Pain in the cheekbone
Pain in the cheekbone is observed in traumatic injuries, osteomyelitis, neuralgia, bruxism, myofascial syndrome, dental and otolaryngological diseases, some variants of headache and facial pain. It can be blunt, acute, short-term, prolonged, aching, bursting, jerking, shooting. It often occurs due to irradiation, combined with pain in neighboring anatomical structures. The cause of the symptom is established according to the survey, dental and otolaryngological examination, additional studies. Therapeutic measures include anesthesia, etiopathogenetic therapy, surgical interventions.
Why does the cheekbone hurt
Traumatic injuries
Osteomyelitis
Neuralgia
Muscle damage
Dental pathologies
Otolaryngological diseases
Other reasons
Diagnostics
Treatment
Conservative therapy
Surgical treatment
Prices for treatment
Why does the cheekbone hurt
Traumatic injuries
The most common injury to the zygomatic area is a bruise. Occurs in fights, less often – when falling or hitting a hard surface (for example, a door jamb). The pain is moderate, subsides quickly. Local edema and hyperemia are observed, abrasions are possible. Opening the mouth is not difficult, speech is not changed. All symptoms disappear within a few days or 1-2 weeks.
With a fracture of the zygomatic bone, the pain is very acute, intense. Bruising is detected, swelling quickly spreads to the adjacent parts of the face. There are pains when trying to open the mouth, numbness of the cheek, nose wing and upper lip, sometimes – diplopia. If the integrity of the maxillary sinus is violated, nasal bleeding develops, subcutaneous emphysema is possible. When the fragments are displaced, a step is felt in the cheekbone area.
The zygomatic bone is involved in the formation of the orbital wall. When the bone wall of the eye socket is damaged, along with the symptoms listed above, there is a restriction of the mobility of the eyeball, visual disturbances, subcutaneous emphysema, exophthalmos or endophthalmos. Orbital injuries can also be accompanied by double vision, strabismus, and in severe cases – blindness.
Osteomyelitis
Severe twitching, throbbing pain in the cheekbone may be a consequence of post-traumatic osteomyelitis. The disease develops after an open fracture, surgery on the zygomatic bone and nearby tissues. The wound becomes edematous, its edges turn red. Suppuration, intoxication, general hyperthermia are observed. After opening the abscess, the pain and inflammation subside, a fistula is formed in the wound area.
Neuralgia
Burning, shooting pains in the cheekbone, resembling an electric discharge, are characteristic of the defeat of the second branch of the trigeminal nerve. Pain sensations spread from the side of the face to the center, capture the upper part of the cheek, upper jaw, upper lip, nasal mucosa. Attacks of neuralgia last up to 2 minutes, are repeated repeatedly, causing patients to freeze in place.
In patients with ganglionitis of the pterygoid node, intense prosopalgia prevails in the area of the cheekbone, eye, hard palate and base of the nose, but the symptom is never clearly localized, since a large number of nerve branches causes the spread of soreness to neighboring parts of the face, gums, teeth, sometimes the occiput, neck, temple and ear. A distinctive feature of the pathology is pronounced vegetative symptoms: lacrimation, hypersalivation, hyperemia and swelling of half of the face.
Sometimes the cause of radiating pain in the cheekbone becomes ganglionitis of the cranial node, although for this variant of ganglioneuritis, ear pain with irradiation to the back of the head, face and neck is more typical. Pain sensations are paroxysmal in nature, in a number of patients they are combined with neuritis of the facial nerve.
Pain in the cheekbone
Pain in the cheekbone
Muscle damage
In patients with bruxism, bilateral aching pains in the cheekbones are caused by overstrain of the masticatory muscles during repeated nocturnal episodes of gnashing teeth. Drowsiness, headache and toothache, soreness in the jaw area are possible. Often there are chips, cracks, hyperesthesia and pathological tooth abrasion. With myofascial syndrome, the pain increases gradually, is the result of constant muscle tension when clenching the jaws against the background of overloads, stressful situations, neurotic disorders.
Dental pathologies
Irradiation to the cheekbone is noted when the upper premolars and molars are affected from the corresponding side. In some cases, the pain in the cheekbone is so pronounced that it prevails over the pain in the teeth. The symptom may occur after tooth extraction, with alveolitis, pulpitis, periodontitis. With deep caries, it does not occur spontaneously, it is associated with the ingestion of food into the carious cavity.
Otolaryngological diseases
The maxillary sinus is located in the body of the maxillary bone. Its wall borders on the zygomatic bone, which causes the spread of pain to the cheekbone when this sinus is affected. The symptom appears in the following diseases:
Acute sinusitis. There are bursting pains in the projection of the sinus, cheekbone, root of the nose and forehead area, which increase when feeling. Intoxication syndrome, fever, nasal congestion are detected.
