question-icon

Hello: my problem started around 15 years ago. Went to

default
Posted on Fri, 22 Feb 2019
Question: Hello: my problem started around 15 years ago. Went to see my oral surgeon and he took a cone scan and asked if I was having any problems with my submandibular or jaw. I told him no but he scratched his head and said he was concerned but never went into detail with my husband and I. It was a day before we were leaving to head to Florida for summer vacation. Since that time things got worse. Four years ago I went back to same oral surgeon and he said he didn’t remember what he saw 15 years ago and since that time that converted the office record and radiology system to a new system and had no past records so was unable to review old records to find out what he saw.

Since this time I have spent the last 4 1/2 years seeing every specialist to find out what is causing my swelling, numbness and pressure in the left side of my face.

It started with swelling and major pressure in my jaw. From that point the swelling is so bad and now has moved to my cheek and my upper lip is now numb and looks like I have paralysis in my upper lip from the corner of my mouth to the center with the lip dropping.

My husband remembers that at our consultation 15 years ago the oral surgeon said something about vascular blockage but that’s about all he remembered.

Today, my condition is 10 times worse where the pressure feels like it is under my lower teeth and now my lower teeth feel like they are so tight and even have a hard time flossing my teeth from tightness. There is a substantial difference from the left side of my face to the right side as the swelling on the left can’t get any worse and I can’t handle the pressure anymore.

Please tell me what type of doctor I need to see as I am at the end of my rope and ready to give up.
doctor
Answered by Dr. Erion Spaho (1 hour later)
Brief Answer:
Imaging studies take an important role in your case.

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

I have read your query and here is my advice.

As a start, consultation with a Maxilofacial Surgeon is a good point to start your evaluation.

This in order to evaluate any problems with your salivary glands, and with the temporomandibular joint.

Diagnostic tests such as MRI with vascular protocol ( MRA ) and gadolinium enhancement of your face and brain, and a review from an experienced Radiologist also is a necessary step in achieving a correct diagnosis.

CT scan with thin cuts of your anterior cranial base also may be necessary.

Discuss with your primary care Doctor for these issues.

He can guide you through the process of consultations and examinations necessary for a correct 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
doctor
default
Follow up: Dr. Erion Spaho (1 hour later)
In the last 4 years I have had at a minimum 6 to 8 MRI’s and all they shows is swelling but nobody has ordered further testing or been able to diagnose. Have seen ENT, Maxial facial, neurologist, primary care with radiology with each of them and still no answers.

Can you please tell me the exact test that needs to be done to finally figure out what is causing the pressure, swelling and numbness please. I truly can’t take anymore.
doctor
Answered by Dr. Erion Spaho (4 hours later)
Brief Answer:
The biopsy is a possibility.

Detailed Answer:
Hello again.

Biopsy of the swelled tissue (it is necessary to provide more information about the location, characteristics, consistency etc) may be a useful diagnostic test.

It may be done under imaging guidance and assistance (Ultrasound for example) and the sample should be evaluated histopathologically.

I think this procedure should give valuable information about the diagnosis.

Hope this helps.

Feel free to discuss with me if you have further questions.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
Answered by
Dr.
Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3866 Questions

premium_optimized

The User accepted the expert's answer

Share on
Hello: my problem started around 15 years ago. Went to

Brief Answer: Imaging studies take an important role in your case. Detailed Answer: Hello and welcome to "Ask a Doctor " service. I have read your query and here is my advice. As a start, consultation with a Maxilofacial Surgeon is a good point to start your evaluation. This in order to evaluate any problems with your salivary glands, and with the temporomandibular joint. Diagnostic tests such as MRI with vascular protocol ( MRA ) and gadolinium enhancement of your face and brain, and a review from an experienced Radiologist also is a necessary step in achieving a correct diagnosis. CT scan with thin cuts of your anterior cranial base also may be necessary. Discuss with your primary care Doctor for these issues. He can guide you through the process of consultations and examinations necessary for a correct diagnosis. Hope you found the answer helpful. Let me know if I can assist you further.