Tongue Pain and Dental Issues: A Patient's Journey

Tongue issues?

Dear Dr.
Tseng,
Last December, I suddenly developed a hard lump in the area of my left mandible (approximately 2-3 cm in the 8 o'clock direction from the corner of my mouth).
At the same time, I experienced skin breakdown and a tingling sensation on the left side of my tongue, along with pain in my left ear and left shoulder.
After consulting with an oral surgeon, I was informed that it was an odontogenic tumor and that I needed to have the left posterior tooth extracted.

I have a couple of questions:
1.
It has been about six months since then, and although the lump on the left side has decreased, it has not completely resolved, and there is still a small nodule present, which is not painful.
Does this require further intervention?
2.
The pain at the very tip of my tongue on the left side has persisted.
It is not neuropathic pain but rather a continuous sensation of skin breakdown.
For instance, when I extend my tongue outward and move it to the right to examine the far left tip, or when I press my tongue against my closed lips to check for pain, I particularly feel this sensation of skin breakdown.
Sometimes, when I shine a flashlight at home, I also notice pain in that area.
Over the past six months, I have consulted with neurologists and pain management specialists, but the issue remains unresolved.
This pain has become quite bothersome, occasionally accompanied by a foreign body sensation, and it is also associated with pain in my left ear, which has begun to affect my emotional well-being.
Given my father's history of oral cancer, I am particularly concerned.
I would like to ask you what steps I should take to address this issue.
Thank you for your assistance.

Lin, 30~39 year old female. Ask Date: 2018/05/13

Dr. Zeng Guanghui reply Dentistry

1.
If the dental tumor is not completely removed after surgery, a postoperative follow-up examination is necessary to check for any residual lesions.

2.
Persistent pain in the left posterior part of the tongue, feeling like a sore, sometimes accompanied by a foreign body sensation, may indicate inflammation of the tongue mucosa.
Please consult an oral surgeon for further evaluation.

Reply Date: 2018/05/13

More Info

Hello, thank you for sharing your detailed medical history and concerns regarding your oral health issues. It sounds like you have been through a challenging journey with various symptoms affecting your mouth, tongue, and surrounding areas. I will address your questions and provide some insights based on the information you've provided.

1. Regarding the persistent lump in your lower jaw: It is not uncommon for dental cysts or tumors to take time to resolve after extraction or treatment. If the lump has reduced in size but remains present, it may not necessarily indicate a problem, especially if it is not painful. However, it is essential to monitor it closely. If the lump changes in size, becomes painful, or if you notice any new symptoms, it would be wise to consult your oral surgeon or a specialist for further evaluation. In some cases, imaging studies such as an ultrasound or a CT scan may be warranted to assess the nature of the lump more accurately.

2. Regarding the pain at the back of your tongue: The sensation of pain and the feeling of a "broken skin" texture can be quite distressing. This type of pain can arise from several causes, including trauma, irritation, or even conditions like geographic tongue or oral lichen planus. Given that you have already consulted with various specialists without resolution, it may be beneficial to revisit an oral medicine specialist or a maxillofacial surgeon who can perform a thorough examination and possibly a biopsy if there are any suspicious lesions.
The association of tongue pain with ear and shoulder pain could suggest a referred pain pattern, which is not uncommon in cases of temporomandibular joint (TMJ) disorders or nerve-related issues. The trigeminal nerve, which supplies sensation to the face, can sometimes cause pain that radiates to the ear and shoulder areas.
3. Considering your family history of oral cancer: It is understandable that you are concerned about the possibility of a serious underlying condition. If you have not already done so, I recommend discussing your family history with your healthcare provider, as this may warrant more frequent screenings or specific diagnostic tests.
4. Managing your symptoms: In the meantime, managing your pain and discomfort is crucial. Over-the-counter pain relievers, topical anesthetics, or mouth rinses may provide temporary relief. Additionally, maintaining good oral hygiene and avoiding irritants such as spicy or acidic foods can help minimize discomfort.

5. Further investigations: If your symptoms persist, consider asking your healthcare provider about additional diagnostic tests. These could include imaging studies to evaluate the structures of your jaw and tongue, or even a referral to a pain management specialist if the pain becomes unmanageable.

In conclusion, while the lump may not require immediate intervention, the ongoing pain in your tongue and associated symptoms should be thoroughly investigated. It is essential to advocate for your health and seek further opinions if you feel your concerns are not being adequately addressed. Your well-being is paramount, and finding the right specialist who can provide a comprehensive evaluation may lead to a clearer diagnosis and effective treatment plan. Please take care, and I hope you find relief soon.

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