Nerve damage in nose

[Ifzat]

After a plastic surgery to my nose, I have experienced a lot of sensory trouble. After eating my nose gets hot and sometimes a little red. After 10 to 30 minutes it then gets very cold. Both phases are followed by light, but very irritating pain. This first happened after I ate potato chips, a month or two after the operation. But now it can happen from a lot of things. And when my nose has been irritaded I can barely eat anything for several days, before it normalizes. And then I still need to be very causious. For instance I can't eat an apple. That would be to much crunch. And I can not eat a big meat meal as that would be to much heavy chewing.

Can anyone tell me what this is, and if there is something I can do with it? I would be tremendously grateful.

My nose is also sensitive to winter cold and sun. I cannot be exposed to the sun more than a few seconds before getting sunburned reactions. But this might be another problem not related to the nerves.

I can also add that I was pregnand and very thin when I did the surgery. The skin cracked and healed poorly, so I might have been lacking zink.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

When soft tissue is injured, various small nerve fibers can be injured and may result in a condition called complex regional pain syndrome. This syndrome typically has associated symptoms such as abnormal skin color or temperature changes, abnormal sweating, and/or swelling of the affected area. The exact pathophysiology is unclear. It is likely due to an abnormal reflex arc from the sympathetic nervous system modulated by cortical pain centers, e.g., brain, causing an increase in catecholamine hypersensitivity. This latter statement is important because the emotional disturbance caused by the injury in many patients may be a precipitating factor in the pain syndrome. The treatment is multi-factorial and should begin with neuropathic treatment such as neurontin, lyrica, or elavil. If you do not meet the criteria for diagnosis, you can have allodynia (pain to nonpainful stimuli) as a result from the surgery. The treatment is the same.  

I would suggest you discuss this with the ENT who performed the surgery. You may need a referral to a pain specialist.

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.

[Ifzat]

Thank you for answering! This was very useful!
I would be very grateful if you could take the time to answer a few follow-up questions:

1. Will the pain just escalate if I ignore it and just do the things that trigger it (i.e. eat crunchy things, go out in the cold, sun, etc), and will it be irreversible? I am asking because I am putting way to many constraints on my life because of this, and my husband wants me to take a tougher approach..

2. Will there be physical problems as well (edema, skin atrophy, cancer)?

3. Have you heard about UV-induced neuropathy, or could this just be a rosacea problem getting a hundred times worse due to the nerve damage? Sunscreen does'nt help, and no dermatologists seem to understand my problem. As I wrote I cannot be exposed to sun at all (not even at cloudy days), without getting burning sentsations and redness. But I have'nt really tried to expose my self much, because I am so afraid my skin will be destroyed.

4. You write: "the emotional disturbance caused by the injury in many patients may be a precipitating factor in the pain syndrome". Do you mean my emotional responses as stress and anxiety? It is impossible for me not to be anxious about this, as it effects my life so much..

5. Your write "The treatment is multi-factorial". What other than medications does that imply?

6. Will the medications just remove the pain, or will it remove the physical reactions as well?

I am immensly grateful for your answer. I will also contact a new neurolog here in Norway.

[Ifzat]

By the way I have tried topical xylocain (lidocain) with no effect.