Nasal mucosal contact points with facial pain and/or headache: lidocaine can predict the result of localized endoscopic resection

Abstract

The objective of the study was conducted to evaluate the effectiveness of nasal endoscopy for both diagnosis and localized excision of intranasal contact areas that cause headache and/or facial pain as well as to evaluate the use of lidocaine test for diagnosis of such cases and predicting the result of surgery. This study included 120 patients aged between 18 and 45 years, with an average period of headache and/or facial pain of 2.5 years. Patients were classified into two groups according to lidocaine test. Group A that was lidocaine positive and group B which was negative. Excision of contact points was done, under endoscopic guidance, from the septum as well as the lateral nasal wall. 98.75% of patients in group A got benefit from surgery as most cases were cured from headache and facial pain. In group B, 40% got benefit with most patients had unchanged symptoms. In conclusion, endoscopic surgery gives a more precise complete excision of limited areas without time wasting or morbidity. Lidocaine test can be used as a test to aid in diagnosis and to predict the result of surgery where there were high cure rate within the lidocaine-positive group.

Middle Turbinate Evacuation Conchoplasty in Management of Contact-Point Rhinogenic Headache in Children

“…Performing a "topical anesthesia test" before surgery thereby enabled the authors to select children who reported an improvement. Nevertheless, this test did not guarantee the selection of those patients who would benefit from surgery, as reported by different authors [31][32][33]. However, none of these authors has found a distinct correlation between a positive test result and a surgical outcome.…”

Mucosal contact points and paranasal sinus pneumatization: Does radiology predict headache causality?

“…In spite of the low level of evidence, selected patients with mucosal contact points who appear to benefit from directed nasal surgery are those who have failed medical therapy for migraine and tension‐type headache, have otherwise normal endoscopy and CT scan, and have symptomatic improvement with local anesthetic application to the contact point in preoperative evaluation . However, it is not clear why a significant proportion of patients have residual symptoms after surgery . In addition, several studies claimed good response to surgical treatment in patients with less strict selection criteria.…”

“…A false‐positive test may be seen in some migraineurs due to resolution of allodynia or neuroplasticity . To further confound the above‐mentioned selection criteria, some patients still benefit from surgery with a negative lidocaine test, although responders were found to have better outcome …”

“…[22][23][24] If intranasal mucosal contact is responsible for headache, then it is not clear why many patients with contact points do not have any pain symptoms. Although several authors have reported postoperative relief or improvement of headache in some patients, [25][26][27][28][29][30][31][32][33][34][35] almost all studies had no control subjects and many lacked long-term follow-up. 1,2 Therefore, headache improvement may be attributed to cognitive dissonance, a placebo effect that can last for several months, 36 or to neuroplasticity.…”

“…2 However, it is not clear why a significant proportion of patients have residual symptoms after surgery. [25][26][27][28][29][30][31][32][33][34][35] In addition, several studies claimed good response to surgical treatment in patients with less strict selection criteria. For example, migraine itself was hypothesized to be triggered at times by mucosal contact abnormalities and was found to respond to their surgical correction.…”