Treatment, symptoms, causes & diagnosis

Trigeminal neuralgia is a rare nerve disorder that causes sudden, sharp, and severe pain, usually on one side of the face. People describe it as a shooting, electric shock-like pain in the teeth, jaw, gums, and other areas. Prescription drugs may help manage it.

Trigeminal neuralgia is also known as tic douloureux. Some describe it as “the most excruciating pain known to humankind.” The pain is typically focused on the lower face and jaw, although it sometimes affects other areas of the face, such as around the nose and above the eyes.

Trigeminal neuralgia is caused by irritation of the trigeminal nerve, which starts at the ear and branches out to the forehead, cheeks, and lower jaw. Pain from this disorder is usually limited to one side of the face and can be triggered by actions such as eating or brushing teeth.

This article discusses what trigeminal neuralgia is as well as its symptoms, treatment, diagnosis, and causes. Read on to learn whether the disorder is hereditary and if it can be prevented.

Trigeminal neuralgia is a chronic pain disorder that affects the trigeminal nerve, also known as the fifth cranial nerve. It is a type of neuropathic pain, which is a pain associated with nerve lesions or injuries.

The most typical form of trigeminal neuralgia is type 1, or TN1, which causes attacks of sudden and severe facial pain. The pain can last between seconds and minutes. Attacks can occur one after another in cycles lasting as long as 2 hours.

Type 2, or TN2, is the atypical form of the disorder and is characterized by a constant pain that people have described as aching, stabbing, and burning at a lower intensity than TN1. A person may experience both types of pain, sometimes at the same time, which can be incapacitating.

The trigeminal nerve is one of 12 pairs of nerves attached to the brain. It has three branches that communicate sensations from the top, middle, and lower areas of the face, as well as the oral cavity, to the brain. They are:

• the upper ophthalmic branch, which supplies sensation to:
  • most of the scalp
  • front of the head
  • forehead
• the middle maxillary branch, which supplies sensation to the:
  • upper jaw
  • cheeks
  • teeth
  • gums
  • top lip
  • sides of the nose
• the lower mandibular branch, which stimulates the:
  • lower jaw
  • bottom lip
  • teeth
  • gums

Trigeminal neuralgia can affect more than one nerve branch, but it usually only affects one side of the face. Rarely, the disorder may affect both sides of the face, which is called bilateral trigeminal neuralgia.

Someone with trigeminal neuralgia may have one or more of the following symptoms:

• sudden attacks of severe, shooting pain in the face that last between seconds to around 2 minutes
• pain affecting one side of the face
• excruciating pain in the lower or upper jaw, teeth, or cheek, or — more uncommonly — in the forehead or eye
• a sense that an attack of pain is about to happen, although they typically start suddenly
• a slight ache or burning sensation after the most severe pain has subsided
• regular episodes of facial pain for days, weeks, or months at a time, which may disappear and not return for months or years

Trigeminal neuralgia can sometimes be progressive, with fewer pain-free days as time goes on.

Pain attacks in trigeminal neuralgia can be triggered by:

• eating
• drinking
• brushing teeth
• talking
• wind blowing across the face
• touching the face, such as when shaving

Atypical trigeminal neuralgia

Atypical trigeminal neuralgia can be harder to diagnose than TN1. People often describe it as aching or burning rather than stabbing or shocking pain. Pain is usually less severe than with typical trigeminal neuralgia.

Similarly to trigeminal neuralgia, temporomandibular joint (TMJ) disorders can also cause facial pain and headaches. However, these conditions are different in nature.

The TMJ is the jaw joint. A number of things can cause this joint to become stiff or painful. Examples include teeth grinding or clenching (bruxism), an uneven bite, or an injury. However, the symptoms of a TMJ disorder are unlikely to be as sudden or severe as trigeminal neuralgia.

