Abu-Bakra M, Jones N S
Department of Ororhinolaryngology, University Hospital, Nottingham, UK.
J Laryngol Otol. 2001 Aug;115(8):629-32. doi: 10.1258/0022215011908685.
A cohort of 973 consecutive attendants at a rhinology clinic was studied prospectively and divided into patients without facial pain (n = 566, 58 per cent) and patients with facial pain (n = 407, 42 per cent). The prevalence of nasal mucosal contact points was the same in both groups, being four per cent in patients with nasal contact points without facial pain and four per cent in patients with facial pain. A contact point is defined as when contact remains after topical decongestion. Of the 18 patients with facial pain, nine had a spur contacting the lateral nasal wall and nine had a middle turbinate contacting the septum. These 18 patients were followed up for a mean of two years and two months. In the light of their treatment and response the following diagnoses were made: five had tension-type headache, six had midfacial segment pain, one had migraine, two had cluster headache and four had purulent nasal disease. Of the four with unilateral symptoms, two had a contact point on the contralateral side. Eleven of these 18 patients responded to medical treatment for tension-type headache or midfacial segment pain, migraine and cluster headache, three patients were better after surgery for coexisting purulent nasal disease and one patient had a spur removed surgically and remained better at 2 years follow-up, whereas three patients were no better after the same procedure. The results demonstrate that the prevalence of nasal contact points in patients with facial pain is the same as in those within pain. Surgery undertaken to remove mucosal contact points for facial pain is usually unnecessary as the aetiology of this facial pain appears to be a more central processes.
对973名连续到鼻科门诊就诊的患者进行了前瞻性研究，并将其分为无面部疼痛的患者（n = 566，58%）和有面部疼痛的患者（n = 407，42%）。两组鼻黏膜接触点的患病率相同，无面部疼痛的鼻接触点患者为4%，有面部疼痛的患者也为4%。接触点定义为局部减充血后仍存在接触的情况。在18名有面部疼痛的患者中，9名有骨嵴接触鼻外侧壁，9名有中鼻甲接触鼻中隔。对这18名患者平均随访了两年零两个月。根据他们的治疗情况和反应做出了以下诊断：5名患有紧张型头痛，6名患有面中段疼痛，1名患有偏头痛，2名患有丛集性头痛，4名患有化脓性鼻病。在4名有单侧症状的患者中，2名在对侧有接触点。这18名患者中有11名对紧张型头痛、面中段疼痛、偏头痛和丛集性头痛的药物治疗有反应，3名患者在因并存的化脓性鼻病接受手术后病情好转，1名患者接受了骨嵴手术切除，在2年随访时仍状况良好，而3名患者在进行相同手术后病情没有改善。结果表明，有面部疼痛的患者中鼻接触点的患病率与无疼痛患者中的患病率相同。为治疗面部疼痛而进行的去除黏膜接触点的手术通常没有必要，因为这种面部疼痛的病因似乎是一个更中枢性的过程。
