Ask a doctor on the topic of Otorhinolaryngology

Persistent jaw pain after sneezing

August 18, 2017 | 25,00 EUR | answered by Christian Welsch

Dear doctors,

I am seeking assistance with the following problem:

Pain in the left upper jaw, dark, throbbing,
Missing teeth 25-28,
History of maxillary sinus surgery. Chronic maxillary sinusitis
on the left, Pollinosis, mite, decongestant
nasal spray with cortisone and nasal care spray.

History: Pain in upper jaw 26, 07/2016, root canal treatment
unsuccessful, extraction 08/2016 Jaw pain
still present, smoothing of bone surgically.

09-10/2016 Pain unchanged, ENT found no evidence
of acute sinusitis, CT jaw/nose, bone spur
discovered 10/2016 Jaw height surgery, removal
of bone spur, incision above 26, tooth would probably be fine,
sensitivity present but delayed with cold spray.
histological finding: chronic maxillary sinusitis,
antibiotics.

11/2016 Pain improvement.

01/2017 After sneezing, pain, pressure in the jaw. Left upper jaw.
ENT consultation, antibiotics, followed by CT paranasal sinuses, no acute sinusitis
visible, Neurological trigeminal neuralgia was
excluded. Pain free after 6 weeks.

02/2017 After sneezing, pain, pressure in the jaw. Left upper jaw.
ENT consultation, antibiotics, followed by X-ray paranasal sinuses, no acute sinusitis visible,
CT image control jaw surgery, no abnormalities.
Pain free after 6 weeks.

04/2017 After sneezing, unfortunately sneezed inwards, pain, dark pressure in the left
upper jaw. Consultation with jaw surgery at the university hospital as a second opinion,
suspicion that the last tooth could be the cause. Appointment for
sinus revision set if no improvement.
Worsening of pain, dark and bright pain,
extraction of tooth 25 improvement, pain-free thereafter until 10.08.17.

08/2017 After sneezing, (half with open mouth, pain,
pressure in the jaw. Left upper jaw, less at night.

Could the problems, always after sneezing, be a kind of barotrauma?
How could one prevent this, I always try to release the pressure when sneezing
with an open mouth, I feel a momentary
pain (lasting a few seconds). But if, for example, I fail to sneeze inwardly,
then persistent jaw pain.

Torn due to pressure conditions?
Something not properly covered during surgery?

Seeking help,

Best regards, Sven

Christian Welsch

Dear questioner,

A lack of pressure equalization between the nasal cavity and the paranasal sinuses can trigger such pain. Without knowledge of the CT images and the ENT physician's findings from the endoscopic examination, it is difficult to say anything specific about your situation. However, frequent procedures in this area can leave patients with intermittent pain from the scars.

The question of what came first, the chicken or the egg, is not easy to answer. If you are experiencing acute pain, you may want to try taking an anti-inflammatory pain reliever like ibuprofen or diclofenac for a few days, but do so regularly and in low dosages. Sometimes irritations in this area also respond to a combination of cortisone as a spray and as tablets.

Unfortunately, many patients who only experience scar pain are operated on again or have teeth extracted without experiencing lasting improvement. There is often a tendency to surgically remove something (bone spur?) that may be causing the pain, but this can often create new scars and perpetuate the cycle of pain.

Overall, it is not easy to solve or answer these issues. Do you have any more questions?