Reflex sympathetic dystrophy (RSD) of the face is an infrequently repo
rted clinical pain syndrome characterized by dysesthesia, hyperalgia,
hyperpathia, and allodynia. Treatment strategies, extrapolated from RS
D and causalgia of the extremities, remain variable and poorly defined
. Sympathetic blockade is generally the diagnostic and therapeutic tre
atment of choice; however, the frequency, timing, and duration of inje
ctions; need for neurolytic blocks; and role of sympathectomy are not
well understood. The objectives of this report are to highlight the cl
inical behavior of facial RSD and contrast its essential differences f
rom extremity RSD in response to standard treatment regimes. The case
studies of two patients with this syndrome, following vascular surgery
in the neck, are retrospectively reviewed with existent reported case
s. Age, gender, etiology, symptoms, onset, triggers, and examination f
indings; timing, duration, and method of treatment; and outcome are su
mmarized, forming the database for this study. Findings demonstrate an
infrequent association of vasomotor and sudomotor changes with facial
RSD, and lack of progression to a dystrophic or an atrophic stage, in
contrast to extremity RSD. Furthermore, treatment response to sympath
etic blockade is durable and less critically dependent on timing. The
authors conclude that facial RSD has a favorable prognosis and should
be managed conservatively with nonneurolytic stellate ganglion blocks,
even when initiated as a delayed and repetitive injection series.