Differential Diagnosis for Trauma to Left Side of Face

Single Most Likely Diagnosis

• Temporomandibular Joint (TMJ) Disorder: This condition is a likely cause of the symptoms described, given the history of trauma to the left side of the face. The intermittent pain in the left zygomatic and cheek area, as well as sharp pain in the left ear, can be referred pain from the TMJ. The TMJ is susceptible to injury from facial trauma, and symptoms may not appear until much later.

Other Likely Diagnoses

• 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. Given the sharp pain and the distribution of pain, trigeminal neuralgia could be a consideration, especially if the trauma affected the nerve.
• Dental Issues: Problems such as abscesses, impacted teeth, or dental fractures could cause referred pain to the ear and face. The history of trauma increases the likelihood of dental issues.
• Myofascial Pain Syndrome: This condition involves pain and inflammation in the muscles and their surrounding soft tissues. Facial trauma could lead to myofascial pain in the muscles of mastication, causing pain in the zygomatic and cheek area.

Do Not Miss Diagnoses

• Cranial Nerve Injuries or Neuromas: Direct injury to the facial nerve or other cranial nerves from the trauma could result in pain, numbness, or other neurological symptoms. Missing a diagnosis of nerve injury could lead to permanent disability.
• Malignancy: Although rare, it's crucial not to miss a diagnosis of malignancy, such as a parotid gland tumor, which could cause facial pain and ear pain due to the proximity of the parotid gland to the ear and facial structures.
• Infections: Post-traumatic infections, including osteomyelitis or abscesses in the facial bones, could cause persistent pain and require urgent treatment to prevent serious complications.

Rare Diagnoses

• Eagle Syndrome: This is a rare condition where an elongated styloid process or calcified stylohyoid ligament causes pain in the face and ear. It could be considered if other diagnoses are ruled out and the patient's symptoms persist.
• Sluder's Syndrome: This involves sphenopalatine ganglioneuralgia, which could cause facial pain, including pain in the cheek and ear area, though it is less common and typically associated with specific triggers like weather changes.