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Suggest Treatment For Lower Lip Paresthesia And Burning Lips
Question: Hello
49 yr woman with lower lip paresthesia, burning lips.
I have a sudden onset of a very distressing and worrisome strange facial nerve issue. Two weeks ago, I became aware of a faint tingling or buzzing of my lower center lip- almost as if a spider web or tickling hair was on the lip, but of course was not. It has progressed over the last two weeks to a definite tingling. But not pain. I cannot find an exact trigger; it tingles whenever I chew, speak, "pop my lips. It does not if I lock my jaw and speak without moving it. or if I am quiet. There is no pain at night when sleeping. There is a definite spot on my chin that I can tap and reproduce the tingling. I am aware that this corresponds to the location of the "mental nerve." I am aware of trigeminal neuralgia-- both typical and atypical- but it doesn't correspond to either the lancing or constant pain-- just this constant tingling. And a sense now of my lips being almost sunburned.
The only things I can think of-- I had a number of years ago, a misdiagnosed very mild case of the shingles on my face with hardly a lesion. This around the jawline and there was pain- I did fear TGN then, but it just didn't match up. I did have two- what I thought were pimples-- one above the upper lip on the right side, and then a larger lesion on the lower left chin-- it turned into a bit of an infected (whitehead) painful pimple. The location seems to correspond on the area when if I can tap- I can reproduce the tingling. I have wondered about-- could the pimple have turned into an infection that affected the nerve? Could this be a return of shingles? But shingles do not develop whiteheads, do they? There's lots on line about mental nerve paresthesia related to recent dental work, but I have had none. Other causes point to a malignancy, which of course scares me terribly. I do have a history of breast cancer, but with no metastasis and going on 15 years now. I am checked out every 6 months.
I have had very few dental issues, but was diagnosed with lichen planus 2 years ago- this determined by biopsy. It has actually improved greatly, so I'm not sure if this figures in at all or not. Some of this matches up to "Burning Mouth Syndrome"-- but my tongue is fine and not hurting. ?
I am really not sure where to turn. I do have an oral surgeon- I thought this might be the best place to start? Or a neurologist...though terribly hard to get into. I know there are greater problems, but this is really bothering me, worrying me and I'm terribly worried that it might progress to something else. I sounds so bizarre that I'm actually really embarrassed to write all this. Was wondering if I might receive some kind advice on what this might be and where to turn.
Thank you XXXXXXX
49 yr woman with lower lip paresthesia, burning lips.
I have a sudden onset of a very distressing and worrisome strange facial nerve issue. Two weeks ago, I became aware of a faint tingling or buzzing of my lower center lip- almost as if a spider web or tickling hair was on the lip, but of course was not. It has progressed over the last two weeks to a definite tingling. But not pain. I cannot find an exact trigger; it tingles whenever I chew, speak, "pop my lips. It does not if I lock my jaw and speak without moving it. or if I am quiet. There is no pain at night when sleeping. There is a definite spot on my chin that I can tap and reproduce the tingling. I am aware that this corresponds to the location of the "mental nerve." I am aware of trigeminal neuralgia-- both typical and atypical- but it doesn't correspond to either the lancing or constant pain-- just this constant tingling. And a sense now of my lips being almost sunburned.
The only things I can think of-- I had a number of years ago, a misdiagnosed very mild case of the shingles on my face with hardly a lesion. This around the jawline and there was pain- I did fear TGN then, but it just didn't match up. I did have two- what I thought were pimples-- one above the upper lip on the right side, and then a larger lesion on the lower left chin-- it turned into a bit of an infected (whitehead) painful pimple. The location seems to correspond on the area when if I can tap- I can reproduce the tingling. I have wondered about-- could the pimple have turned into an infection that affected the nerve? Could this be a return of shingles? But shingles do not develop whiteheads, do they? There's lots on line about mental nerve paresthesia related to recent dental work, but I have had none. Other causes point to a malignancy, which of course scares me terribly. I do have a history of breast cancer, but with no metastasis and going on 15 years now. I am checked out every 6 months.
I have had very few dental issues, but was diagnosed with lichen planus 2 years ago- this determined by biopsy. It has actually improved greatly, so I'm not sure if this figures in at all or not. Some of this matches up to "Burning Mouth Syndrome"-- but my tongue is fine and not hurting. ?
I am really not sure where to turn. I do have an oral surgeon- I thought this might be the best place to start? Or a neurologist...though terribly hard to get into. I know there are greater problems, but this is really bothering me, worrying me and I'm terribly worried that it might progress to something else. I sounds so bizarre that I'm actually really embarrassed to write all this. Was wondering if I might receive some kind advice on what this might be and where to turn.
Thank you XXXXXXX
Brief Answer:
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
Reading at the research you have done I must say you seem to have done most of the work yourself and most of the conclusions you draw are correct.
From a neurological point of view the localization of your symptoms excludes a central, brain related cause which would cause unilateral widespread manifestations.
The same goes for the main cranial nerves like the trigeminal nerve as its proximal involvement would affect a wider area in the face.
That leaves a more peripheral branch involvement like the mental nerves you mention. At times they can be the initial manifestation of a herpes simplex infection, but would be followed by skin manifestations soon later. As for herpes zoster I would say that distribution, lack of other signs makes it unlikely. Other peripheral neuropathies are also extremely unlikely to affect the mental nerve. Do not worry about the pimples infection in the past affecting the nerve, that is not the case.
So as you yourself mentioned some mandibular issue which would require a dentist or oral surgeon consult is advised. It doesn't have to be a malignancy as you fear, especially a metastasis after such a long time, other causes possible such as a cyst, infection etc.
If nothing turns out there is another cause, pretty common actually, which is anxiety. It can mimick many neurological manifestations, lip numbness being a common one. As bothering as it may be it's a harmless cause.
I remain at your disposal for other questions.
Read below
Detailed Answer:
I read your question carefully and I understand your concern.
Reading at the research you have done I must say you seem to have done most of the work yourself and most of the conclusions you draw are correct.
From a neurological point of view the localization of your symptoms excludes a central, brain related cause which would cause unilateral widespread manifestations.
The same goes for the main cranial nerves like the trigeminal nerve as its proximal involvement would affect a wider area in the face.
That leaves a more peripheral branch involvement like the mental nerves you mention. At times they can be the initial manifestation of a herpes simplex infection, but would be followed by skin manifestations soon later. As for herpes zoster I would say that distribution, lack of other signs makes it unlikely. Other peripheral neuropathies are also extremely unlikely to affect the mental nerve. Do not worry about the pimples infection in the past affecting the nerve, that is not the case.
So as you yourself mentioned some mandibular issue which would require a dentist or oral surgeon consult is advised. It doesn't have to be a malignancy as you fear, especially a metastasis after such a long time, other causes possible such as a cyst, infection etc.
If nothing turns out there is another cause, pretty common actually, which is anxiety. It can mimick many neurological manifestations, lip numbness being a common one. As bothering as it may be it's a harmless cause.
I remain at your disposal for other questions.
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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