TMJ disorders typically cause:

• pain and stiffness in the jaw
• pain around the ear and temples
• popping or clicking sounds when opening the mouth
• a jaw locking sensation

Unlike trigeminal neuralgia, over-the-counter (OTC) pain medications, such as ibuprofen, will often help relieve the symptoms of a TMJ disorder.

Trigeminal neuralgia is often diagnosed by a dentist, as people often report pain in their teeth and jaw. A dentist may ask questions about the symptoms and perform a dental X-ray to rule out other, more common causes of facial pain, such as:

• infection
• TMJ disorder
• cluster headaches
• postherpetic neuralgia, which occurs after someone has shingles

A medical professional will usually diagnose the disorder based on a description of the pain and symptoms once they have ruled out other possibilities. Next, a doctor will typically order an MRI scan to see if there is an underlying cause for the condition.

Trigeminal neuralgia can be primary or secondary. If it is secondary, it means there is another condition that is causing the pain. This could be:

• a cyst
• facial injury
• previous surgery
• multiple sclerosis (MS), or another condition that damages the protective sheath around nerves
• in rare cases, a tumor

An MRI scan may be able to detect signs of some of these underlying causes.

Primary trigeminal neuralgia is not caused by another condition. Often, it happens because a blood vessel is pressing on a nerve. An MRI can sometimes pick up on this, but not always. In most cases, the cause of trigeminal neuralgia is unknown.

Sometimes, trigeminal neuralgia can be due to an injury to the trigeminal nerve.

It is unclear if trigeminal neuralgia is related to genetics. A 2021 review states that around 1–2% people with trigeminal neuralgia have a relative with the condition. However, because so few people have the condition, it is difficult to know how influential genetics might be.

Most people with this condition do not have family members with trigeminal neuralgia.

There are currently no guidelines on preventing the development of trigeminal neuralgia. However, people who already have the condition may be able to prevent attacks and pain by keeping track of potential triggers and avoiding them.

Trigeminal neuralgia is a nerve disorder that affects the face. It causes sudden and severe pain in areas of the face, usually only on one side.

Treatment usually consists of medication such as anticonvulsants or surgery such as rhizotomy or neurectomy. Identifying and avoiding triggers may help with reducing attacks.

Living with a chronic pain condition may be difficult for some individuals. People with trigeminal neuralgia may need support for their physical and mental health.

Is Your Pain Being Caused By the Trigeminal Nerve?

Severe facial pain is immediately disruptive to everyday life. And unless you were in a recent accident, you may not have any clue what’s causing sudden and significant pain over one or more areas of your face.The trigeminal nerve is one of the most common sources of chronic facial pain on one side of the face. At first, many people mistake trigeminal pain for a dental abscess or a migraine condition. But if you’ve been living with facial pain for more than six months, your dental examinations are all clear, and traditional pain medications aren’t effective, you may be suffering from neuropathic pain stemming from the trigeminal nerve.

Keep reading to learn signs and symptoms that indicate the trigeminal nerve is causing your chronic pain.

What Is the Trigeminal Nerve?

The trigeminal nerve is a cranial nerve that carries sensations from the face to your brain. It’s actually a pair of nerves — one on each side of the face. Each nerve has three branches that control sensations in different areas of the face and mouth.

• Ophthalmic branch: eye, upper eyelid and forehead
• Maxillary branch: lower eyelid, cheek, nostril, upper lip and upper gum
• Mandibular branch: jaw, lower lip and lower gum

Trigeminal neuralgia (TN) — also called tic douloureux — is a chronic pain condition that develops when the trigeminal nerve becomes injured, damaged or compressed. In many cases, TN occurs when a nearby blood vessel presses against the nerve and causes pressure, irritation and malfunction. TN can also develop with age (it’s most common in women over 50), a tumor, facial trauma, a stroke, or as a result of multiple sclerosis.

