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Discomfort In Hard Palette. Biopsy Shows Irritated Tissue. Have Pain, Teeth Numbness. Nerve Problem?
Question: I've been having an on going problem with an irritation on my right back hard palette, just before the soft palette I've seen several oral surgeons and one Ent. It started 8 months ago. Felt like maybe a piece of popcorn got stuck there. It Felt like a tiny cut or crack with an occasional minor stinging sensation. Had a biopsy done.. results- irritated tissue and found some bacteria like you see from under a fingernail. Five months later it feels worse. I now have some throbbing/aching, stinging feeling and my front right teeth feel a little numb. [ X-ray of those teeth was normal] Also, I feel an occasional ache near my right nostril. There is some scaring from the biopsy, which was done with a laser. If I press there with my finger I can hear it make a squish sound and flattens out a little. It really is irritating and bothers me every day. All the doctors have a hard time seeing anything that looks abnormal. Had an MRI done of the area that was normal except small amount of fluid in my right sinus. Saw the Oral Surgen three weeks ago and he could not see any thing that looked irritated to him. If it is a minor salivary gland that’s causing the problem could they just cut it out? Could it be a nerve problem caused by the biopsy?
Hello
Welcome to Health Care Magic
You are having problem of irritation or foreign body sensation in palate. You have visited multiple oral surgeons and also ENT doctors. Almost all of reports have came in normal range, biopsy also came normal. Later you have also developed throbbing feeling in right teeth but that was also normal under X-Ray. You have pain near right nostril also. On pressing you can hear sound also. But doctors fail to find anything abnormal. MR scanning was also normal, slight fluid in sinuses is a normal finding.
Now coming to your questions-
- It is not a minor salivary gland because all tests came normal and usually minor salivary glands present with inflammation with severe pain but they don't cause chronic pain. And also you have been declared normal by ENT as well as oral surgeon.
- It can be a nerve problem caused by biopsy. But you are having this problem before biopsy also. So as per my opinion this is not due to biopsy.
Then what is it?
There may be multiple possibilities as-
- One possibility is thyroid gland abnormality. I will advise you to go for thyroid function test (T3/T4/TSH). Abnormal thyroid gland may cause symptoms mimicking foreign body sensation in throat. But other symptoms of thyroid should also be present. But I assume that you are absolutely normal apart from this symptom, as you have not mentioned in question.
- Other possibility which is common in a lot of people with this problem is that these symptoms may be Stress Related. Its generation is also typical. Some times under stress accidentally an individual may have some bodily symptoms like in your case irritation in throat. Even when stress or anxiety goes, the symptom don't go. Instead they start persisting, and individual become fixated to these symptoms. With time he start developing hypochondrical ideas about symptoms. He may think about symptoms again and again. He may think about having some serious illness but everything comes normal in investigations. With time he may start remaining anxious and low through out the day. Treatment by a team of doctors consisting of ENT doctor and Psychiatrist is needed in this case. Although usually patient will not not accept his symptoms as purely stress related so repeated investigations are needed to declared patient normal pathologically. Grossly the pictures you have uploaded don't show anything abnormal apart from minor scar of biopsy. So don't take undue stress as it will further potentiate the symptoms and then consequent stress. You will be alright in some time.
Management consists of-
- Proper reassurance about condition and relaxation therapy.
- Medicine like SSRI which are very useful in stress related hypochondrical ideas. Although these are anti depressant drugs but they are found to be very useful in such symptoms. Fluoxetine, Paroxetine are most useful.
- Use of lozenges to keep mouth moist is also needed in initial stages to get early relief.
- Repeated checks by a ENT doctor to reassure patient again and again that everything is normal.
Hope I cleared your query and If you have more questions you can ask again. I will be happy to answer you again.
Thanks
Dr. Seikhoo Bishnoi MD
(Psychiatrist)
Welcome to Health Care Magic
You are having problem of irritation or foreign body sensation in palate. You have visited multiple oral surgeons and also ENT doctors. Almost all of reports have came in normal range, biopsy also came normal. Later you have also developed throbbing feeling in right teeth but that was also normal under X-Ray. You have pain near right nostril also. On pressing you can hear sound also. But doctors fail to find anything abnormal. MR scanning was also normal, slight fluid in sinuses is a normal finding.
Now coming to your questions-
- It is not a minor salivary gland because all tests came normal and usually minor salivary glands present with inflammation with severe pain but they don't cause chronic pain. And also you have been declared normal by ENT as well as oral surgeon.
- It can be a nerve problem caused by biopsy. But you are having this problem before biopsy also. So as per my opinion this is not due to biopsy.
Then what is it?
There may be multiple possibilities as-
- One possibility is thyroid gland abnormality. I will advise you to go for thyroid function test (T3/T4/TSH). Abnormal thyroid gland may cause symptoms mimicking foreign body sensation in throat. But other symptoms of thyroid should also be present. But I assume that you are absolutely normal apart from this symptom, as you have not mentioned in question.
- Other possibility which is common in a lot of people with this problem is that these symptoms may be Stress Related. Its generation is also typical. Some times under stress accidentally an individual may have some bodily symptoms like in your case irritation in throat. Even when stress or anxiety goes, the symptom don't go. Instead they start persisting, and individual become fixated to these symptoms. With time he start developing hypochondrical ideas about symptoms. He may think about symptoms again and again. He may think about having some serious illness but everything comes normal in investigations. With time he may start remaining anxious and low through out the day. Treatment by a team of doctors consisting of ENT doctor and Psychiatrist is needed in this case. Although usually patient will not not accept his symptoms as purely stress related so repeated investigations are needed to declared patient normal pathologically. Grossly the pictures you have uploaded don't show anything abnormal apart from minor scar of biopsy. So don't take undue stress as it will further potentiate the symptoms and then consequent stress. You will be alright in some time.
Management consists of-
- Proper reassurance about condition and relaxation therapy.
- Medicine like SSRI which are very useful in stress related hypochondrical ideas. Although these are anti depressant drugs but they are found to be very useful in such symptoms. Fluoxetine, Paroxetine are most useful.
- Use of lozenges to keep mouth moist is also needed in initial stages to get early relief.
- Repeated checks by a ENT doctor to reassure patient again and again that everything is normal.
Hope I cleared your query and If you have more questions you can ask again. I will be happy to answer you again.
Thanks
Dr. Seikhoo Bishnoi MD
(Psychiatrist)
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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