jawsurgeryforums.com
General Category => Functional Surgery Questions => Topic started by: Lazlo on May 03, 2019, 11:36:01 PM
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So sometimes the nerve problem in my lip/chin sometimes drives me crazy. Two plus years after surgery my chin still hurts and the side of my lip feels dead.
I just read this. Who the f**k do you go to to find out if your nerve or something can be repaired. Who even does an x-ray to look into if the nerve is severed. Why can't you have nerve grafting or that sort of thing? Has anyone looked into it?
https://www.ncbi.nlm.nih.gov/pubmed/27783836
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I mean here's another article, but again, this is from 2013, no f**king progress?
Is like all medical publishing f**king BULLs**t!!???
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146018/
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I think only Lyrica could maybe help you a little bit against the nerve pain.
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Who the f**k do you go to to find out if your nerve or something can be repaired. Who even does an x-ray to look into if the nerve is severed.
Pretty sure they can see what type of injuries your nerves have had by doing a MRN (Magnetic resonance neurography), which is basically a MRI of your nerves. I would see someone who specialises in microsurgery.
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I can’t offer advice on this topic but will say I’m likely heading down that road with my lower lip and chin. It’s still completely dead. I’m only 7 weeks out, sure, but my upper lip, nose, cheek, etc. were all also completely numb and have significantly regained sensation.
When I rub a small part of one side of my chin, I also get nerve pain in my lower teeth. It makes washing that area of my face unpleasant.
I’m taking very high doses of methylated B12 to oversaturate my body and will see if that helps..
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That is crazy 2 years out you still get chin PAIN. Surely this must be a rare occurrence.
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That is crazy 2 years out you still get chin PAIN. Surely this must be a rare occurrence.
between 2-5% in the best, most capable hands.
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between 2-5% in the best, most capable hands.
I've heard the percentage of major numbness in lower jaw is 30-60 percent from bsso.
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Honestly Lazlo, you'll just be wasting your time and money currently. I do think nerve regeneration will be doable in the future though, if you can wait... I know that's not what you want to hear.
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Honestly Lazlo, you'll just be wasting your time and money currently. I do think nerve regeneration will be doable in the future though, if you can wait... I know that's not what you want to hear.
yeah, i know you're probably right. the problem is clearly with my mental nerve. I have a bit of a hope that the pain/numbness may be exacerbated or caused by the screws and plate from the genio. I am going to look into having that removed.
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I've heard the percentage of major numbness in lower jaw is 30-60 percent from bsso.
I've seen those numbers but they were from papers published in the 90s. Nerve tracing via CBCT has really made a world of difference. G quoted me 2-5 percent for permanent localized numbness from bsso.
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I don't think surgeons are very honest when it comes to talking about this.
Unless you're young, you'll probably be left with some degree/area of permanent numbness. Nerves are still stretched, injured and severed even with CBCT. I used to think imaging and the best hands would help prevent this, but it doesn't seem to be the case.
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I've seen those numbers but they were from papers published in the 90s. Nerve tracing via CBCT has really made a world of difference. G quoted me 2-5 percent for permanent localized numbness from bsso.
Yet almost everyone you ask has "localised numbness", unless by localised he means half of the lower lip.
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Yet almost everyone you ask has "localised numbness", unless by localised he means half of the lower lip.
yeah. don't f**king believe that 2-5 % projection. 60 percent of BSSO patients will have half of their lips numb for life. it's just something you have to accept. it most probably will happen.
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Yet almost everyone you ask has "localised numbness", unless by localised he means half of the lower lip.
Except that you obvious lose feeling with a nerve damage, are there other implications such as paralysed muscles and unable to control parts of the face? Or is it always only lost feeling that is ment by nerve damage?
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Except that you obvious lose feeling with a nerve damage, are there other implications such as paralysed muscles and unable to control parts of the face? Or is it always only lost feeling that is ment by nerve damage?
I made full nerve recovery but while I had damage my mouth would lips would open more on one side than the other. I think my chin muscles were pulling my mouth more on the side without damage than the 'dead' side. Though I'm not actually sure how all the muscles work together.
Even now when I open my mouth wide my bottom lip sort of 'cants' to one side. Almost like it was stretched out asymmetrically. It's not really a problem though and my regular speech looks and sounds normal now.
