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Atypical Facial Pain
(Persistent / Chronic
Idiopathic Facial Pain)
What is Atypical Facial Pain?

Atypical Facial Pain (ATFP), also known as Persistent
Idiopathic Facial Pain
(PIFP) is a syndrome encompassing
a wide group of facial pain problems.

ATFP refers to pain within the territory of the Trigeminal
Nerve
(it can extend into the upper neck or back of the scalp
as well) that does not fit the classic presentation of other
head and neck
neuralgias.

The duration of pain is usually long, lasting most of the day
(if not continuous).  Pain is one-sided and without
autonomic
signs
or symptoms.

It is described as a severe ache, crushing sensation or
burning sensation.

Recent studies propose that
ATFP is an early form of
trigeminal neuralgia (TN).  Indeed, some patients have
components of both
ATFP and TN symptoms.
Last Updated 13th July 2016
Treatment Algorithm for Atypical Facial Pain
Useful Websites:

Facial Neuralgia Resources

Eastman Dental Institute Oral Medicine Clinic - Atypical Facial Pain Information
Sheet

Emedicine.com (Neurology)

European Association of Oral Medicine

American Academy of Oral Medicine

Wikipedia

Medscape.com

Orofacialpain.org.uk


Useful Articles:

Dental Update 1999.  Orofacial Pain

British Medical Journal 2000.  ABC of Oral Health - Oro-facial Soreness and Pain

Acta Neurol Belg 2001.  Differential Diagnosis of Facial Pain

J Oral Pain 2003.  Pharmacologic Interventions in the Treatment of TM Disorders,
Atypical Facial Pain & BMS.  A Qualitative Systematic Review

British Dental Journal 2006.  Oral Medicine, Update for the GDP - Oro-Facial Pain

Dental Update 2011.  Differential Diagnosis for Orofacial Pain, Including Sinusitis,
TMD, Trigeminal Neuralgia

BSOM 2013.  Persistent Idiopathic Facial Pain

Br J Anaesth 2013.  Differential Diagnosis of Facial Pain & Guidelines for
Management

J Headache & Pain 2013.  Review Article.  Multi-Dimensionality of Chronic Pain of
the Oral Cavity & Face

Brain & Spine Foundation 2014.  Face Pain.  A Guide to Patients & Carers

EFIC 2014.  Persistent Idiopathic Facial Pain

Int J Contemp Dent & Med Rev 2015.  Atypical Facial Pain & Atypical Odontalgia -
A Concise Review
What are the Signs & Symptoms of Atypical Facial Pain?

The International Headache Society defines ATFP as the following:

  • Pain is in the face
  • Pain is present daily and persists for all or most of the day
  • Pain is confined at onset to a limited area on one side of the face, deep ache,
    and poorly localised

In addition, the pain is not associated with numbness or tingling or other physical
signs with no abnormalities in laboratory or imaging studies.

Within the group of
chronic facial pain syndromes, ATFP represents a diagnostic
challenge.  Patients frequently are misdiagnosed or attribute their pain to a prior
event such as a dental procedure or facial trauma.

Depression and anxiety are prevalent in this population and compound the
diagnostic puzzle.

The estimated incidence of
ATFP is 1 in a 100,000, although this number may be
an underestimate.  
ATFP affects both sexes approximately equally but more
women than men seek medical care.  
ATFP mainly affects adults and is rare in
children.


How Is It Diagnosed?

Diagnosing atypical facial pain is not an easy task.  It's not unusual for ATFP
patients to have undergone numerous dental procedures, seen numerous doctors
and undergone numerous medical tests before being successfully diagnosed and
treated.

When a patient complains of constant
facial pain restricted to one side of the face,
the doctor / dentist must first rule out any other conditions.

Tests include X-rays of the skull, MRI or CT scan with particular attention to the
skull base, careful dental and ENT evaluation and thorough neurological
examination.

Only after tests rule out other factors can a diagnosis of
ATFP be made.


How is it treated?

Treatment is less effective than in other facial pain syndromes.

Medication is usually the first course of treatment.

Surgical procedures generally are not successful with
ATFP patients.

Anti-convulsants and anti-depressants are the mainstays of medication treatment.

Alternative therapies such as
acupuncture and neuro-muscular re-education have
been tried and should be considered as part of a comprehensive treatment plan.