One Month Since my Nose and Cheek Surgery - Why is my Face Still Numb?

Question

I was shot in the face and had to have surgery to repair the fragments in my cheek and nose. The surgery was almost a month ago but the left side of my face is still numb. How long does the recovery take and when will the numbness go away?

Lewis Albert Andres, MD · Answer

Hello!  Thank you for your question!  Numbness after any surgical 
procedure is expected for several weeks to months following.  As the 
nerves to the area are traumatized and will then experience a temporary 
neuropraxia, a transient loss of nerve conduction.  This usually 
resolves over the next 6-12 weeks, but depending on the procedure 
performed, sometimes much longer.  Typically this should resolve by 1 
year.  As it goes past this date, the likelihood of the sensation 
returning is small.  However, it can take up to 2 years.  If no return 
from there, it is unlikely to return.  It should be discussed that 
persistent sensory changes may develop following any surgical 
procedure.   Given the traumatic incident for your case, it is possible that you may have persistent numbness, and or facial paralysis.  Only time will tell at this point.The usual signs of the nerves regenerating and neuropraxia
 resolving is itching, followed by a burning sensation and then 
occasional sharp, shock-like pains.  These will be normal to experience,
 and actually a promising sign.  Usually, normal sensation returns, but 
is is also possible to have decreased sensation or even increased 
sensation to the areas affected.  Re-educating nerves postoperatively is
 often helpful and will allow proper instruction for the affected 
sensory nerves - methods include using different textures to the 
affected areas when showering, bathing, applying lotion, etc.  If 
bothersome, there are some medications that may be helpful, including 
Neurontin for pain for hypersensitivity.  You can try various textures 
such as washcloths, loofahs, cotton sheets, etc.  Massaging the areas is
 also beneficial for the incision to make the finest scar possible.  The
 last place to regain the sensation will be directly adjacent to the 
incision/scar as the nerves will make its way from the periphery to this
 location.  If continual pain arises, evaluation is warranted.  After 
ruling out other causes, one rare explanation may be that a neuroma has 
developed and may require surgical excision.  This is very unlikely 
unless a large sensory nerve has been transected inadvertently during 
the procedure.  Hope that this helps!  Best wishes!

Ritu Chopra, MD · Answer

The way nerves heal is sort of mysterious.  They often get better, sometimes the improvement happens way down the line.  By the way, congratulations on surviving the injury.   You look pretty good, considering the injury.  Some people believe in electrical muscle stimulation to keep the muscle that the injured nerve serves alive and well.  For the infraorbital nerve, this would be the orbicularis oris, left upper lip.  Ask your doctor about it.

Sapna A. Patel, MD · Answer

After any major surgery, numbness is common and can take several months to go away. Typically, patients notice a burning/ itchy/ stinging sensation which is a sign that the nerves are growing back. Hardest thing is that it takes time. However, in your case, without knowing the details of your injury, there may have been damage to the nerve that supplies the face. The midface / cheek region is supplied by the infraorbital nerve which can be damaged easily with broken bones to face. There is not much that can be done differently but you check with the operating surgeon to see if they were able to identify the nerve or if they know whether it is intact.

Travis L. Shaw, MD · Answer

Chesapeake

	Numbness in the face after an injury can often be a challenging issue. From what you have written, it sounds as if you may have injured the infraorbital nerve. This nerve exits the skull from just under the bone of the eye socket and gives feeling to the majority of the middle face. 

	I have treated many patients with severe fractures of the bones in this area who had numbness in the middle of the face. Many of them had a good return of feeling by 6 months postop. So keep hope! Often repositioning the bones so the nerve is not pinched or removing bone can be helpful. 

	Keep a postive outlook, and how wonderful that you came through such a terrible ordeal. 

	Dr S

Michael Bowman, MD · Answer

Numbness after severe facial trauma like a gunshot wound is not uncommon, and may indeed get better.

	If you have not, this is certainly something to discuss with your surgeon.  He/she may know details which will help clarify your expectations.  One of the biggest questions is whether or not you had numbness in those areas after the injury, but before the surgical repair.   If you had lost sensation of those areas after the accident but before surgery, the loss is more likely to be permanent.  The main nerves which give sensation to the cheek exit the cheek bones below the eyes (infraorbital nerves).   If those nerves were severed by bullet fragments, they may not recover.

	However, surgery (or the trauma itself) in this area can often stretch or bruise the nerves, which makes them stop working temporarily.  Any surgery in the area of the infraorbital nerve can cause numbness.  As long as the nerve was not cut, sensation will usually come back, but could take 6-8 months.  This recovery of the nerve is usually heralded by tingling or other unusual sensations in the numb area.   

	Best wishes to a speedy recovery!

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