Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Nottingham, UK.
Clin Otolaryngol. 2013 Feb;38(1):8-22. doi: 10.1111/coa.12081.
There is a body of opinion in the clinical literature advocating the removal of intranasal contact points to treat facial pain.
To review the evidence that intranasal mucosal contact points cause facial pain or headache and their removal is therapeutic.
Systematic review.
A systematic search of the available literature was performed using MEDLINE, EMBASE, Cochrane library and NHS Evidence from inception to September 2011. Terms used include facial pain and contact point (3628), rhinologic headache (6) contact point and surgery/endoscopy (38).
Inclusion criteria applied. Assessment of papers were undertaken by one reviewer and checked by the second. A narrative review of each study was performed and results recorded in tables.
In one study, 973 consecutive patients with a provisional diagnosis of rhinosinusitis were divided into groups with (42%) and without facial pain. There was a 4% prevalence of nasal contact in both groups, which was unrelated to the presence of facial pain. In another study of 100 patient's coronal paranasal sinus CT scans, 29% had headache and 55% had a contact point but their presence was inversely related to the presence of pain.(1) In a further study, ten healthy volunteers had palpation, adrenaline, substance P and placebo applied to different areas throughout the nasal cavity and none of these stimuli caused facial pain. Nineteen studies were identified where nasal mucosal contact points had been removed surgically for the treatment of facial pain. They were small case series, not randomised and subject to selection bias, had no control group, a limited follow-up and were open to observer bias with level IV evidence. Seven studies had a statistically significant improvement in pain postoperatively compared with preoperative questionnaire results but the majority had residual facial pain.
The majority of people with contact points experience no facial pain. The presence of a contact point is not a good predictor of facial pain. The removal of a contact point rarely results in the total elimination of facial pain making the theory that a contact point is responsible unlikely. The improvement in postoperative symptoms following the removal of contact points in some patients may be explained by cognitive dissonance or neuroplasticity. A randomised, controlled and blinded trial with a followed up period of over 12 months is needed to assess the place of surgery in the removal of a contact point for the treatment of facial pain.
临床文献中有一部分观点主张去除鼻腔内接触点来治疗面部疼痛。
综述鼻腔黏膜接触点是否会引起面部疼痛或头痛，以及去除这些接触点是否具有治疗作用。
系统综述。
使用 MEDLINE、EMBASE、Cochrane 图书馆和 NHS Evidence 从建库至 2011 年 9 月进行了全面的文献检索。使用的术语包括面部疼痛和接触点（3628）、鼻科头痛（6）接触点和手术/内镜（38）。
应用纳入标准。由一位评审员评估文献，并由第二位评审员进行核对。对每项研究进行叙述性综述，并将结果记录在表格中。
在一项研究中，对 973 例经初步诊断为鼻窦炎的连续患者进行分组，一组（42%）有面部疼痛，另一组（42%）无面部疼痛。两组均有 4%的鼻腔接触，且与面部疼痛无关。在另一项 100 例患者冠状位副鼻窦 CT 扫描的研究中，55%有接触点，但头痛的发生率为 29%，且接触点的存在与疼痛的存在呈负相关。在进一步的研究中，10 名健康志愿者接受了鼻腔不同部位的触诊、肾上腺素、P 物质和安慰剂刺激，这些刺激均未引起面部疼痛。有 19 项研究报道了因面部疼痛而行鼻腔黏膜接触点切除术，这些研究为小样本的病例系列研究，未随机分组，存在选择偏倚，无对照组，随访时间有限，观察者偏倚的可能性较大，证据等级为 IV 级。与术前问卷调查结果相比，7 项研究术后疼痛有统计学意义的改善，但多数患者仍存在面部疼痛。
大多数有接触点的患者并无面部疼痛。接触点的存在不能很好地预测面部疼痛。去除接触点很少能完全消除面部疼痛，因此接触点是导致疼痛的原因这一理论不太可能成立。在一些患者中，去除接触点后术后症状的改善可能是由于认知失调或神经可塑性所致。需要一项随机、对照、盲法研究，且随访时间超过 12 个月，以评估手术在去除接触点治疗面部疼痛中的作用。
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