TN is one of the most painful medical conditions ever recorded. Cycles of sharp, stabbing, burning or electric facial pain come and go spontaneously or as a result of activities that wouldn’t normally cause pain. Many people with TN are afraid to socialize and go out because they live in constant anticipation of the next attack. It can be a physically and mentally crippling condition that leads to severe depression, anxiety and social isolation.

Luckily, there are treatments available to help reduce pain and help people with TN regain their quality of life. Read on to learn common signs and symptoms of TN and the treatments available.

7 Signs and Symptoms of Trigeminal Neuralgia (TN)

Trigeminal neuralgia typically causes distinct symptoms that meet one of more of these patterns:

1. Severe bursts of facial pain. For many people with TN, episodes of pain erupt spontaneously, with no known trigger. The pain is severe, sharp, burning, stabbing or electric, and episodes can last anywhere from several seconds to several minutes before receding.
2. Periods of remission. Many people experience multiple attacks of pain over several hours, days, weeks or months, and then the pain goes into remission. Periods of remission can last anywhere from a few days to a few years.
3. Pain that is triggered by normal, daily activities. Sometimes, facial pain is triggered by a specific motion or activity. Common activities that trigger TN include: touching your face, eating, drinking, shaving, applying makeup, washing your face, brushing your teeth, talking, smiling, blowing your nose, or the wind hitting your face.
4. One-sided facial pain. TN typically only affects one side of the face and jaw. It rarely occurs on both sides of the face.
5. A burning sensation or facial numbness. Sometimes, a TN flare-up may be preceded by persistent aching, burning, tingling or facial numbness over the affected area of the face.
6. Pain episodes that worsen over time.  Over time, episodes of pain usually worsen in frequency, duration and severity. Pain attacks last longer and there are fewer, shorter periods of remission between attacks.
7. Muscle spasms. Muscle spasms or facial twitching may occur after an episode of pain.

How Is Chronic TN Treated?

Trigeminal neuralgia is a chronic, progressive condition that’s usually managed with medications and surgery.

• Medications. Anticonvulsants and muscle relaxants are first-line treatments prescribed to block pain signals from reaching the brain. These medications are very strong and may produce side effects like dizziness, confusion, double vision, drowsiness and nausea. Aside from side effects, there are several downsides to anticonvulsants and muscle relaxants. Many people require high doses for effective treatment, but higher dosages run the risk of producing more side effects. Additionally, while these medications can be effective at first, TN symptoms often become resistant to medications over time.

Because medications often become less effective over time, surgery is the treatment of choice for many people suffering from TN. There are multiple procedures used to reduce pain and symptoms, with varying levels of success.

• Microvascular decompression. During the procedure, the blood vessel pressing against the trigeminal nerve is moved out of the way and an insulating cushion is placed between the nerve and the blood vessel. This surgery is the most invasive treatment for TN, but also the most effective for long-lasting pain relief.
• Rhizotomy. There are several types of rhizotomies, but all involve destroying the nerve fibers that carry pain signals to the brain. Rhizotomy procedures are minimally invasive and performed on an outpatient basis. There’s a chance the nerve fibers will regrow after a few years and cause pain again, but rhizotomy procedures can be repeated if necessary.
• Radiosurgery (Gamma Knife).  During the procedure, radiation is used to damage the trigeminal nerve and prevent the transmission of pain signals. It’s the least invasive procedure to treat TN. If there’s a recurrence of pain after a few years, the procedure can be repeated.

Over-the-counter pain medications are typically not effective for managing trigeminal nerve pain.

Where to Turn If Traditional Treatment Is Ineffective

As we’ve mentioned above, some people with TN stop responding well to medications and surgery isn’t always effective for long-lasting relief. Is there an alternative option for people suffering from excruciating trigeminal neuralgia?