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yeah. don't f**king believe that 2-5 % projection. 60 percent of BSSO patients will have half of their lips numb for life. it's just something you have to accept. it most probably will happen.
Does the numbness that lingers affect speech? I’m still not speaking properly, it’s difficult when your bottom lip is numb.
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Does the numbness that lingers affect speech? I’m still not speaking properly, it’s difficult when your bottom lip is numb.
i mean my main speech problems come from my tongue being constricted after bicuspid removal.
I do sometimes notice my dead half-lip has affected my speech but you kind of get used to it and adapt.
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i mean my main speech problems come from my tongue being constricted after bicuspid removal.
I do sometimes notice my dead half-lip has affected my speech but you kind of get used to it and adapt.
It might just be me that finds speech difficult with the numb lip. Probably others noticed less of a problem and recovered normal function quicker.
I don’t mean to hijack your thread with my concerns, so I’ll just quickly say a new development for me is nerve pain in my lower teeth when I tap or rub some areas of my chin and jaw, mostly my chin. Hoping it’s temporary.
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It might just be me that finds speech difficult with the numb lip. Probably others noticed less of a problem and recovered normal function quicker.
I don’t mean to hijack your thread with my concerns, so I’ll just quickly say a new development for me is nerve pain in my lower teeth when I tap or rub some areas of my chin and jaw, mostly my chin. Hoping it’s temporary.
Probably temporary. It's important to relax and especially since you're still healing I would do some yoga if you can do it. The body can enlist its natural energies to heal when you're in a relaxed state. I know for example relaxation exercises help tremendously with periodontal issues. I mean to a degree, but a few degrees help may be all you need.
Honestly, I'm pretty sure at the 2 month point the numbness you have is what you're going to have to live with.
Even today I noticed I had a few problems feeling what I was saying because of my numb half of the bottom lip and I'm 2 plus years post op. It f**king sucks. Which is why I'm hoping they do something about it soon!
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I made full nerve recovery but while I had damage my mouth would lips would open more on one side than the other. I think my chin muscles were pulling my mouth more on the side without damage than the 'dead' side. Though I'm not actually sure how all the muscles work together.
Even now when I open my mouth wide my bottom lip sort of 'cants' to one side. Almost like it was stretched out asymmetrically. It's not really a problem though and my regular speech looks and sounds normal now.
You're fortunate in that regard. Age is definitely a factor with these things.
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You're fortunate in that regard. Age is definitely a factor with these things.
I'm waiting for the day when regardless of age they'll be able to repair such things. Ahh f**k, will science hurry up or what!?
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I'm waiting for the day when regardless of age they'll be able to repair such things. Ahh f**k, will science hurry up or what!?
It does boggle the mind that medical problems with massively lucrative monetization potential such as m/f pattern baldness have not been fully solved.
I imagine niche issues like acute nerve regeneration are even further down the line.
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It does boggle the mind that medical problems with massively lucrative monetization potential such as m/f pattern baldness have not been fully solved.
I imagine niche issues like acute nerve regeneration are even further down the line.
When you think about how complicated any kind of regeneration is, it's really not too surprising. I think the whole industry has been essentially waiting on ML applications to come to fruition to be able to process the sheer amount of variables involved.
It's possible that instead of a very slow trickle of regeneration technology becoming available, it will come in waves. Of course, I'm highly optimistic, and I know people like Plosko don't share this view...
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When you think about how complicated any kind of regeneration is, it's really not too surprising. I think the whole industry has been essentially waiting on ML applications to come to fruition to be able to process the sheer amount of variables involved.
It's possible that instead of a very slow trickle of regeneration technology becoming available, it will come in waves. Of course, I'm highly optimistic, and I know people like Plosko don't share this view...
I'm kind of optimistic too. Because the literature on things like hydrogel scaffolds (that help any kind of tissure regeneration), Crispr and stem cell regeneration is now a few decades old. It's time clinical applications will begin to trickle in come 2020 and then in a massive wave in 2025 and after. It's inevitable. So just cope as best you can till 2025 and then we're laughin. That's for sure.
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I think this is what the nerve guys currently use now to try deal with this - AxoGen
https://www.cincinnatijawsurgery.com/success-stories/case-study-nerve-repair-surgery/
But the thing is you have to be treated early, which is likely not gonna happen after jaw surgery for reasons this websites already says. it's just "wait and see", and then it's possibly too late.
