AN UNUSUAL CASE OF SYMPATHETICALLY MAINTAINED FACIAL-PAIN COMPLICATEDBY TELANGIECTASIA

A 32-year-old woman with a history of maxillary sinusitis, multiple su rgical interventions in the maxillary sinus, and a hyperalgesic, eryth ematous skin lesion in her left infraorbital area, had severe burning pain in the left face. The dermal lesion was diagnosed as atypical tel angiectasia and the sinus pathoses determined to be unrelated to her s ymptoms. Two diagnostic stellate ganglion blocks were performed with c oncurrent bilateral monitoring of blood flow in the infraorbital skin. Blood flow was significantly increased in the painful erythematous pa tch although no significant change in flow occurred in the unaffected contralateral skin. The changes correlated to patient's relief from pa in. The patient's symptoms were subsequently controlled with an oral s ympatholytic agent. This article demonstrates the usefulness of laser doppler flowmetry to establish the diagnosis of sympathetically mainta ined facial pain despite several confounding conditions and supports t he theory that sympathetically maintained pain involves altered functi on of alpha-1 adrenoreceptors.