Sunday, August 1, 2010

Neuropathy caused by Nose Surgery. It does happen!

Can a permanent neuropathic condition occur as a result of nose surgery?

Answer: YES.

After my second major revision nose surgery by a young inexperienced surgeon in Toronto, Ontario, i developed within 6 months time severe neuropathic pain all around the tip lobe and, columella regions. The pain was so excruciating it felt like someone was taking a scalpel to my nose and slashing it. Without proper medication the pain continues to intensify feeling like a ball of  intense fireworks going off all around the tip area. Tingling leading to burning sensation would precede or accompany the severe intense pain. Another phenomena in conjunction with this pain, is hyperesthesia and allodynia.  This means the pain could be triggered further, by light sensation to the nose by touch, blowing fan, cold temperature, rain, etc.. I finally realized normal pain medication doesn't take away the pain. The only thing that helped control the pain, was anti-convulsant pills such as neurontin (gabapentin) however even though that helped somewhat, my neurologist recommended Lyrica (Pregabalin). That worked far better then gabapentin and you don't have to take as many pills. It however does have side effects one being lack of concentration and making you lethargic.

So what may of caused this? The likely explanation in my opinion according to the operative report would be the combination of or the single result of performing one of the following: excessive removal of residual scar tissue around the tip which can contain nerve tissue, and/or injuring a nerve while dissecting along the floor of the septum in order to resect a small portion of the maxillary crest. Other factors may of been use of dull scalpel, re-opening incision over previous open surgery incision along columella, improper elevation of the S-STE and/or nerve impingement or division during closing of S-STE.  My reason for mentioning this is so you are aware of this as a future patient, and that surgeons should be aware of this as well, and will hopefully make future patients aware of this as a possible side effect from the surgery, even though its remote. In fact I am not aware of anyone else with this condition, however i have read forums where a couple people mentioned they experienced nerve pain after surgery, but they never mentioned they required to be medicated with special medications like i take, or that they have a permanent condition.  One very plausible explanation for my pain according to one reconstruction rhinoplasty surgeon  is that I developed Traumatic Neuroma as a result of the surgery.

What have I done for my neuropathic pain, besides taking medication?
I first had to do a lot of research. I discovered a site which i have linked on this blog, endthepain.org which is a great site about facial neuropathic pain.  The section about Trigeminal nerve pain explains how this pain works. It's atypical however in my case, i have pain on both sides of my nose. I've had CT Scan to rule out Trigeminal Condition caused by pressure on a nerve in the brain.  I have had temporary nerve blocks, at a pain clinic, i almost had radio pulsed frequency-sphenopalatine block done, but after the pain specialist  after many appointments told me that the freezing injection could cause permanent loss of sight, i backed down from going ahead with that procedure. In fact the pain clinic in my city never performed radio pulse frequency until i mentioned it to them that it has been used as a treatment elsewhere for facial neuropathic pain. I have had botox injection in my tip area's, cortisteroid Kenalog, and inside my nose a sphenopalatine and ethmoid freezing block. I've tried cold lidocaine ointment and gabapentin cream and hot cayenne ointment cream. None had worked. The injections may of worked temporarily, but even that was inconclusive.

http://www.mcvitamins.com/neuropathy.htm

http://www.painclinic.org/nervepain-posttraumaticneuropathy.htm

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