Aerosinusitis. A similar localization of painful sensations is noted with aerosinusitis (if the maxillary sinus is affected), but hyperthermia and intoxication are joined only with secondary infection.
Acute pansinusitis. A vivid clinical picture is characteristic. There are chills, febrile temperature, severe intoxication. The general condition is serious. The pains from the cheek and cheekbone extend to the eyebrows, orbits, crown and occiput, sometimes they are given to the lower jaw, combined with a constant diffuse headache, with a prolonged course they are supplemented by progressive neurological disorders (insomnia, weakness, paresthesia).
In addition, acute bursting pain in the cheekbone is typical for one of the orbital complications of sinusitis – osteoperiostitis of the orbit. The spread of the inflammatory process to the lower outer wall of the eye socket causes the involvement of the zygomatic bone. Along with the symptoms of sinusitis, significant swelling of the periorbital fiber, exophthalmos, displacement and limitation of eye mobility are detected.
Other reasons
Headaches with possible irradiation into the cheekbone are observed in diseases with a definitively unexplained etiology – cluster headache and paroxysmal hemicrania. Sometimes the epicenter of painful sensations in the cheekbone with the spread to other areas is noted with atypical facial pain. Pain syndrome of psychogenic genesis against the background of stress or fatigue is formed in emotionally unstable, hypochondriacal people. In some cases, the symptom is found in patients with hypochondria, occurs with delusional and hallucinatory disorders.
Diagnostics
The cause of pain in the cheekbone is determined by the maxillofacial surgeon. According to the patient’s indications, they are referred to an otolaryngologist, neurologist, and other specialists. During the survey, the time and circumstances of the appearance of the symptom, the dynamics of its development, the presence of other manifestations indicating the nature and localization of the pathological process are established. As part of a dental examination, dental diseases are excluded.
In determining the etiology of neuropathic pain, an important role is played by the study of trigger points, special tests (for example, with dicaine and adrenaline for ganglionitis of the wing node). To clarify the diagnosis , the following procedures are prescribed:
Radiography. X-ray examination of the zygomatic bone, orbit or maxillary sinus is used for injuries, osteomyelitis, sinusitis, pansinusitis. Allows you to determine the type and severity of pathology, determine the need for additional techniques or treatment tactics.
Other visualization methods. They are used at the final stage of the examination with ambiguous radiography data. Provide detailed information about the localization, features and prevalence of the pathological focus.
Otolaryngological examination. It is indicated for ENT diseases. It may include anterior rhinoscopy, diagnostic puncture and probing of the maxillary sinus.
Laboratory tests. Inflammation is characterized by leukocytosis with a shift to the left, an increase in ESR. In purulent processes, the pathogen is determined by the results of sowing the material on nutrient media, antibiotic sensitivity is established.
Dental treatment
Dental treatment
Treatment
Conservative therapy
Analgesics are used to eliminate intense pain syndrome. The list of other therapeutic measures is determined depending on the features of the pathological process:
Traumatic injuries. Patients with a fresh fracture of the zygomatic bone without displacement are shown a protective regime, gentle nutrition, physiotherapy. If there is an offset, reposition is performed, then maintenance is carried out in the same way as in the previous case.
Osteomyelitis. The basis of treatment is antibiotic therapy, carried out taking into account the sensitivity of the pathogen. Antibiotics are administered intramuscularly, as part of surgical intervention – intraosseous. They or nitrofurans are used to wash the surgical wound.
Neuralgia. Patients with trigeminal nerve damage are prescribed anticonvulsants, antispasmodics, antihistamines, medications to improve microcirculation are used as auxiliary agents. With ganglionitis, the nasal cavity is lubricated with dicaine, sometimes ganglioblockers are used. Along with general remedies for neuropathic pain, therapeutic blockades are effective.
Dental diseases. Taking into account the nature of the pathology, the tooth well is washed or the tooth cavity is treated, followed by the application of anti-inflammatory and regenerating pastes. The list of general-action drugs includes sulfonamides and antibiotics.
Inflammation of the paranasal sinuses. Patients are recommended antibacterial, anti-inflammatory, detoxifying and antihistamines, immunocorrectors. Punctures are performed, the installation of a YAMIK catheter.
Surgical treatment
It is possible to carry out the following surgical interventions:
Traumatic injuries: open reposition of the zygomatic bone or the zygomatic complex, followed by fixation with wire sutures, tampons, metal mini-plates or plates made of fast-hardening plastic.
Osteomyelitis: opening and drainage of the wound, removal of mini-plates and other structures (if available).
Neuralgia: decompression or radiofrequency destruction, stereotactic surgical techniques.
Diseases of the paranasal sinuses: traditional and endoscopic sinusitis, microhaimorotomy, polysinusotomy.
