Hi Doctor! I Recently Asked Another Doctor In An Online

Posted on Thu, 29 Nov 2018

Question: Hi Doctor! I recently asked another doctor in an online forum mybquestion, and he indicated something about trigeminal neuralgia that made me a bit concerned, so I thought that maybe you could give me some reassurance:

I’m attaching an image of my CT scan report, as I had visited my doctor for left sided pain in my ear and upper teeth region. He gave meantibiotics and told me to use flonase. Can you please take a look and tell me if there’s anything to be concerned about...from what I can see, there doesn’t appear to be. When the other doctor answered he indicated that everything looked fine and he thought perhaps I should consider it being trigeminal neuralgia. I have had pain primarily just in my upper left teeth for quite a few months now and the dentist has done xrays and found nothing wrong. I also feel some milder pains and pressure in my left ear and have some soreness in my left neck, probably due to posture. I was actually thinking that if it wasn’t sinus related perhaps it could be TMJ disorder. Well, I mistakenly googled trigeminal neuralgia after the other doctor mentioned it and saw it can be caused by tumors, multiple sclerosis, etc. Do you think it could be trigeminal neuralgia and should I be worried about those causes? I had an MS scare fifteen years ago after having a c-section and experiencing parasthesias, and went to a neurologist who ran tests and MRIs. No specific lesions were found and he couldn’t definitely diagnose MS. I do have chronic fatigue and fibromyalgia, however, and nothing suggestive of MS has arisen over the past fifteen years. I just got worried when I googled trigeminal neuralgia and the mention of tumors and multiple sclerosis came up!

Answered by Dr. Dr. Erion Spaho (3 hours later)

Brief Answer:
Not a typical case of trigeminal neuralgia.

Detailed Answer:
Hello and welcome to "Ask a Doctor" service.

I have read your new query and here is my advice.

I examined the CT scan report too.

CT scan report indicates that there may be a degree of sinusitis, that's why your Doctor has prescribed the medications.

This CT scan is not appropriate in trigeminal neuralgia evaluation.

There is no TMJ dysfunction neither.

In my opinion, sinusitis may justify your symptoms, and I think that you should give time to the treatment to see the results.

Trigeminal neuralgia hallmark symptom is a throbbing short-lasting pain, not a continuous mild to moderate pain.

Even if it was trigeminal neuralgia, in most cases there is a neurovascular conflict that is causing it, only in very rare cases, a tumor may be the culprit.

If your Doctor really thinks that it may be trigeminal neuralgia, a brain MRI may be necessary to be sure for the diagnosis.

Hope you found the answer helpful.

Let me know if I can assist you further.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Erion Spaho (41 minutes later)

Hi Dr. Spaho....thank you for your kind and reassuring answer! I will actually be making an appt with my ENT for a follow up. One more theoretical question....would a tumor compressing on the trigeminal nerve most likely show up on a CT scan of the Maxillofacial structures, which is the CT scan which I just had...?

Answered by Dr. Dr. Erion Spaho (11 hours later)

Brief Answer:
Read below.

Detailed Answer:
Welcome back.

If the tumour was located on the bone structures where the trigeminal nerve passes, then the CT scan of the maxillofacial structures may reveal it.

Again, I don't think that there is a tumour that is causing your issues, anyway, if, in doubt, a brain MRI excludes with high accuracy regarding this possibility.

Hope I helped you.

Greetings.

Above answer was peer-reviewed by : Dr. Vaishalee Punj