Face / Head / Neck

Infra-orbital Neuralgia

Definition

Infra-orbital neuralgia is a neurological disorder of the infra-orbital nerve due to a lesion and/or dysfunction of this nerve.

Aetiology

Possible causes are: trauma (orbital fractures), infection (sinusitis), complications after maxillary sinus operation (Schluder's syndrome), primary nerve tumours, dehiscent osseous roof of the maxillary sinus, and idiopathic.

Signs and symptoms

The main complaint is usually unilateral pain in the cheek, upper teeth and jaw. This pain can be provoked by shaving, and is neuropathic in character. The complaints are deemed to be maxillary sinusitis.

Diagnostics

Physical Examination

General physical and neurological examinations accompanied by an ENT examination are indicated.

Additional Somatic Diagnostics

The diagnosis can be made based on medical history and exclusion of other ENT causes.

CT scan of the cranial sinuses, MRI scans in case of any suspicion of primary nerve tumours. A diagnostic test block the infra-orbital nerve can confirm the diagnosis.

Additional Psycho-cognitive Diagnostics

  • RAND-36 (quality of life)
  • VAS-Pain (maximal, minimal, actual, average/week)
  • PCS (catastrophising)
  • HADS (fear and depression)

Multidisciplinary Treatment

Whether or not somatic treatment is indicated is based on the pain diagnosis. Based on the findings of the pain questionnaires, additional diagnostics and/or multidisciplinary treatment comprising various non-somatic treatments may be necessary.

Non-somatic Treatment

Somatic Treatment

Pharmacological treatment:

  • Tricyclic antidepressants
  • Anticonvulsives: carbamazepine, oxcarbazepine, gabapentine en pregabaline.

Interventional Pain Treatments