Unbearable tightness in chin

[Silverstone]

Thelmacue, just to clarify. You have solved the sensation of tissue tightness, tugging and restriction on your lower lip and chin by doing the following…

- injection torodol ( Ketorolac) and lidocaine

- followed immediately by aggressive massage to break up the tissue?

Is this correct?

[Silverstone]

And what caused your initial tightness, tethered, sewn down feeling? Was it a genioplasty surgery?

Do you have to repeat this treatment or was it a one-off fix?

I am trying to understand what caused you to recover from misery to being your normal self. Is it the torodol that caused the recovery or the massage?

[JamesMR]

Sara123456789 wrote:
> no its ruined my life

Hi Sara,
I am wondering if you ever managed to get relief somehow. I am in the same situation as you. I got double jaw surgery for sleep apnoeia in Oct 2021 and ever since have had unbearable tightness in the left hand side of my mouth and chin. It is getting worse and worse (I almost feel it getting worse by the day) and I am at the point where I dread having to talk because it hurts so much. I have been to the surgeon multiple times about it but he said re-operating will not fix it and that I should try Cognitive Behavioural Therapy. This is really affecting my mental health and I really just want it all to be over. I am 46 and just don't think I can deal living like this for the rest of my life.

[JamesMR]

Wml wrote:
> Sara123456789 wrote:
> > no its ruined my life
>
>
> Your issue is the mentalis muscle, it happens very often when you have a sliding
> genioplasty reduction/reversal. What you need is a mentalis muscle resuspension and
> your issue should be fixed. Please update your situation, thanks.

Hi Wml,

Please I hope you can provide me with some information about this. I am really struggling to live my life. It is getting worse every day. I can't send you a PM as I havent had enough posts. Where would I get this kind of surgery? Is it complex? My e-mail is james_m_rimmer at yahoo dot com

[JamesMR]

So I have an update on this.

I have seen an excellent Pain Specialist in Australia and he indicated that the issue is likely damage of the "Mental Nerve" through over stretching. After a couple of visits he suggested we try Pulsed Radiofrequency at the Trigeminal ganglion (at the top of the cheek bone) and also where the mental nerve exits the mandibular canal (around the chin area). I had this procedure two days ago and I have to say there is a noticeable improvement. My lip doesnt feel as tight when I talk and Im not constantly thinking about it like I was. There is a slight increase in numbness in my chin but I can deal with that. Supposedly the results improve over a couple of weeks also. I had this under general anasthetic but the doctor said he gets even better results without anasthetic, where the patient can communicate when they hit the nerve (doesnt sound like much fun though!)

Anyway, just thought I would let you all know in case somebody else is faced with this issue

[djspeece]

I was intrigued by your saga and did a quick search on Google AI, which may help others:

"Pulsed radiofrequency at the trigeminal ganglion" refers to a minimally invasive medical procedure where a doctor uses pulsed radiofrequency energy to target and disrupt the pain signals coming from the trigeminal ganglion, a nerve cluster responsible for sensation in the face, often used to treat conditions like trigeminal neuralgia (severe facial pain) and postherpetic neuralgia (pain following shingles infection on the face) by delivering short bursts of radiofrequency waves to the affected nerve area; this can provide pain relief without major surgery.
Key points about pulsed radiofrequency at the trigeminal ganglion:
Treatment for facial pain:
This procedure is primarily used to manage chronic facial pain conditions, particularly trigeminal neuralgia, where patients experience sharp, stabbing pain in the face.
Minimally invasive:
Unlike surgical interventions, pulsed radiofrequency is considered minimally invasive, often performed with image guidance (like fluoroscopy) to precisely target the trigeminal ganglion.
Mechanism of action:
The pulsed radiofrequency energy disrupts the abnormal electrical signals within the nerve fibers, leading to reduced pain transmission.
Procedure details:
A thin needle electrode is inserted near the trigeminal ganglion through a small incision, and controlled pulses of radiofrequency energy are delivered.
Potential side effects:
Some potential side effects can include temporary facial numbness, discomfort at the injection site, and in rare cases, more significant nerve damage.

This is for informational purposes only. For medical advice or diagnosis, consult a professional. Generative AI is experimental.

