Having Severe Pain On Right Side Of Face. Done With CT Scan. Prescribed With Doxycycline. Could This Be Cellulitis?

Posted on Thu, 7 Nov 2013

Medically reviewed by Ask A Doctor - 24x7 Medical Review Team

Thu, 7 Nov 2013 Answered on

Fri, 29 Nov 2013 Last reviewed on

Question : I have had severe pain the right side of my face mainly in my cheekbone area and right under my eye. I have been to an ENT who put me on antibiotics which helped with the pain on that side for a while when i was on the antibiotics but the pain is now back. He says it has nothing to do with my sinuses because he did a ct scan of them and they are completely clear. My mother had cellulitis in her face and I am wondering if i could have that as well. I have the ct scan and the right side of my face and was wondering if cellulitis would show on a ct scan? Already Tried: I have been put on doxycycline which helped for a while and then the pain got even more severe after that and was put on clindamycin which helped alot but was only on it for 6 days and now my pain is back.

Answered by Dr. Sumit Bhatti (50 minutes later)

Brief Answer: Trigeminal Neuralgia and other conditions below: Detailed Answer: Hi, Thank you for your query. 1. There is no sinusitis or cellulitis seen in the attached CT Scan. 2. Trigeminal Neuralgia is possibility. The area where you are experiencing severe pain corresponds to the Maxillary (V2) division of the Trigeminal Nerve (Fifth Cranial Nerve). 3. The feeling of swelling is sometimes associated with neuralgia. Other conditions that must be ruled out are dental infections, temporomandibular joint disorders, parotid duct blockage, migraine variants, herpes, mucosal contact in the nose (seen in the middle image, middle row of your scan, between the septum and inferior turbinate) and referred pains. 4. Medication for neuralgia differs from regular pain killers. Request your physician for a trial with amitriptyline, carbamazepine, gabapentin or pregabalin. 5. If medication fails, get a Neurologist's opinion to trace the course of the nerve back to the brain and look for any abnormality. I hope that I have answered your query. if you have any further questions, I will be available to answer them. Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (14 minutes later)

Your answer while hilarious doesn't seem like you even read what i wrote. I have been on pain medicine and gabapentin and both made the symptoms i have worse. The only and let me repeat only thing that has helped is antibiotics!! I can't believe i paid for this.

Answered by Dr. Sumit Bhatti (2 hours later)

Brief Answer: You gave NO history of pain medication!!!!! Detailed Answer: Hi, Thank you for writing back. 1. There is NO mention of any pain medication and gabapentin in your earlier query or that they made the symptoms worse. 2. You have mentioned that you had relief from antibiotics TEMPORARILY (assuming that you were not taking any other supportive medication) and then the pain RETURNED after both doxycycline and clindamicin (which helped you a lot). Clindamicin achieves a high concentration in saliva. 3. You are experiencing pain on ONE side. That is not in favor of an infection unless you have a small septic focus with a resistant bacteria. 4. Your mother may have cellulitis, but there are no other details such as her age, the extent on her face, diabetic status, immune status, her response to treatment (so that you could try the same). 5. Rule out all the above conditions and try the rest of the pain medication (you may have not responded to gabapentin, you have not mentioned the dose, but what about the rest?). I hope that I have answered your query. if you have any further questions, I will be available to answer them. Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar