Facial pain and sinonasal surgery

Volume: 41 - Issue: 4

Firstpage: 193 - Lastpage: 200

N.S. Jones - T.R. Cooney

Objectives: To examine the causes of facial pain that persists after endoscopic and other
sinonasal surgery.
Study Design & Setting: A study of a cohort of 973 patients presenting in the outpatient clinic
with symptoms of facial pain and/or rhinosinusitis. The study subgroup consisted of 75
patients with facial pain persisting after sinus surgery (endoscopic procedure n=48, other
intranasal procedures n=27). The patients in the subgroup were studied with particular reference
to their original presenting symptoms, endoscopic signs, and findings at CT as well as
their symptoms when they presented to this unit and, importantly, these were analysed in the
context of their response to treatment and follow-up after a mean of 2 years 7 months.
Results: Of the 75 patients who had persistent pain after surgery, 40 had no evidence of disease
at endoscopy or CT at their initial presentation, whilst 35 had preoperative evidence of
sinonasal disease. However, after surgery and re-evaluation, as well as neurological medical
treatment, it was found that sinonasal disease was not the cause of these patients pain. The
causes of their facial pain that persisted after sinonasal surgery were tension-type headache,
atypical facial pain, migraine, paroxysmal hemicrania, cluster headache but the most common
cause was ‘midfacial segment pain’, which has all the characteristics of tension-type
headache but primarily affects the midface.
Conclusions & Significance: Some patients with facial pain are undergoing endoscopic sinus
surgery in the mistaken belief that rhinosinusitis is the cause of their facial pain. All surgeons
dealing with facial pain should be familiar with non-sinonasal diagnoses. A new category of
facial pain, ‘midfacial segment pain’, is described and proposed.

N.S. Jones - T.R. Cooney - Facial pain and sinonasal surgery
Rhinology 41-4: 193-200, 2003

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