Causes and Management of Facial Pain Due to Sinonasal Disease

The patients with facial pain presents a diagnostic challenge. Difficulties arise because of the frequency of referred pain and the overlap in symptoms between different conditions. Patients with facial pain are commonly referred to the otorhinolaryngologists. Commonly they have been diagnosed as suffering from sinusitis by both their general practitioners and other specialists. Some of these patients do not have sinus disease and pain can be attributed to other causes. The aim of the study is to define the incidence of facial pain due to sinonasal diseases in Iraqi patients and the role of otolaryngologist in the management. This prospective study was conducted at the department of otolaryngology-hospital of surgical specialities-Medical city in Baghdad during the period from April 2008 to December 2008 , including 140 adult patients complaing of facial pain. Evaluation of facial pain related to sinonasal diseases was done at the time of presesntation and 3 months after receiving treatment. Among 140 patients suffering from facial pain presented to otolaryngology clinic, 67.86% were due to sinonasal diseases and 32.14% of them were not related to ENT diseases. patients age ranged from 17 years to 67 years. Acute sinusitis represent the commonest cause of facial pain due to sinonasal diseases (26.31%). Only 40 patients from the total of 51 that treated surgically can be followed up (78.43%), and showed that 30 patients from 40 (75%) improved and got benefits from surgery. The best result obtained from FESS, removal of antrocoanal polyps and reduction of fractured nose which was 100% for each one, while 82.35% of the patients treated by septoplasty improved and got free from facial pain following the surgery. In conclusion the majority of patients with facial pain were related to sinonasal diseases of which acute sinusitis was the commonest. Carcinomas (maxillary or nasopharyngeal) and other serious illness may presents with facial pain, so good assessment of suspicious patients is needed.