At Radiant Pain Relief Centres, we perform scrambler therapy to help people living with chronic, debilitating pain. The procedure uses cutaneous (skin surface) electrostimulation to retrain the brain to accept non-pain, non-threat information. Our FDA-cleared device digitally creates and sends synthetic, rapidly changing, non-pain nerve transmissions across the same nerve fibers sending pain signals. Over the course of several treatment sessions, the brain will come to accept the new non-pain, non-threat signals as the correct message. Scrambler therapy helps restore the brain to a healthy perception of pain and provides long-lasting relief for the majority of our patients.

Scrambler therapy has proven effective for people suffering from chronic, neuropathic pain that hasn’t responded to traditional treatments. The therapy is non-invasive and quite safe.

Radiant Pain Relief Centres Treats Chronic Pain

Radiant Pain Relief Centres exclusively performs scrambler therapy for the treatment of chronic pain. We treat a wide range of chronic conditions that affect multiple body parts. Because of our exclusivity, our center has a level of experience and expertise you won’t find anywhere else. On average, our patients experience an 84% reduction in pain, and more than 90% of our patients conclude therapy with a pain score of zero or near zero.

We have a start-to-finish comprehensive care model and payment plans that make scrambler therapy accessible and affordable for everyone with chronic pain. We offer a free evaluation and free treatment session so that you can make an informed decision on whether or not this treatment is right for you before you invest.

It’s time to take the leap and find lasting relief for your chronic pain. Call us today or submit a contact form for more information.

Pain in the lip – causes, diagnosis and treatment

Pain in the lip is observed in various types of cheilitis, herpes, traumatic injuries, atypical form of lichen planus of the oral cavity, trigeminal neuralgia, lip cancer. In the absence of significant skin defects, it is often burning, often combined with itching, with the appearance of cracks – sore, with neurological pathology – extremely intense, shooting. The cause is established on the basis of examination data, instrumental and laboratory methods. Treatment includes anti-inflammatory, anti-allergic, antipruritic local agents, immunomodulators, regeneration stimulants, other drugs of general action, physiotherapy techniques. Surgery is sometimes recommended.

Why the lip hurts

Cheilitis

Cheilitis is an extensive group of inflammatory diseases of the mucous membranes and skin of the lips. Occur primarily or develop against the background of other pathologies. Typical signs are pain and burning in the lips when eating, opening the mouth, peeling, hyperemia, the appearance of cracks, crusts, bleeding ulcers. The symptom can be provoked by the following types of cheilitis:

• Exfoliative. Formed against the background of neurotic disorders, more often detected in women. It affects the red border without involving the mucous membrane, corners of the mouth, areas adjacent to the skin of the chin and nasolabial triangle. Manifested by burning, dry lips, the formation of scales. The pain is more pronounced with the exudative form, also accompanied by swelling of the lips.
• Glandular. Diagnosed in people with malformations and acquired diseases of the minor salivary glands, caries, periodontal disease. The lower lip is more commonly affected. Initially, a slight dryness is found, which is subsequently replaced by painful erosions, deep bleeding and weeping cracks.
• Contact allergic. Potentiated by cosmetics, formed by the habit of holding various objects in the mouth, developed in people of certain professions (for example, in musicians playing wind instruments). Severe itching, redness, swelling of the lips prevail. The resulting bubbles open with the formation of painful erosions and cracks.
• Meteorological. Occurs under the influence of sunlight, less often – wind and cold. The exudative form is accompanied by burning, itching, the appearance of small vesicles, in place of which painful erosions remain. For the dry form, the presence of erosive defects is uncharacteristic, the pain appears on the background of burning, dry lips. There is a risk of developing precancerous diseases, malignancy.
• Atopic. Diagnosed in patients with neurodermatitis and atopic dermatitis. Disturbed by hyperemia, peeling, itching. Pain occurs when cracks form in the corners of the mouth. These manifestations are complemented by peeling, dryness of the face.
• Hypovitaminosis. Provoked by a lack of B vitamins, especially B2. The skin of the lips is dry, hyperemic, covered with small vertical cracks that hurt and bleed. The mucosa is reddened, slightly swollen. The tongue is enlarged.

