Septoturbinal surgery in contact point headache syndrome: long-term results

Facial pain syndrome secondary to sinonasal pathology is reported by the International Headache Society (IHS) classification (1988). It is underlined that a clear and proven nasal pathology with adequate painful stimuli must be present, i.e., acute sinusitis, vacuum sinus, or other unspecified pathologies. No clear role of septal abnormalities and turbinate hypertrophy has been attributed in the genesis of pain by the IHS classification. One of the most difficult problems in dealing with patients with sinonasal headaches is the definition of the primary cause of the pain. In our experience possible guidelines are history, endoscopic evaluation, diagnostic blocks, and computed tomography. The data reported here is from a long-term follow-up study of facial pain in a group of 34 patients with facial pain and nasal obstruction due to septoturbinal contact that did not respond to medical therapy. Patients, free from sinus disease or other causes of headache, were treated by septoplasty/rhinoseptoplasty,and middle turbinate electrocauterization. Pre- and postoperative patency was assessed by endoscopic evaluation and nasal resistance was assessed by anterior rhinomanometry. Patients were interviewed regarding pre- and post-operative intensity of pain (subjective pain was evaluated using the 0-10 Visual Analogue Scale (VAS) and frequency of the facial pain. The follow-up period ranged from 12 to 47 months (mean: 26.7 +/- 8.5 months). In 25% of the cases the pain relapsed post-operatively (from two days to one year); but in only three patients (8%) the relapses were persistent. Two out of three, however, reported a decreased VAS score after surgery. These results seem to indicate septoplasty and turbinate decongestion to be a fairly good surgical option in treating facial pain due to septoturbinal contact resistant to conservative nasal therapy.