undetermined, intermittent unilateral mouth and nose pain

[saly-gearhart]

    
      Re: undetermined, intermittent unilateral mouth and nose pain
    


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Posted by ccfNeuro MD on June 03, 1997 at 15:15:15:

In Reply to: undetermined, intermittent unilateral mouth and nose pain posted by sally gearhart on May 29, 1997 at 13:10:07:

: Over 2 years ago (early spring) I experienced several months of stinging
  tongue and burning sensations in one nostril, with
  intermittent teeth pain, particularly near the gums, mild jaw and tongue sensations
  of various kinds.  These apparently went away and then
  recurred again late this spring.  I had a clear MRI
  2 years ago, a CT scan (showing sinusitis, which has
  been a significant, but intermittent problem as well
  during this time), and otherwise good lab tests, such
  as hemoglobin, urinalysis, ekg, this past month.
  Have had consultations with ENT and l with a neurolgist
  who basically ascribed the symptoms to "neuralgia."
  I am 54 and consider myself healthy except for the
  sinusitis and these episodes which can last for months.
  I do notice they occurred with, before, or after flu viruses when I'm
  "run down."
  
  I don't describe them as intense pain, but certainly
  they interfere with my life. Does "neuralgia" seem
  to describe them to you?  (Incidentally, I did have
  chicken pox at puberty, not as a child. I don't have
  herpes.)
  One other odd happening.  About the time of the occurrence of this episode,
  I experienced a sudden, intense pain on the opposite
  jaw, radiating to the shoulder, collar bone, and ear.
  I don't recall having that before and this time as
  before, the discomfort is all on the opposite jaw,
  nose, teeth and tongue, primarily the latter.
  
  Also:
  The first time the symptoms began with a stinging near
  (not on) the mouth, no cold sore (never have them), but with
  tiny rash that lasted several weeks and went away only
  after tetracycline.  No rash this time on face. Instead,
  I had muscular pain in the shoulder and arm on the
  opposite side.
  I don't even know if these things are related, but I
  offer them for your consideration.   The doctors have
  checked me and found nothing apparent.  Thanks for your
  input to this annoying problem which seems not to have
  left for good.
  I am a part time teacher in a community college by
  profession and appreciate this opportunity to be further
  educated.  What a great service!
===============================================================
Sally,it sounds like the term "neuralgia" would fit your symptoms of facial pain.  "Neuralgia" is a nonspecific term that just indicates painful symptoms thought to be caused by a peripheral nerve.  Trigeminal neuralgia is probably the most common type of facial pain.  It is usually characterized by intermittent, stabbing, intense pain that occurs on the cheek, chin or rarely, around the eye. A characteristic feature of trigeminal neuralgia is that it can be triggered by touching the affected part of the face. The paroxysms of pain recur frequently for several weeks at a time.  Your symptoms, although intermittent, are not quite typical for this. Another possible cause for facial pain is inflamed sinuses (as occurs with sinus infections)It is perhaps conceivable that the pain can be referred to other areas of the face, as in your case.  Mouth pain could also be due to a dental problem such as a small tooth abscess or bone infection.  A thorough dental examination by a dentist is sometimes worthwhile. Occasionally, no cause for facial pain can be found, and these cases are sometimes referred to as "atypical" facial pain. The treatment of facial pain depends on the cause; first-line treatment for trigeminal neuralgia is usually an antiseizure medication called carbamazepine, which is often effective for this problem, as well.  Sinusitis or dental infections are best treated with antibiotics and other dental procedures, as necessary. Atypical facial pain is often treated with a group of medications called tricyclics, (such as nortriptyline or amitriptyline). These medications are also useful for other chronic pain conditions as well as  depression. If you would like a second opinion at the Cleveland Clinic on the etiology and treatment of your facial pain, Dr. Gretter, a neurologist specializes in headaches and facial pains would be a good person to see. (Call 216-444-5559 for an appt) This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options of your specific medical condition.