Herpes

The red border of the lips and the corners of the mouth are the favorite localizations of herpes simplex. The patient feels burning, tingling, bursting. In the affected area, rashes are formed, which are an accumulation of small bubbles. As the changes progress, unpleasant symptoms increase, pain syndrome joins them. Then the bubbles are opened individually or previously merged into one or more multi-chamber bubbles. In their place, irregularly shaped erosions appear, painful to the touch, movements of the lips.

Oral lichen planus

Involvement of the lip (primarily the upper lip) is a rare atypical form of the disease. On the skin and mucous membranes, papules, plaques or ulcers, erosive defects of irregular configuration, covered with a fibrinous coating, are found. The pain syndrome is most pronounced in the presence of ulcers, accompanied by burning. Several forms of lichen planus often combine with each other or transform into one another, so lesions can be present not only on the lips, but also on the gums, tongue, and oral mucosa.

Pain in the lip

Traumatic injuries

Acute damage to the mucous or skin of the lip occurs as a result of injury by foreign objects, biting. It occurs quite rarely. It is manifested by the formation of a hematoma or an erosive defect. The pain persists for 1-3 days. With secondary infection, erosion transforms into an ulcer, the surrounding tissues swell, and the pain increases.

Chronic trauma is possible when the sharp edges of the anterior carious teeth are damaged. It proceeds with swelling, slight soreness, a feeling of discomfort. With prolonged injury, an ulcer forms. Perhaps the development of a local or widespread inflammatory process with increased pain, swelling, the appearance of purulent discharge.

Bruising of the lip usually results from fighting. Children often develop as a result of falls. They are characterized by rapidly increasing edema, may be accompanied by abrasions of the mucous membrane due to sharp contact with the teeth. Pain sensations are pronounced in the first minutes after the injury, and then gradually subside. Recovery occurs after 1-2 weeks. Wounds of the lips are often torn, manifested by acute sore pain, bleeding.

Trigeminal neuralgia

Multiple shooting intense pain impulses, resembling electric shock, are observed when the 2nd branch of the trigeminal nerve is involved. The pain extends to the upper lip, upper cheek, upper jaw. With the defeat of the 3rd branch, similar sensations occur in the area of ​​the lower lip, chin, lower jaw, lower cheek. The duration of an attack of neuralgia ranges from a few seconds to 2 minutes.

Cancer of the lip

In the early stages of lip cancer, there is no symptom. A painless, sometimes itchy sore or area of ​​induration forms on the lip (often the lower one). The pain appears with the germination of nearby tissues. Becomes constant, progresses, reaches considerable intensity. On examination, an ulcer with uneven edges or a node in the form of a wart or cauliflower inflorescence, covered with cracks and sores, is revealed.

Diagnosis

The cause of the symptom is determined by the dentist or maxillofacial surgeon. If the pain is neuropathic, a consultation with a neurologist is required, and if malignant neoplasia is suspected, an examination by an oncologist is required. With cheilitis, herpes simplex and traumatic injuries, the basis of diagnosis is complaints and examination data, additional studies are not prescribed or are carried out in a minimal amount. Neuralgia is confirmed on the basis of the clinical picture, the results of palpation of trigger points. Taking into account the nature of the disease, the examination plan includes:

• Cytological or histological examination. It is the basic method for verifying the diagnosis of lip cancer, lichen planus. In patients with cheilitis, according to indications, it is performed for differentiation with other pathologies. With herpes simplex, it is carried out if necessary to identify the virus.
• Other laboratory tests. Patients with cheilitis are prescribed a biochemical blood test to identify metabolic disorders and possible provoking diseases. With herpes, PCR, RIF, ELISA are performed. In patients with lichen planus, accumulation of immunoglobulins M is detected by direct immunofluorescence.
• Imaging techniques . The presence of lichen is indicated by a yellowish-orange glow when examining smears-imprints under a Wood’s lamp. Patients with cancer are shown ultrasound of the lips, radiography of the lower jaw. With signs of metastasis, an extended examination is performed, including ultrasound of the OBP, chest x-rays.

