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Oral Surgery/TMJ and face and head tingling after lingual nerve damage from wisdom tooth surgery

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QUESTION: Hi Dr. Teig, it's April again. I sent you an e-mail on 26 April asking about lingual nerve damage. I still have burning tongue (top and underside), the lingual gum, and the flabby area between the lingual gum and the underside of tongue. I also still have painful and sensitive lower front teeth. On 12 May I had new symptoms: the area in front of my ear became too hot and then after an hour or so I had tingling under my left eye, left side of face, forehead, and head. Then I had dull pain in the socket of my eye, the left side of my nose became sensitive as if it was open inside, and my lower front teeth became too tight, painful,and throbbing.I also had headache on the left side of my head (top and back). Since that time I have got those symptoms that I mentioned above. I also have swelling in the left side of face. I have got pain in front of and back of my ear. I have also got stiff left side of neck and shoulder.My headache is so bad. I had an MRI for my brain and everything is normal. I also checked the inside of my ear and there is no infection and everything is normal. I am taking Lyrica 150mg per day now. I tried muscle relaxant, but it did not work.Nothing has worked for headache. I wondered if you could tell me what problems I have and what causes them? how to treat them? Many thanks

ANSWER: April - I, of course, cannot be completely sure what is the cause of your problem, but it sounds like a neurological problem.  I am not a neurological specialist, but it sounds like trigeminal neuralgia.  My suggestion is for you to be evaluated by a neurologist.

After a little research, I have discovered that Arab Medical Center, Jabal Amman - 5th Circle, PO Box 3128, Amman, is known as a hospital that evaluates and treats neurological problems.  I suggest you contact them and have a neurologist there evaluate you.

I hope you can be helped soon.

---------- FOLLOW-UP ----------

QUESTION: I saw a neurologist and he asked me to get MRI and MRA for brain to make sure that there is nothing putting pressure on nerves in the brain. The MRI and MRA showed that everything is normal. He prescribed me Lyrica 150mg per day for two months. He said it is not a classical Trigeminal neuralgia. Does TMJ cause painful and sensitive teeth (lower front teeth, one-sided headache, and stiff shoulder? I also have a few questions about my lingual nerve. The burning sensation on top of my tongue has improved, but I started to have it on the underside of tongue, lingual gum, and the flabby area between the underside of tongue and the lingual gum. I have also got a burning sensation on my lower lip for 4 weeks. My surgery was on 24 March. Is this a good sign that my lingual nerve is healing? is it normal to have a burning sensation during the healing process? If my lingual nerve is damaged, then why are my lower front teeth painful and sensitive? and why does my lower lip have a burning sensation?(the latter has started recently). Do you think that my lingual nerve being damaged has affected my Trigeminal nerve and has caused the Trigeminal symptoms that I have got? I have been asking too many questions,but I cannot find somebody who can answer my questions. I do appreciate your help. Many thanks.

Answer
April -  It is a little difficult to tell you if your symptoms, besides the tongue situation, is a TMJ related problem.  It is possible, I have seen this before, that with the tongue problem, the jaw function is altered, not due to damage, but in response to the altered sensation of the tongue.  With an altered function, the jaw muscles can respond with spasms of the muscles of the temple region, the jaw and neck.  

It is a very good sign that healing is progressing with the changes, even though it is not comfortable with the burning.  The pain of the lower front teeth and burning of the lower lip might not be due to injury to the mandibular nerve, but that nerve could have been close to the lingual nerve injury or you are suffering from referred pain. This is a situation that does occur in some. Is that your situation  I just don't know.  

So it is possible that the lingual nerve has produced referred changes to the trigeminal nerve?  Referred nerve changes do occur, but it is tough for anyone to fully determine if this is the cause.  If the neurologist that you have been seeing has not come up with an answer, it might be beneficial for you to be evaluated by a neurologist at a major medical center elsewhere.  I'm not saying that something will be proved, but it is possible that a doctor at a major medical center elsewhere might have seen a similar occurrence.  

I wish I could have given you a more definitive answer, but neurological situations need to be addressed by a doctor who has seen many different situations.  I wish you well and hope you continually improve and eventually the problem resolves.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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