Jaw Pain: Is It TMJ Disorder or Trigeminal Neuralgia? - Neurology

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Your symptoms suggest a complex interplay between dental issues, muscle tension, and possibly nerve-related pain. Given your description, it seems that you are experiencing pain primarily in the right side of your jaw, which radiates to the ear and temple area. This could indeed be indicative of a temporomandibular joint (TMJ) disorder or trigeminal neuralgia, but let's break down the possibilities.

TMJ Disorder: TMJ disorders are often characterized by pain in the jaw joint and surrounding muscles. Symptoms can include jaw pain, difficulty chewing, clicking or popping sounds when moving the jaw, and referred pain to the ear, neck, or head. The fact that you have experienced muscle tightness and have been grinding your teeth (bruxism) at night could contribute to this condition. Stress and anxiety are known to exacerbate TMJ disorders, leading to increased muscle tension and pain. The muscle relaxant you took may help, but it might not be sufficient if the underlying tension persists.

Trigeminal Neuralgia: This condition is characterized by sudden, severe facial pain that can feel like electric shocks. However, you mentioned that your pain does not fit the typical description of trigeminal neuralgia, which often involves sharp, shooting pain rather than a dull ache or pressure. The absence of the classic "electric shock" sensation makes this diagnosis less likely, but it cannot be completely ruled out, especially considering your history of jaw surgery, which may have affected the trigeminal nerve.

Other Considerations: Given your history of jaw surgery and the incomplete recovery of the nerve on the right side of your mouth, it is possible that you are experiencing neuropathic pain related to nerve damage or irritation. This could manifest as a dull ache or pressure in the jaw, which might explain the discomfort you feel when pressing on certain areas.

Diagnosis and Treatment: Since you have already consulted with a dentist and a general practitioner, and have sought acupuncture treatment, it may be beneficial to see a specialist, such as an oral and maxillofacial surgeon or a neurologist. They can provide a more comprehensive evaluation and may recommend imaging studies, such as an MRI, to assess the TMJ and surrounding structures, as well as the trigeminal nerve.

In terms of treatment, continuing with muscle relaxation techniques, stress management, and possibly physical therapy could be beneficial. If your symptoms persist or worsen, medications such as anti-inflammatory drugs, muscle relaxants, or even nerve pain medications (like gabapentin) may be considered.
Additionally, if you suspect that your symptoms are stress-related, cognitive behavioral therapy or mindfulness practices could help manage anxiety and reduce muscle tension.
In summary, while your symptoms may suggest TMJ disorder, the possibility of trigeminal neuralgia or neuropathic pain related to your previous surgery should not be overlooked. A thorough evaluation by a specialist will help clarify the diagnosis and guide appropriate treatment.