Complex regional pain syndrome involving the face following snowball injury

Abstract

Complex regional pain syndrome (CRPS) is a condition of unknown etiology characterized by autonomic, sensory, and motor disturbance. CRPS usually follows an injury in the affected limb, which is often trivial in nature. CRPS involving the facial region is rare, and there have been no previous descriptions in children. We describe a 13-year-old girl with CRPS involving the face, which developed after being struck by a snowball. The clinical characteristics were similar to those of CRPS elsewhere in the body involving burning pain, hyperalgesia, and hyperesthesia. This was later accompanied by skin edema, fluctuating color, and temperature changes, as well as loss of eyebrow hair. Following detailed but inconclusive investigations, a clinical diagnosis of CRPS was made in line with Budapest diagnostic criteria. Over the next year, her condition gradually improved with ongoing comprehensive multidisciplinary input. We present this patient to alert clinicians to consider CRPS in the differential diagnosis of similar cases who present with chronic facial pain and skin changes.

Complex regional pain syndrome of the face in a child

“…Goenka, et al, reported a 13-year-old girl, struck by a snowball, who developed facial CRPS. 3 Interestingly, she also had impairment of the left frontalis muscle as well as ptosis but retained full eye movement. In both cases, extensive investigations were undertaken before making the diagnosis because of the unusual location of CRPS.…”

“…This is the second reported case of pediatric facial CRPS. Goenka, et al ., reported a 13‐year‐old girl, struck by a snowball, who developed facial CRPS . Interestingly, she also had impairment of the left frontalis muscle as well as ptosis but retained full eye movement.…”

“…Complex regional pain syndrome (CRPS) is an amplified musculoskeletal pain syndrome that is characterized by extreme pain out of proportion to the history and physical findings, accompanied by one or more signs of autonomic dysfunction . There has been just one case report on pediatric facial CRPS …”

Desfiguramento facial em contexto pediátrico: Revisão integrativa da literatura

“…Em Portugal são realizadas cerca de quarenta mil médias/grandes cirurgias reconstrutivas (Mendes & Figueiras, 2013), que apesar de ser desconhecida a sua etiologia, considera-se que por cada cem mil habitantes em Portugal, cento e trinta e sete pessoas sofrem de lesões na cabeça (Whitfield, 2009). De realçar que o trabalho multidisciplinar no desfiguramento facial adquirido ou congénito é consensual (Almeida et al, 2017;Baker, Owens, Stern, & Willmot, 2009;Braaf et al, 2016;Ewing-Cobbs et al, 2014;Ferraz-Torres et al, 2016;Goenka, Aziz, Riley, & Vassallo, 2014;Joseph et al, 2014;Kuhn et al, 2012;Linares, 2013;Masnari et al, 2012;Mendes, 2017;Zeytinoğlu et al, 2016), existindo a necessidade de programas de formação que permitam uma prevenção primária, no intuito de reduzir o impacto físico e psicológico da imagem corporal comprometida. Perante a evolução tecnológica, sugerem-se estratégias inovadoras educacionais que capacitem os indivíduos de conhecimentos e informações que se adaptem às suas necessidades (Landeiro et al, 2016).…”

Dor facial crônica e sua associação com morbidades odontológicas e sistêmicas

“…A síndrome da ardência bucal é considerada uma dor neuropática não paroxística e contínua (Merskey e Bogduk, 1994;Siqueira e Teixeira, 2012). Por outro lado, há condições faciais crônicas complexas de critérios controversos, como a dor facial idiopática persistente (odontalgia atípica e/ou dor facial atípica) e a síndrome complexa de dor regional, podendo apresentar mecanismos variados e alterações sensitivas ao menos em parte dos doentes (De Seta, Mancini et al, 2014;Goenka, Aziz et al, 2014).…”