Treatment outcomes of midfacial segment pain: experience from the Liverpool multi-disciplinary team facial pain clinic.

OBJECTIVES: Midfacial segment pain (MSP) has the characteristics of tension-type headache which is confined to the midface cor- responding to the second division of the trigeminal nerve. This review presents treatment outcomes of MSP patients managed at the Multi-disciplinary Team (MDT) Facial Pain Clinic in Liverpool. METHODOLOGY: Prospective clinical outcome performed in a tertiary referral centre for complex facial pain syndromes. MAIN OUTCOME MEASURES: Sino-Nasal Outcome Test (SNOT). Clinical "success" was defined as an improvement in total SNOT score of >9 points and a reduction of the ear-facial symptoms sub-domain score by ≥50% from baseline. RESULTS: The average age of the cohort was 49 years, with an average follow-up of 12 months. The overall pre-treatment total SNOT-22 score was 59.5 which improved significantly to 42 at latest follow-up. Although the average scores of all sub-domains improved, only the ear-facial symptoms and psychological issues sub-domains achieved statistical significance. When the criterion for success was applied, nine patients fulfilled this definition at an average of 12 months follow-up. The baseline total SNOT score in this cohort improved from 60.6 to 19.7. Half of these patients achieved success within 18 months of commencing treatment and the probability of attaining success at long-term follow-up was high. CONCLUSIONS: Treatment of midfacial segment facial pain is complex and requires follow-up to achieve any meaningful clinical outcome.