nose