Differential Diagnosis for Left Sided Face Pain

Single Most Likely Diagnosis

• Trigeminal Neuralgia: This condition is characterized by sudden, severe, and stabbing pain typically on one side of the face, which matches the patient's symptoms. It's more common in older adults, making it a likely diagnosis for a 58-year-old.

Other Likely Diagnoses

• Temporomandibular Joint (TMJ) Disorder: Pain in the face, particularly in the area of the jaw, can be associated with TMJ disorders. This condition is common and could easily cause unilateral face pain.
• Dental Problems: Toothaches, abscesses, or other dental issues can cause severe pain on one side of the face. Given the prevalence of dental problems, this is a plausible diagnosis.
• Sinusitis: Inflammation of the sinuses can cause pain in the face, particularly if the sinuses on one side are more affected than the other. This condition is relatively common and could explain unilateral face pain.

Do Not Miss Diagnoses

• Stroke or Transient Ischemic Attack (TIA): While less common, facial pain can be a symptom of a stroke or TIA, especially if accompanied by other neurological deficits. Missing this diagnosis could be catastrophic.
• Multiple Sclerosis: This condition can cause facial pain, among other neurological symptoms. Early diagnosis is crucial for effective management.
• Lymphoma or Other Cancers: Certain cancers can cause facial pain, either by direct invasion or by causing inflammation. These conditions are less common but critical to diagnose early.

Rare Diagnoses

• Glossopharyngeal Neuralgia: Similar to trigeminal neuralgia but involves the glossopharyngeal nerve, causing pain in the throat and base of the tongue, which can sometimes radiate to the face.
• Occipital Neuralgia: Involves the occipital nerves and can cause pain that radiates from the back of the head to the face, although this is less common.
• Raeder's Syndrome: A rare condition characterized by a combination of facial pain, ptosis (drooping eyelid), and miosis (constricted pupil) on one side of the face, often associated with sympathetic nervous system dysfunction.

Each of these diagnoses has a different treatment approach, ranging from medication and physical therapy to surgery, depending on the underlying cause. A thorough clinical evaluation, including history, physical examination, and possibly imaging studies, is necessary to determine the correct diagnosis and appropriate treatment.