Prosopalgia

Prosopalgia - pain in the facial area. The pathogenesis of prosopalgia extremely diverse. A common cause of pain in the facial area is a disease of the nasal cavity of the nose (see Antritis, Frontitis). Persistent pain can be in the cyst nasal cavity tumors her and ethmoid bone.
Severe pain in the jaw, tongue and ear syndrome are Trotter. In the basis of the syndrome Trotter is the growth of nasopharyngeal space. As the depth of the tumor and germination her muscles lifting the soft sky, and the medial pterygoid muscle joined by other symptoms include paralysis of the soft palate and jaw (see Trism), and also the lowering of hearing due to compression of the lumen of the hearing (Evstafieva) pipe. When the disease nourishing nerve (the branch of the trigeminal nerve) notes syndrome Carlina: sharp pain in the eyeball and the corresponding half of the nose, which are enhanced by night. On the skin of the forehead and nose rash appears. There are conjunctivitis, keratit, iridotsyklit, corneal ulcers and other Mucous membrane of the nasal cavity hyperemic, allocated significant amounts of liquid secret. Palpation of the inner corner of the socket and the corresponding half of the nose painful.
Paroxysmal (duration-sometimes up to several hours) pain in the eyes, nose, radiating to the ear, the teeth, the head, neck, are in neuralgia nerve pterygoid canal syndrome File I. The pain is often accompanied by inflammation of the paranasal cavities of the nose.
When infectious neuritis of the facial nerve pain localized in the area of the ear and mastoid process, sometimes in the lower jaw.
Very severe pain characterized by inflammation of the crankshaft site (intermediate nerve syndrome hunt. The disease begins pain in the ear, gradually covering the face, neck, and even on the neck. There rash on the skin of the ear and the ear, which quickly pass, but sometimes extend to the ear drum, the sky, the tonsils, the face, the scalp. After a few days can join neuritis of the facial nerve. In the basis of the disease is a viral infection. Over - long, usually ends recovery.
Pain in the face often vascular origin, for example in the temporal arteritis diagnostics - Horton syndrome - magatha - brown. Have a burning pain in nature, are located in the temple, the crown and nape of the neck and spread to the jaw, temporomandibular joint, sometimes on the face. Pains arise spontaneously and with a slight irritation - touching jaw, mouth opening, amplified by night. Temporal artery swollen, painful to palpation, ripple weakens or disappears completely. The surrounding tissue giperemiei, swollen. Lymph nodes in the neck are enlarged, painful. The body temperature is raised. The disease lasts up to 8-12 months. and often ends with the recovery. Possible relapses.
Severe pain were observed when neuralgia of the trigeminal nerve (see Neuralgia).
Pains and disorders of sensitivity in the area of innervation of the trigeminal nerve may occur when the cervical osteochondrosis.
Prosopalgia often observed with glaucoma (see), the anomalies of refraction of the eye (see), in the pathology of the bite (see).
Pain in the faces can be caused by internal diseases (stenocardia, gynecological diseases and others). Will not have a precise localization and sometimes accompanied vasomotor disorders.
Treatment. At occurrence of pain in the facial area must examination of a patient to determine the underlying disease; it is often necessary to attract physicians of various specialties. For struggle against an excruciating pain for the patient spend intravenous or subcutaneous injections of Novocain injections of alcohol; the blurring of the corresponding site solutions of novocaine, anestezina; electrophoresis with novocaine, etc. In some cases, the patient requires hospitalization in the appropriate clinic.
Cm. also Odontalgia.

Prosopalgia (from the Greek. prosopon - face and algos - pain) - pain in the facial area. With these pains meet representatives of various clinical specialties (neurologists, otolaryngologists, dentists and others). Among the large contingent of patients seeking care about the pain in the face, only a few are suffering from trigeminal neuralgia, most of prosopalgia has a different origin.
Prosopalgia see if malocclusions (syndrome, Kostina), diseases of the wing-palatal site (syndrome Sladura), naso-ciliated nerve syndrome Carlina), cranked node syndrome (hunt), albanova nerve syndrome Reicherti), widawa nerve syndrome File).
Pain in the face often and vascular origin. Most often observed temporal arteritis diagnostics. Somewhat less than temporal, affect the facial artery. Pains are burning in nature, are localized in the lower or upper jaw and distributed to the inner corner of the socket. In some cases, arterial pulsation is missing. Described facial pain and pathology of the internal carotid artery.
A role in the pathogenesis of prosopalgia play diseases of paranasal cavity of the nose. Inflammatory processes, cysts, tumors can cause a painful facial pain. These pains can be odontogenic nature, and in some cases, we are talking about their irradiation, others about zones Zakharyin - Ged (reflex pain).

