Orofacial pain due to rare interosseous hemangioma first diagnosed as secondary to trauma

Pain is among the most common reasons for patient visits to healthcare providers, especially to dental practitioners. This case illustrates the obligation of the general dentist and specialist to recognize facial pain disorders of nonodontogenic origin, and outlines a paradigm for treatment of this unusual case. A 59-year-old man presented with chronic, progressive right periorbital pain since 2006, of 7 years duration. The initial diagnosis was a fracture of the right outer rim of the orbit secondary to trauma. The patient had undergone a variety of clinical and radiographic evaluations, pharmacologic therapies, and limited surgical procedures with no benefit. The description of his pain varied. Initially complaints were consistent with musculoskeletal pain, ie chronic, localized, aching, and evoked by pressure. It evolved into a neuropathic quality with increasing and spontaneous pain associated with sensory changes. Pain levels, which were initially mild, became moderate to severe. After a detailed review of the patient's history, radiographic records, and a comprehensive clinical evaluation, a CBCT of the maxilla was performed. While not considered a routine radiographic study, CBCT is readily available to the general dentist and specialist. CBCT was indicated in this case and revealed a rare interosseous hemangioma of the maxilla. The portion of the maxilla containing the lesion was surgically removed and a prosthetic replacement was placed. At 12 months after the procedure the patient remains pain free.