Facial Pain: A Comprehensive Review and Proposal for a Pragmatic Diagnostic Approach.

BACKGROUND: Facial pain, alone or combined with other symptoms, is a frequent complaint. Moreover, it is a symptom situated at, more than any other pain condition, a crosspoint where several disciplines meet, for example, dentists; manual therapists; ophthalmologists; psychologists; and ear-nose-throat, pain, and internal medicine physicians besides neurologists and neurosurgeons. Recently, a new version of the most widely used classification system among neurologists for headache and facial pain, the International Classification of Headache Disorders, has been published. OBJECTIVE: The aims of this study were to provide an overview of the most prevalent etiologies of facial pain and to provide a generic framework for the neurologist on how to manage patients presenting with facial pain. METHODS: An overview of the different etiologies of facial pain is provided from the viewpoint of the respective clinical specialties that are confronted with facial pain. Key message: Caregivers should "think outside their own box" and refer to other disciplines when indicated. If not, a correct diagnosis can be delayed and unnecessary treatments might be given. The presented framework is aimed at excluding life- or organ-threatening diseases, providing several clinical clues and indications for technical investigations, and ultimately leading to the correct diagnosis and/or referral to other disciplines.

Fusobacterium necrophorum and other Fusobacterium spp. isolated from head and neck infections: A 10-year epidemiology study in an academic hospital.

BACKGROUND: Fusobacterium spp. from clinical specimens are increasingly reported. We sought to describe the epidemiology, the microbiological, and the clinical characteristics of head and neck infections caused by Fusobacterium necrophorum and other Fusobacterium spp. MATERIALS AND METHODS: Retrospective cohort study between October 1st, 2004 and September 30(th), 2014 performed in an academic hospital. Electronic patient charts and the laboratory information system were reviewed for demographic and microbiological data. The number and percentages of specific diagnosis and treatment among patients with positive Fusobacterium spp. culture were calculated. The incidence was calculated based on the number of specimens investigated each year. RESULTS: Included were 230 cultures of 230 patients (median age of 28 years, 61.7% men). F. necrophorum was often found in young patients with high C-reactive protein (CRP) and high number of leukocytes in blood. Other Fusobacterium spp. were often found in middle aged patients with relatively high CRP and slightly increased leukocytes. Three major causes of the isolation of F. necrophorum and other Fusobacterium spp. were acute tonsillitis (n = 18, incidence of 0.2%), peritonsillar abscess (n = 39, 0.5%) and acute otitis (n = 45, 0.1%). While F. necrophorum was found in majority (37/57) of patients with acute tonsillitis or peritonsillar abscess, Fusobacterium spp. other than F. necrophorum were found in the majority (35/45) of patients with acute otitis. Isolated fusobacteria were susceptible to beta-lactam antibiotics, clindamycin and metronidazole. The outcomes of patients with Fusobacterium spp. were good. CONCLUSION: F. necrophorum and other Fusobacterium spp. are rare cause of head and neck infections. The infections are well treated by combination of antibiotics and surgery.

Infected nasal gout tophus: A case report.

Gout is a common form of inflammatory arthritis, characterized by the deposition of monosodium urate crystals. If chronically present and not adequately treated by serum urate reducers, gout tophi can develop at various locations. Here, we report the first infected gout tophus at the septal cartilage and nasal tip.

Spontaneous extradural hematoma as a presentation of sinusitis: case report and literature review.

Spontaneous extradural hematoma is rarely mentioned in literature as intracranial complications of sinusitis. The authors presented a girl with spontaneous extradural hematoma secondary to pansinusitis and reviewed the literature. In a child with spontaneous extradural hematoma without a history of head trauma, sinusitis should be excluded.

Number of descriptors in cued odor identification tests.

OBJECTIVE: To investigate whether results from cued odor identification tests are influenced by the number of verbal descriptors presented with each odor and whether a larger number of descriptors would improve the differentiation between individuals with various degrees of olfactory loss. DESIGN: Randomized, crossover study. SETTING: University Clinic in Brussels. PARTICIPANTS: Two hundred thirty-eight study participants (128 with olfactory concerns and 110 control individuals without such concerns). The study took place from March 1, 2008, to April 30, 2009. MAIN OUTCOME MEASURES: Results of the 3-alternative forced choice (AFC) and 6-AFC identification tests, which consisted of 32 odor items each. RESULTS: A high correlation was found between the results obtained with the 2 tests. Although no sex-related differences were present, age was found to interact with performance in that lower test scores were obtained for older participants with the 6-AFC test, compared with the 3-AFC test. Of the 2 tests, the 6-AFC better separated participants with self-assessed olfactory deficits from participants without such concerns. It also discriminated more strongly between posttraumatic and postviral and sinonasal underlying causes of olfactory loss. CONCLUSIONS: Cued odor identification tests with various numbers of verbal descriptors produce similar results. However, an increasing number of alternative descriptive items seem to allow for better discrimination between individuals with and without olfactory loss.