Differential Diagnosis for Patient's Symptoms

The patient reports shooting pain and swelling in the left side of the face, jaw, and ear after eating popcorn, with persistent swelling that is not visible and no signs of infection. Here is a differential diagnosis organized into categories:

• Single Most Likely Diagnosis

  • Temporomandibular Joint (TMJ) Disorder: The symptoms of shooting pain in the face, jaw, and ear, especially after eating popcorn (which can trigger TMJ issues due to the need to open the mouth wide), are highly suggestive of a TMJ disorder. The absence of visible swelling and infection signs further supports this diagnosis, as TMJ disorders often present with pain and dysfunction without overt signs of inflammation or infection.

• Other Likely Diagnoses

  • Dental Issues (e.g., tooth abscess, cracked tooth): Pain in the jaw and face can be referred from dental problems. Although there are no signs of infection, a deep-seated dental infection or a cracked tooth could cause the described symptoms without visible swelling.
  • Trigeminal Neuralgia: This condition involves sudden, severe, shock-like pain around the eyes, lips, or nose mainly because of abnormal blood vessels pressing on the trigeminal nerve in the head. Eating can trigger the pain, which fits the patient's symptoms.
  • Salivary Gland Disorder: Disorders of the salivary glands, such as sialadenitis or a salivary gland stone, could cause pain and swelling in the face and jaw, especially after eating.

• Do Not Miss Diagnoses

  • Angioedema: Although rare and typically associated with other symptoms like urticaria or a history of allergic reactions, angioedema can cause swelling of the face and jaw without visible signs of infection. It's a potentially life-threatening condition if not recognized and treated promptly.
  • Parotid Gland Tumor: While less common, a tumor of the parotid gland could cause facial and jaw pain, along with swelling that might not be overtly visible. Given the potential for malignancy, this diagnosis should not be missed.
  • Temporal Arteritis: This condition, more common in older adults, involves inflammation of the blood vessels and can cause jaw claudication (pain when chewing) and facial pain. It's a diagnosis that should not be overlooked due to its potential to lead to serious complications like vision loss.

• Rare Diagnoses

  • Eagle Syndrome: This rare condition involves an elongated styloid process or calcified stylohyoid ligament, which can cause facial and jaw pain, especially when swallowing or turning the head. It's a less common diagnosis but could be considered if other more likely causes are ruled out.
  • Neuroma of the Trigeminal Nerve: A rare benign tumor of the nerve, which could cause severe facial pain.

Each of these diagnoses should be considered and investigated based on the patient's specific symptoms, medical history, and the results of a thorough physical examination and diagnostic tests.