From the Guidelines
The patient's left-sided facial pain after a motor vehicle collision (MVC) should be managed with a careful history and physical examination to determine the underlying cause, and given the absence of red flags such as vision issues, swelling, or redness, a trial of conservative management with medications such as amitriptyline may be considered.
Key Considerations
- The patient's ability to move his jaw and lack of vision issues or swelling suggests that the facial pain may not be related to a serious condition such as a fracture or infection 1.
- The absence of loss of consciousness (LOC) and other severe symptoms suggests that the patient may not require immediate imaging or surgical intervention 1.
- A biopsychosocial approach is needed for successful management, considering the patient's potential co-morbidities such as depression and chronic pain elsewhere 1.
Potential Causes and Management
- Temporomandibular disorders (TMDs): The patient's symptoms could be related to TMDs, which are common causes of facial pain 1.
- Neuropathic pain: If the patient's pain is unilateral and episodic, it could be related to neuropathic pain, which may require management with medications such as carbamazepine 1.
- Conservative management: Given the patient's symptoms and lack of red flags, a trial of conservative management with medications such as amitriptyline and physical therapy may be considered 1.
From the Research
Assessment and Management
The patient, a 9-year-old male, presents to the Emergency Department (ED) with left-sided facial pain after a motor vehicle collision (MVC). Given that he is able to move his jaw, has no vision issues, and exhibits no swelling or redness, and his parents deny loss of consciousness (LOC), the management approach should focus on assessing for potential injuries related to the MVC and the facial pain.
Potential Causes of Facial Pain
- The causes of facial swelling or pain in pediatric patients can be diverse, including acute swelling with inflammation, nonprogressive swelling, slowly progressive swelling, and rapidly progressive swelling 2.
- Conditions such as lymphadenitis, sinusitis, odontogenic infection, and abscess can cause acute swelling accompanied by inflammation, and contrast-enhanced computed tomography may be used for detection of abscesses requiring surgical drainage 2.
Consideration of Loss of Consciousness
- Although the patient's parents deny LOC, it is crucial to understand that LOC can be a significant indicator of the severity of head injuries or other conditions 3, 4.
- LOC at the time of concussion or other head injuries must be viewed as reflecting a potentially worrisome traumatic brain injury, and its presence can be associated with more severe acute mental status abnormalities and a greater risk of intracranial pathology 3.
- The absence of reported LOC, however, does not rule out the need for careful assessment and monitoring for potential complications or the presence of other conditions that could cause transient loss of consciousness or syncope 5, 6.
Diagnostic Approach
- A thorough history and physical examination are essential in the diagnostic workup of patients presenting with facial pain or potential head injuries.
- Additional diagnostic tests such as imaging studies (e.g., CT or MRI) may be considered based on the clinical presentation and suspicion of underlying conditions.
- For patients with suspected transient loss of consciousness or syncope, basic diagnostic workup includes a 12-lead electrocardiogram (ECG), and further testing such as blood tests, EEG, or echocardiography may be indicated in specific contexts 6.