Visual examination of the lips

Treatment

Conservative therapy

The list of therapeutic measures is determined taking into account the characteristics of the pathology that causes pain in the lip:

• Cheilitis . Exclude or minimize provocative factors (dental pathologies, meteorological effects, contact with cosmetics), treat neurotic disorders. Apply anti-inflammatory, antipruritic, antiallergic ointments (including hormonal), protective creams, immunocorrectors, antiviral agents of general action.
• Herpes . The tendency to recurrence necessitates complex therapy aimed at restoring immunity. Antiviral drugs are used in the first 5-7 days of illness, subsequently immunomodulators, recombinant alpha-interferons are prescribed. Vaccination is recommended after 1-2 months.
• Lichen planus . To eliminate inflammation and pain in ulcerative defects, topical corticosteroids, anesthesia with local anesthetics, drugs to stimulate regeneration are indicated. To prevent fungal infections in the treatment of steroids, oral antimycotic agents are prescribed. With neurotic disorders, a sedative is required, with an allergic predisposition – hyposensitizing, with immunodeficiencies – immunomodulatory therapy.
• Injuries . Patients with chronic injuries need treatment of carious teeth to eliminate the traumatic factor. In other cases, in the absence of wounds requiring surgical treatment, a sparing diet is advised, cold to reduce swelling, then dry heat to accelerate resorption.
• Trigeminal neuralgia . Therapy is carried out using anticonvulsants, antispasmodics, antihistamines. Effective therapeutic blockade with glucocorticoids, physiotherapy procedures: ultraphonophoresis with hydrocortisone, galvanization with novocaine.
• Lip cancer . At stage 1, in some cases, radiotherapy is used as the main method of treatment. For patients with advanced stages, radiotherapy and chemotherapy are prescribed in the pre- and postoperative period or carried out as part of palliative care.

Surgical treatment

Operative methods for pain in the lip are used infrequently. Exceptions are open injuries, oncological diseases. With fresh wounds, PST of the wound of the maxillofacial region is necessary. Neoplasms are excised, according to the indications, the Vanach operation, the Krail operation, and other interventions involving the removal of regional lymph nodes are performed. Patients with damage to the branches of the trigeminal nerve with persistent neuralgia can be recommended methods of stereotactic radiosurgery, percutaneous radiofrequency destruction.

Pain in the lip – causes, diagnosis and treatment

Pain in the lip is observed in various types of cheilitis, herpes, traumatic injuries, atypical form of lichen planus of the oral cavity, trigeminal neuralgia, lip cancer. In the absence of significant skin defects, it is often burning, often combined with itching, with the appearance of cracks – sore, with neurological pathology – extremely intense, shooting. The cause is established on the basis of examination data, instrumental and laboratory methods. Treatment includes anti-inflammatory, anti-allergic, antipruritic local agents, immunomodulators, regeneration stimulants, other drugs of general action, physiotherapy techniques. Surgery is sometimes recommended.

Why the lip hurts

Cheilitis

Cheilitis is an extensive group of inflammatory diseases of the mucous membranes and skin of the lips. Occur primarily or develop against the background of other pathologies. Typical signs are pain and burning in the lips when eating, opening the mouth, peeling, hyperemia, the appearance of cracks, crusts, bleeding ulcers. The symptom can be provoked by the following types of cheilitis:

