If the nerve is hit during oral surgery

by Karen A
(Tulsa OK)

Pterygoid pocket

Pterygoid pocket

Prior to having oral surgery I had tmj for about 2 months. Everyone agrees it was from a molar with a filling that I finally had removed under local anesthetic. In the process of numbing the dentist "hit" the large nerve. Now the tmj is worse. It is in the hinge of my jaw, the ear drum, temple, eye socket, upper neck and even the top of my head. The pain in my temple is almost unbearable at times; like lightening flashes. Anti-inflamatories help but my question is: Is this a case of the nerve having to heal or continued tmj?

Hello Karen,
You say you had TMJ syndrome before the removal of the molar; was there popping or clicking in the joint, just in front of the ear when you chewed, spoke, kissed...? Then my guess, and it's only an educated guess, then the molar probably had nothing to do with the jaw joint pain.

The increased pain could be due to the 'hitting' the nerve - how do you know by the way? - but more likely due to having to open your jaw quite wide to get at the molar. If there was a damaged meniscus in the TMJ, and the dentist had to force your mouth open wide, then it would only have made it worse.

The trigeminal nerve has a very wide distribution, the biggest cranial nerve, hence the pain all over; and the sensory nucleus of the nerve is in the upper spinal cord, almost always also causing neck pain.

But that's all surmise; what's done is done and the real question is where do you go from here?

Place your forefinger on the painful side into the pterygoid pocket, beyond the last upper molar, pulp side of your finger outwards. Is it extremely tender? Does it radiate into the eye or to the temple area? How does it compare with the other side?

Is that TMJ still clicking or popping?

If the answer to these two questions is yes, then a skilled chiropractor, with experience working with the TMJ, can probably do quite a lot to help you. The upper cervical spine often needs attention too, but that may be only referred pain.

Do you get migraine type headaches? If you prick the side of your face, right and left, is there a difference.

Do you grind your teeth? A bite plate worn at night often helps.

All in all as you already know this is a very complex and painful condition. Do your utmost to avoid TMJ surgery.

Let me have some answers.

Dr B

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