zone Zakharyin - Ged
Fig. 1. Zone Zakharyin - Ged at the dental disease: 1 - frontal-bow; 2 - nasolabial; 3 - maxillary; 4 - temporal; 5 temporomandibular; 6 - sublingual; 7 - guttural; 8 - vertical; 9 - chin.


The area reflect the pain associated with diseases of the teeth is shown in Fig. 1 (Ged). When the disease of the upper incisors felt pain in frontal nose area (Fig. the 1.1). The upper canines, and first upper premolar correspond naso-labial area (Fig. 1,2). In the maxillary zone (Fig. 1,3) pain occur in diseases of the second upper premolar and first upper molar; however, the area of the latter is often the temporal area (Fig. 1,4). Temporomandibular area (Fig. 1,5) corresponds to the second and third upper molars. Next to the temporomandibular, blocking it, lies sublingual area (Fig. 1,6), which corresponds to the first and mainly the second lower molar teeth. Simultaneously with the hyoid is determined and the other area on the edge of the language, some distance on 1-1,5 cm from the tip. The laryngeal area (Fig. 1.7) corresponds to a third lower molar, for which there is also a second area (in the corresponding half of the back of the tongue, 3 cm away from the tip). According to other sources, for a third lower molar there is another area - vertical (Fig. 1,5), which Ged not connected with diseases of the teeth. Chin area (Fig. 1,9) corresponds to the lower incisors, canines, and the first lower premolar. Area for the second lower premolar is not installed. Jaw pain on the face in the areas Zakharyin - Ged observed at full absence of them in the affected teeth. Patients in these cases, seek the help neurologists, otolaryngologist and very distrustful of the Council to go to the dentist. Proper diagnosis and therapy of the patient tooth lead to the complete elimination of pain in the relevant field of the person.
Prosopalgia see and pathological foci located outside of the mouth, such as some diseases of internal organs. The emergence of zones Zakharyin-Ged explain as follows. Part of the sensory fibers running from the internal organs in the composition of wandering and phrenic nerves, shall enter into the spinal cord through the third, fourth and fifth cervical segments associated with the upper cervical segments, which comes down to the root of the trigeminal nerve with accompanying its nucleus. Diseases of internal organs irritation, spreading over sensitive fibers, which are in the composition of wandering and phrenic nerves can irrationality in the cell nucleus of the trigeminal nerve and projected at various areas of the face (Fig. 2). These pains are characterized by a lack of precise definition, do not correspond to the zones of innervation of the cerebrospinal system and are sometimes features of hyperpathia. Sometimes the pain is accompanied vasomotor disorders (hyperemia, swelling).

zone Zakharyin - Ged face
Fig. 2. Zone Zakharyin - Ged face in the localization of pathologic focus outside teeth:
1 - hypermetropia;
2 and 8 - glaucoma;
3 - the defeat of the stomach;
4 - damage to the nasal passage;
5 - damage to the rear part of the language;
6 - the defeat of the larynx;
7 - the defeat of the front half of language;
9 - the defeat cornea, anterior eye chamber, nasal passage;
10 - the defeat of the chest cavity, iris, glaucoma.

There is also a number of reflected, eroticheskih pain in the facial area for diseases of internal organs (liver, heart). Describes pain that was diagnosed as atypical trigeminal neuralgia gynecological diseases.
One of the reasons prosopalgia can be traumatic or amputation of neuroma found in defeat signalvaluerole, USNO-temporal and intrauretralnogo nerves, such as after surgery for facial cavity due to damage of the upper alveolar nerves after a tooth extraction, etc.
Alongside described in the clinic meets a lot of pain in the face, etiology and pathogenesis of which remain outstanding (true prosopalgia).