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Honestly, I'm pretty sure at the 2 month point the numbness you have is what you're going to have to live with.
I still have hope. My upper lip is still quite swollen so I’m clearly still healing. My sensation is not perfect in the upper lip but it wouldn’t bother me if that’s what I’d have to live with since it wouldn’t affect anything functionally. I’m just now getting the stinging and itching in the upper lip that I’ve read is a good sign of recovery. So it still has a ways to go.
Since the lower nerves take longer to heal, I’m hopeful my lower lip is just lagging behind and will eventually go through the same regeneration. I’m taking the chin nerve pain as a good sign, better than complete numbness.
It’s just this lower lip feeling like a gummy worm that’s very annoying. I have trouble pronouncing ‘m’ ‘p’ and ‘b’ sounds. I wasn’t expecting this at 2 months.
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yeah, i know you're probably right. the problem is clearly with my mental nerve. I have a bit of a hope that the pain/numbness may be exacerbated or caused by the screws and plate from the genio. I am going to look into having that removed.
Do you have nerve pain in addition to the numbness? If the plates are close to the nerve, getting the plates removed might aggravate things. Dr. Gunson performed a biopsy too close to my mental nerve after the jaw infection he caused that developed after an abcessed tooth pierced by a surgical screw. If your nerve is just entrapped, or injured vs severed there are some potential procedures but you would need an MRN, an MRI of the nerve. I had mine with one the nation's leading experts for nerve damage. I have multiple class 2, 3 and 4 injuries to the mandibular nerve on both sides.
There is some promising results from fat grafts, prp--giving the damaged nerve some space.
https://www.sciencedirect.com/science/article/pii/S2214541917300202
https://www.nervemed.com/nerve-disorders/nerve-trauma-entrapment-and-rsd/
Bottom line, IMO if you just have numbness be careful with any procedures close to the nerve as you don't want to trade numbness for nerve pain.
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NYCOMS says they can repair trigeminal nerve damage through microsurgery https://www.new-york-oral-surgery.com/oral-surgeon-ny/nyc-trigeminal-nerve-microsurgery-new-york.htm
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NYCOMS says they can repair trigeminal nerve damage through microsurgery https://www.new-york-oral-surgery.com/oral-surgeon-ny/nyc-trigeminal-nerve-microsurgery-new-york.htm
says after 3 months likelihood of repair is significantly decreased. I'm 2 plus years.
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Probably temporary. It's important to relax and especially since you're still healing I would do some yoga if you can do it. The body can enlist its natural energies to heal when you're in a relaxed state. I know for example relaxation exercises help tremendously with periodontal issues. I mean to a degree, but a few degrees help may be all you need.
Honestly, I'm pretty sure at the 2 month point the numbness you have is what you're going to have to live with.
Even today I noticed I had a few problems feeling what I was saying because of my numb half of the bottom lip and I'm 2 plus years post op. It f**king sucks. Which is why I'm hoping they do something about it soon!
Here is an accurate chart:
(https://i.imgur.com/fzpDz21.png)
Source: http://nerve.wustl.edu/NerveInjury.pdf
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well they claim that there are procedures to solve each problem, so why haven't I been offered a nerve graft?
I don't think they actually do repairs on mandibular nerve damage following sugery. At least its never been offered and I've never heard of anyone getting it done.
So what's the deal!?
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well they claim that there are procedures to solve each problem, so why haven't I been offered a nerve graft?
I don't think they actually do repairs on mandibular nerve damage following sugery. At least its never been offered and I've never heard of anyone getting it done.
So what's the deal!?
There is a surgery for paresthesia?
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Except that you obvious lose feeling with a nerve damage, are there other implications such as paralysed muscles and unable to control parts of the face? Or is it always only lost feeling that is ment by nerve damage?
I was told preop and even post op that any nerve damage would just be a slight annoyance and something “you only notice briefly while shaving.” For me that hasn’t been the case. I have pretty bad stiffness in my lower lip and entire chin. It makes talking strenuous. Any speaking problems I have are fairly undetectable over the phone though, so I believe people only notice in person because my lower lip is stiff and not moving properly.
However, Caminitti confirmed for me that lower lip numbness can present with speech problems similar to Bell’s palsy - trouble with letters where the lips come together: F,V,B,P,M. If you go to pronounce ‘f’ your upper teeth are contacting your lower lip to produce this sound, however if you can’t FEEL your damn upper teeth touching your lower lip you can sometimes botch the sound. Not always. For me it happens when I’m speaking quickly. So I still DO have speech problems.