• Exfoliative. Formed against the background of neurotic disorders, more often detected in women. It affects the red border without involving the mucous membrane, corners of the mouth, areas adjacent to the skin of the chin and nasolabial triangle. Manifested by burning, dry lips, the formation of scales. The pain is more pronounced with the exudative form, also accompanied by swelling of the lips.
• Glandular. Diagnosed in people with malformations and acquired diseases of the minor salivary glands, caries, periodontal disease. The lower lip is more commonly affected. Initially, a slight dryness is found, which is subsequently replaced by painful erosions, deep bleeding and weeping cracks.
• Contact allergic. Potentiated by cosmetics, formed by the habit of holding various objects in the mouth, developed in people of certain professions (for example, in musicians playing wind instruments). Severe itching, redness, swelling of the lips prevail. The resulting bubbles open with the formation of painful erosions and cracks.
• Meteorological. Occurs under the influence of sunlight, less often – wind and cold. The exudative form is accompanied by burning, itching, the appearance of small vesicles, in place of which painful erosions remain. For the dry form, the presence of erosive defects is uncharacteristic, the pain appears on the background of burning, dry lips. There is a risk of developing precancerous diseases, malignancy.
• Atopic. Diagnosed in patients with neurodermatitis and atopic dermatitis. Disturbed by hyperemia, peeling, itching. Pain occurs when cracks form in the corners of the mouth. These manifestations are complemented by peeling, dryness of the face.
• Hypovitaminosis. Provoked by a lack of B vitamins, especially B2. The skin of the lips is dry, hyperemic, covered with small vertical cracks that hurt and bleed. The mucosa is reddened, slightly swollen. The tongue is enlarged.

Herpes

The red border of the lips and the corners of the mouth are the favorite localizations of herpes simplex. The patient feels burning, tingling, bursting. In the affected area, rashes are formed, which are an accumulation of small bubbles. As the changes progress, unpleasant symptoms increase, pain syndrome joins them. Then the bubbles are opened individually or previously merged into one or more multi-chamber bubbles. In their place, irregularly shaped erosions appear, painful to the touch, movements of the lips.

Oral lichen planus

Involvement of the lip (primarily the upper lip) is a rare atypical form of the disease. On the skin and mucous membranes, papules, plaques or ulcers, erosive defects of irregular configuration, covered with a fibrinous coating, are found. The pain syndrome is most pronounced in the presence of ulcers, accompanied by burning. Several forms of lichen planus often combine with each other or transform into one another, so lesions can be present not only on the lips, but also on the gums, tongue, and oral mucosa.

Pain in the lip

Traumatic injuries

Acute damage to the mucous or skin of the lip occurs as a result of injury by foreign objects, biting. It occurs quite rarely. It is manifested by the formation of a hematoma or an erosive defect. The pain persists for 1-3 days. With secondary infection, erosion transforms into an ulcer, the surrounding tissues swell, and the pain increases.

Chronic trauma is possible when the sharp edges of the anterior carious teeth are damaged. It proceeds with swelling, slight soreness, a feeling of discomfort. With prolonged injury, an ulcer forms. Perhaps the development of a local or widespread inflammatory process with increased pain, swelling, the appearance of purulent discharge.

Bruising of the lip usually results from fighting. Children often develop as a result of falls. They are characterized by rapidly increasing edema, may be accompanied by abrasions of the mucous membrane due to sharp contact with the teeth. Pain sensations are pronounced in the first minutes after the injury, and then gradually subside. Recovery occurs after 1-2 weeks. Wounds of the lips are often torn, manifested by acute sore pain, bleeding.

Trigeminal neuralgia

Multiple shooting intense pain impulses, resembling electric shock, are observed when the 2nd branch of the trigeminal nerve is involved. The pain extends to the upper lip, upper cheek, upper jaw. With the defeat of the 3rd branch, similar sensations occur in the area of ​​the lower lip, chin, lower jaw, lower cheek. The duration of an attack of neuralgia ranges from a few seconds to 2 minutes.