[JamesMR]

Just an update. The pulsed radiofrequency neurotomy has not helped. The feeling is back and to be honest is probably worse than before with constant burning in my lower lip. From the moment I wake to when I go to sleep I am unable to stop thinking about it. It is crippling and I can no longer enjoy anything

[djspeece]

So sorry to hear this...any chance that this may improve with time? Also, what is your pain doctor's opinion on the use of steroids (oral or topical) to calm things down? I am an RN and don't give medical advice of course but was curious if these meds had a potential role. Best of luck to you in any event -- you are due for some.

[JamesMR]

djspeece wrote:
> So sorry to hear this...any chance that this may improve with time? Also,
> what is your pain doctor's opinion on the use of steroids (oral or topical)
> to calm things down? I am an RN and don't give medical advice of course but
> was curious if these meds had a potential role. Best of luck to you in any
> event -- you are due for some.

Thanks for your reply. Not sure if it will improve with time. It has actually been getting worse. Initially it was bearable and I was just trying to live with the tightness but it has progressively gotten worse (particularly over the last 6 months). From what Ive read pain from nerve damage does get worse as you age and more nerve cells start to die. So I hate to think what this is going to be like in a few more years. My GP and Pain Specialist had a phone conversation and have prescribed me 60mg Duloxetine and 10mg Amitripyline. Both these are supposed to help treat my nerve pain and the depression. I have been taking them for a few days. Hopefully over time they will help.

[djspeece]

I'm not sure where you are located but perhaps it is time to bring the big guns in at a major referral center (e.g., Cleveland Clinic, University Hospitals, Mayo Clinic, Johns Hopkins, etc.) or a dental school associated with a university. It might be worthwhile to research their websites for ideas.I'm sorry to hear things are not going as hoped.

[pdickson]

Anyone had a reversal genioplasty that helped with the tightness?

[pdickson]

orangetree wrote:
> Sara123456789 wrote:
> > Thanks for your replies. The tightness doesn't just feel like normal muscle
> > tightness. It limits my lower lip mobility and makes speaking feel
> > uncomfortable. For example when I say "oo" or pucker my lips it
> > feels like an elastic band that has been stretched. Same feeling when I
> > move my lower lip in any direction to talk (except down, for some reason
> > downward movements feel normal). For example, when I open my mouth to yawn
> > everything feels find, no stretch and I can open wide, but when I go to
> > close my lips about 2cm from closing I feel resistance and strain. Is this
> > similar to how you all feel?
>
>
> This is exactly what I have. It's not just the feeling of tightness, it's a visible
> physical tugging. The edge of my lip constantly burns and it feels like there's not
> enough space between my lower lip and mental crease. My lower lips rolls out and
> appears bigger. There is an indentation at the centre of my lip, likes it's literally
> pinned down.
>
> I had a chin implant removed, followed by a sliding genioplasty (15mm horizontal
> projection, 6mm vertical lengthening) almost 3 months ago. I suffered from lip
> incompetence afterwards, and then scar contracture from pulling my soft tissues up
> into the bony gap. I had a scar release and dermal fat graft placed 8 weeks later,
> and my doctor said he also reattached my mentalis muscle to the labiomental sulcus to
> help the lip incompetence. The tugging is even worse now. This leads me to believe
> it's something to do with the sutures being too tight or done wrongly.
>
> I have a consultation with Dr. Eppley scheduled to discuss a full reversal of my
> sliding genioplasty and putting back in my old chin implant. I know he's very
> experienced with mentalis suspension, so I'm hoping his technique will provide
> relief. I'm so scared. I'm only in my early 20s and I know for sure that I can't go
> on if this is what I'm left with. It's too painful.




Did you went through with Dr.Eppley

[pdickson]

Corses21 wrote:
> has anyone solved this problem? I believe it is due to the sutured chin
> muscle too much. down . sometimes also facial lengthening that does not
> allow a normal closing of the lips and therefore under stress. I have a
> very low internal scar since the operation, so even the lip too much cannot
> rise and I continually have this feeling I have stretched the tissues of
> the lip and chin downwards .. I am going to the link of a doctor from Korea
> who explains at what height the chin muscle should be sutured. in a few
> months I will have a height reduction genioplasty and a suture of the
> muscle of the chin and of the upper tissues. at rest the lips remain open
> about 4 mm.
>
> https://youtu.be/kKukkMbkbSs



Did you get the surgery?