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Dr. Phil, MD
Dr. Phil, MD, Medical Doctor
Category: Neurology
Satisfied Customers: 56575
Experience:  Medical Doctor Trained at a Top Academic Institution
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49 yr woman with lower lip paresthesia, burning lips. I have

Customer Question

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
Submitted: 2 years ago.
Category: Neurology
Expert:  Dr. Phil, MD replied 2 years ago.
Do you have any other medical problems?
Customer: replied 2 years ago.
I do have a history of breast cancer- diagnosed in 2000 and then a second primary in 2008. Both caught at Stage 1. Did go thru chemo and mastectomies. ER/PR- and no involved nodes or metastasis. I have had numerous bone and CT scans throughout the years, with no indication of mets. I am checked out every 6 mo, the last check just last month. Other than this-- Some dealings with Irritable Bowel Syndrome and did have my appendix out earlier this year. Otherwise, have been basically healthy- BP, bloodwork,healthy weight all good. I have had few dental issues. A few cavities when I was a kid, did need one cap, but have been issue free, other than the lichen planus I referenced.
Expert:  Dr. Phil, MD replied 2 years ago.

Thanks for this reply

Do you have any bumps or rashes consistent with shingles? have you looked closely?

The fact that it comes with chewing points towards TGN. You don't have lancinating pain but something this is the first sign then it progresses

Plus you seem more in tune with your body than most so you might be noticing it early

Your knowledge is excellent as well. are you a doctor or PA?