Cancer of the lip

In the early stages of lip cancer, there is no symptom. A painless, sometimes itchy sore or area of ​​induration forms on the lip (often the lower one). The pain appears with the germination of nearby tissues. Becomes constant, progresses, reaches considerable intensity. On examination, an ulcer with uneven edges or a node in the form of a wart or cauliflower inflorescence, covered with cracks and sores, is revealed.

Diagnosis

The cause of the symptom is determined by the dentist or maxillofacial surgeon. If the pain is neuropathic, a consultation with a neurologist is required, and if malignant neoplasia is suspected, an examination by an oncologist is required. With cheilitis, herpes simplex and traumatic injuries, the basis of diagnosis is complaints and examination data, additional studies are not prescribed or are carried out in a minimal amount. Neuralgia is confirmed on the basis of the clinical picture, the results of palpation of trigger points. Taking into account the nature of the disease, the examination plan includes:

• Cytological or histological examination. It is the basic method for verifying the diagnosis of lip cancer, lichen planus. In patients with cheilitis, according to indications, it is performed for differentiation with other pathologies. With herpes simplex, it is carried out if necessary to identify the virus.
• Other laboratory tests. Patients with cheilitis are prescribed a biochemical blood test to identify metabolic disorders and possible provoking diseases. With herpes, PCR, RIF, ELISA are performed. In patients with lichen planus, accumulation of immunoglobulins M is detected by direct immunofluorescence.
• Imaging techniques . The presence of lichen is indicated by a yellowish-orange glow when examining smears-imprints under a Wood’s lamp. Patients with cancer are shown ultrasound of the lips, radiography of the lower jaw. With signs of metastasis, an extended examination is performed, including ultrasound of the OBP, chest x-rays.

Visual examination of the lips

Treatment

Conservative therapy

The list of therapeutic measures is determined taking into account the characteristics of the pathology that causes pain in the lip:

• Cheilitis . Exclude or minimize provocative factors (dental pathologies, meteorological effects, contact with cosmetics), treat neurotic disorders. Apply anti-inflammatory, antipruritic, antiallergic ointments (including hormonal), protective creams, immunocorrectors, antiviral agents of general action.
• Herpes . The tendency to recurrence necessitates complex therapy aimed at restoring immunity. Antiviral drugs are used in the first 5-7 days of illness, subsequently immunomodulators, recombinant alpha-interferons are prescribed. Vaccination is recommended after 1-2 months.
• Lichen planus . To eliminate inflammation and pain in ulcerative defects, topical corticosteroids, anesthesia with local anesthetics, drugs to stimulate regeneration are indicated. To prevent fungal infections in the treatment of steroids, oral antimycotic agents are prescribed. With neurotic disorders, a sedative is required, with an allergic predisposition – hyposensitizing, with immunodeficiencies – immunomodulatory therapy.
• Injuries . Patients with chronic injuries need treatment of carious teeth to eliminate the traumatic factor. In other cases, in the absence of wounds requiring surgical treatment, a sparing diet is advised, cold to reduce swelling, then dry heat to accelerate resorption.
• Trigeminal neuralgia . Therapy is carried out using anticonvulsants, antispasmodics, antihistamines. Effective therapeutic blockade with glucocorticoids, physiotherapy procedures: ultraphonophoresis with hydrocortisone, galvanization with novocaine.
• Lip cancer . At stage 1, in some cases, radiotherapy is used as the main method of treatment. For patients with advanced stages, radiotherapy and chemotherapy are prescribed in the pre- and postoperative period or carried out as part of palliative care.

Surgical treatment

Operative methods for pain in the lip are used infrequently. Exceptions are open injuries, oncological diseases. With fresh wounds, PST of the wound of the maxillofacial region is necessary. Neoplasms are excised, according to the indications, the Vanach operation, the Krail operation, and other interventions involving the removal of regional lymph nodes are performed. Patients with damage to the branches of the trigeminal nerve with persistent neuralgia can be recommended methods of stereotactic radiosurgery, percutaneous radiofrequency destruction.