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Delayed Onset Pain After Facial trauma?
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Questions in the Oral and Maxillofacial Surgery forum are answered by Dr. Michael H Kirsch and Dr. Mario Tuchman. Topics covered include teeth extractions, wisdom teeth, dental implants, bone grafting, orthognathic surgery, facial bones realignment, facial trauma repair, jaw alignment, anesthesia , jaw cyst or tumor diagnosis, reconstructive jaw surgery, temporomandibular joint syndrome (TMJ) and TMJ surgery.

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Delayed Onset Pain After Facial trauma?

I have been having what is best described as pain and Dysesthesia (ants running/tingling, etc) in the infraorbtal region for 2+ years.  It is persistent and the disturbance is very hard to live with. I have seen many Neurologist, ENT and Dentist and have found no relive after years of pain. I finally found a Neurologist who specializes in Facial Nerve offered an infraorbital nerve block which led to the the pain relief.

It was then I realized this was the exact location of trauma about 14 months to the pain appearing. I received a blow by a racket right below the eye and it slid into the eye. I remember it being fairy viscous, but foolishly did not seek medial attention because my vision was ok the next day. It was sore and swollen for a few weeks, and I had a black eye for a while, but after a month it all signs of the injury were gone which is why it was long forgotten.

I mentioned this and said she would look into finding a specialist in blow out fractures, I said I was look as well and see if there was any options. Until i can get in then i would appreciate any insight into the flowing questions/theories

1. Can pain present itself so long after an injury due to an improperly healed fracture?  I know there are post traumatic neuropathies, but this appeared  long after the injury and the nerve was fine for over a year.  We theorized it could be that the bone around the nerve did not heal correctly or is still unhealed because of lack of medical attention, and with the aging process it is now has a bone pressing against the nerve. I am hoping the nerve is ok and it is just from construction, as the sensory aspect see fine. In fact if i hold my hand over the region that sensory input "trumps" the pain.

2. What test/Imaging study could be done to confirm this?

3.. If this is possible, would having saving surgery to decompressing the nerve(or other type of facial surgery) help even so long after the injury and appearance of pain?

Many Thanks,
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This forum allows for answering one question per posting.  However, I will do my best to help you.

1. Yes, definitel.
2. Ct scan and MRI
3. Absolutely.

I recommend you see an Oculoplastic Surgeon or a Board Certified Oral and Maxillofacial Surgeon who specializes in Craniofacial Reconstruction.

The earlier the intervention the better the outcome.  Also, you don't want your condition to deteriorate and worsen.

Information contained within this reply is intended solely for general educational purposes and is not intended nor implied to be a medical diagnosis or treatment recommendation.  This is not a substitute for professional medical advice relative to your specific medical condition or question. Always seek the advice of your own doctor for medical condition. Only your doctor can provide specific diagnoses and therapies.
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