I'm a 35 yr old male in NY and I had nose surgery 2 months ago. The surgeon made incisions in my mouth just above my canine's and I think it has made my upper lip permanently numb. Also, my left cheek is numb close to my nose. I've read about possible nerve damage and it seems that the numbness has not gotten any better for the past 3 weeks. Can I expect any additional nerve regeneration? Is there anything I can do to increase the healing time/outcome?
Upper Lip and Left Cheek Numbness After Rhinoplasty?
Doctor Answers 6
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.
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!
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!
In general, almost all noses are numb right after a rhinoplasty. In most cases its the tip that is numb, but this numbness can extend down to the upper lip, and in rare cases some of the teeth. It is also not uncommon that one side of the nose is more numb than the other. There are nerves that are cut and stretched during a rhinoplasty, and it takes a long time for those nerves to start working again. This is true of an open as well as closed rhinoplasty, although it tends to be more extensive in open rhinoplasty. This could also be more extensive if a septoplasty is performed at the same time. This, along with the swelling, gives you a stiff, plastic type feel, and can give you an odd smile. However, the nerves will start working and again, and your nose stiffness will go away with time. This takes in most cases months, but can take years in rare cases. Extremely rarely, the numbness is permanent, although I have never seen such as case.
Best Wishes,
Pablo Prichard, MD
Best Wishes,
Pablo Prichard, MD
Web reference: http://www.aaaplasticsurgery.com/photo-gallery/details.cfm?ID=285&StartRow=11
Both problems are very rare after rhinoplasty, especially the cheek numbness. I agree that it does sound like a nerve injury. Sensation can improve for another 3-4 months. Continue to visit your surgeon to document your progress.
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Numbness of upper lip and cheek after rhinoplasty is not common. It should improve over the next few weeks-if not see your surgeon since he knows what he did in the way of surgery.
Upper lip numbness can occur with dissection along the lower, anterior (front) section of the columella during Rhinoplasty. As far as the cheek numbness is concerned, I'm unsure why you'd have an incision in the canine fossa for a Rhinoplasty as this is typically reserved for a Cheek Augmentation with Cheek Implants or a Buccal fat pad removal. This approach can rarely cause numbness from injury to the infra-orbital nerve. You might want to discuss this with your Rhinoplasty Surgeon for further clarification and recommendations.
Web reference: http://www.drfpalmer.com
There are a variety of different techniques that can be used during the rhinoplasty procedure. If aggressive tip work is necessary along with grafting then necessarily more dissection is required. I've noticed specifically that the nasal tip may be numb and stiff for up to 6 months. I've also seen the ocassional pain on smiling if I had to resect or divide a certain muscle that tethers the upper lip to the nose. In terms of overt lip or cheek numbness, I have not experienced this in my postoperative patients. That being said, numbness and tingling may last for quite some time but full sensation almost always returns. Things to be reassured by are what we call paresthesias (tingling/electric shock sensations) and itching. These two sensations usually hearald nerve regeneration. Hope this helps!!
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.
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