Mostly though, I’m concerned with this damn STIFFNESS in my lower face. I really hope this improves but I’m 6 months out so I’m probably screwed. Thankfully, I have no neuropathic pain. My chin/ lip just feels FROZEN. I shudder to think how bad this will be in the winter.
So yes Dogmatix, nerve damage can present as much more than just loss of sensation. It won’t be paralysis though, that’s motor nerves, it’s just that nerve damage can cause all kinds of aggravation and inflammation that can restrict movement somewhat.
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Anyone know how it is determined (if even possible) that the nerve damage was caused by the patient’s simple inability to recover, I.e. nerves are always cut through with a BSSO and so recovery depends on the patient’s recovery, OR if the damage was caused by the surgeon’s cutting the major mandibular nerve?
Doesn’t the surgeon have to “pull back” on the saw before they hit the nerve? This is what I was told by a dental malpractice lawyer. He made it seem like all nerve damage is basically the surgeons fault because he probably overestimates how much bone there is buffering the nerve and accidentally cuts through. FWIW he has successfully sued prominent surgeons for severing this nevre in patients and ruining their lives, so maybe he does know what he’s talking about.
I just want to know if my surgeon made a mistake and severed my mental nerve completely. I just want to be told that.
Like my lower lip and chin shouldn’t be stiff like this. This isn’t typical at all.
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I think this is what the nerve guys currently use now to try deal with this - AxoGen
https://www.cincinnatijawsurgery.com/success-stories/case-study-nerve-repair-surgery/
But the thing is you have to be treated early, which is likely not gonna happen after jaw surgery for reasons this websites already says. it's just "wait and see", and then it's possibly too late.
Dental malpractice lawyer I consulted says he HATES when surgeons say “wait and see” because there are some therapies out there. But he didn’t elaborate. God this is all so stupid. Some patients recover nerve function very quickly after surgery, if you’re one of those patients who at 1.5 - 2 months still is dealing with massive numbness you should be told of treatment options right away.
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Anyone know how it is determined (if even possible) that the nerve damage was caused by the patient’s simple inability to recover, I.e. nerves are always cut through with a BSSO and so recovery depends on the patient’s recovery, OR if the damage was caused by the surgeon’s cutting the major mandibular nerve?
Doesn’t the surgeon have to “pull back” on the saw before they hit the nerve? This is what I was told by a dental malpractice lawyer. He made it seem like all nerve damage is basically the surgeons fault because he probably overestimates how much bone there is buffering the nerve and accidentally cuts through. FWIW he has successfully sued prominent surgeons for severing this nevre in patients and ruining their lives, so maybe he does know what he’s talking about.
I just want to know if my surgeon made a mistake and severed my mental nerve completely. I just want to be told that.
Like my lower lip and chin shouldn’t be stiff like this. This isn’t typical at all.
No one on here is going to know that. Maybe try seeing a neurologist to give a diagnostic work up to isolate where damage is. Here's a link to nerve repair. https://www.ofsinstitute.com/services/nerve-repair/ It's just the first one that came up. So, Google around .
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Anyone know how it is determined (if even possible) that the nerve damage was caused by the patient’s simple inability to recover, I.e. nerves are always cut through with a BSSO and so recovery depends on the patient’s recovery, OR if the damage was caused by the surgeon’s cutting the major mandibular nerve?
Doesn’t the surgeon have to “pull back” on the saw before they hit the nerve? This is what I was told by a dental malpractice lawyer. He made it seem like all nerve damage is basically the surgeons fault because he probably overestimates how much bone there is buffering the nerve and accidentally cuts through. FWIW he has successfully sued prominent surgeons for severing this nevre in patients and ruining their lives, so maybe he does know what he’s talking about.
I just want to know if my surgeon made a mistake and severed my mental nerve completely. I just want to be told that.
Like my lower lip and chin shouldn’t be stiff like this. This isn’t typical at all.
The single best way to tell if the nerve is severed or compressed is to have an MRN of the nerve. There are only a few places in the country who do it. Get a referral to John Zuninga in Dallas. Google him, does almost nothing other than facial nerve repair. Does not believe in an “wait and see” approach!
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who was your surgeon ?
Posnick