Lower Lip Biopsy 2018

Hi margot49 , just wondering how you are now 3 years later as I had my lip biopsy 5 weeks ago and am experiencing everything you and the other two posters in this thread mentioned (tingling, numbness on side of lower lip and swelling inside). I wish I hadn't had it done as I already have enough other health issues and didn't need one of the few body parts that was fine to ow have issues.. oh and of course the lip biopsy was negative!

Hi @Alexande just wondering how you are now 3 years later as I had my lip biopsy 5 weeks ago and am experiencing everything you and the original poster mentioned. I wish I hadn't had it done as I already have enough other health issues and didn't need something new in one of the few body parts that didn't have any issues... oh and of course the lip biopsy was negative!

My ENT surgeon said he's 100% sure I don't have nerve damage. I don't believe him cause he don't feel what I'm feeling. And besides numbness tingling burning is all nerve damage symptoms. He refused to have me see a neurologist. So I'm gonna see one anyway. My pcp prescribed me B12 2500 mcg vitamins. Not sure will B12 solve my symptoms I doubt it. My ENT told me my muscle by the lips are working fine and when he did the lip biopsy he said the incision wasn't near the nerve. And my ENT said he don't understand why I'm having these symptoms cause he done lip biopsys in the past and no patient experience what I have. I know that's a lie. And he said if he knew those are the risks he would of told me so I can make an inform decision. He said give it 3 months and if its not better come see him. I know this is not gonna get better because my lower lip feels the same as day 1. And now it been 3weeks since my surgery. This feels very permanent. I regret getting a lip biopsy for Sjogren's Syndrome yea my test is negative but I would not recommend. If you suspect you have it just live with it like most folks.

Unfortunately the lips are one of the areas of the body which are absolutely crammed with tiny peripheral nerves. This means it's impossible not to damage some of them every time you cut into the lip - whether by accident or design. Your ENT knows this perfectly well, so is clearly talking rubbish when he says he was "nowhere near the nerve".

I suspect he means he was nowhere near the mental nerve. In this context, "mental" has nothing to do with psychiatry, it means pertaining to the chin (mentum in Latin). The mental nerve is a branch of the sensory trigeminal nerve, and provides sensation to the chin and lower lip. He's clearly right in saying he didn't go anywhere near the main mental nerve, as it's easy to identify and locate.

However, the mental nerve splits up into thousands of tiny filaments under the mucous membrane of the lip. This is what all peripheral sensory nerves do. He will inevitably have cut through a few of those filaments, as it's completely impossible to do a lip biopsy without doing so. That's what he should have explained to you in the first place, so you could take an informed decision.

The good news is that peripheral nerves regenerate! However, they don't do it overnight, so you're going to be stuck with those unpleasant sensations for several months - maybe up to a year - and there's nothing anyone can do about them. It will probably be about three months before you start to feel the first improvement, and this will then continue slowly till you wake up one morning and realise you haven't noticed it for a few days!

Wow you know your stuff. Thanks for the Info. You told me more than my ENT surgeon lol. The lip biopsy wasn't the lip itself it was the lower inner lip near the gum line.So is it worth seeing an Neurologist or not? My pcp prescribed me B12 2500 mcg to help with numbness but I'm not sure it will work.

You're right - the biopsy is never taken from the external part of the lip. There wouldn't be any point, as the salivary glands only occur further down on the inside of the lip.

The B12 wouldn't have been prescribed to help the numbness directly, but just as a general background boost to your nervous system while the damaged nerves in your mouth are regenerating. My GP prescribed the same thing to me 20 years ago, when I got an attack of shingles on the acoustic nerve. She told me at the time it would have no curative properties, but was just to give my nervous system "the best possible chance" since there was a tiny potential risk that my hearing in the affected ear could be damaged by the virus. (This didn't happen, and of course I don't know whether it was down to the B12 or not!) I took the full six-week course anyway, just as a kind of general insurance policy. It's practically impossible to OD on Vit B12, since the body excretes any excess, so it won't do you any harm even if it doesn't do any good.

As to whether or not to see a neurologist, that's entirely up to you. However, I suspect that if you see someone at this early stage they're just going to tell you to wait and see what happens, since you're still only at the start of the normal recovery period for peripheral nerve damage to the lip.

There's the medico-legal aspect of course - in the event you eventually decide to sue the ENT - but I can't see how consulting a neurologist at this stage, when you're only suffering the normal after-effects of lip biopsy, could help. There's also no treatment I know of that could speed up the process of new nerve growth. If at the end of, say, a year you still hadn't had any improvement at all, then you'd have a clear-cut legal case of permanent nerve damage. It would definitely be worth consulting a neurologist at that point.

From the legal point of view, your ENT should have a note of your complaint on record already, though you might find it useful to send him a recorded-delivery letter simply describing your concern over your symptoms (in which case he won't be able to kick it into the long grass). If money is no object, I can see no reason why you shouldn't see a neurologist now if you really want to, but I think it would be a waste of money and/or insurance cover at this early stage.

I honestly think you've fallen victim to a communications failure rather than any surgical malpractice. I do wish doctors would be more honest with their patients before embarking on any action, but I suspect that's a lost cause in most cases!

On the bright side, you've provoked some lively discussion about lip biopsy in this forum (both for and against) which could be valuable to other readers who are debating whether or not to go ahead with it.

In the meantime, you have all my sympathies, as a fellow-sufferer from a lip incision - albeit an inadvertent one in my case. I know just how painful and irritating it can be. However, as this was the second time I've face-planted and put my teeth through my lip, I at least have the advantage of knowing the throbbing and tingling will eventually subside. I'm fairly sure this will be the same for you.

Well its obvious that you have a dental background based on your wonderful explanation. If the doctor cuts those filaments every time why doesn't everyone who has these lip biopsy get this response? 

?One day it was explained to me by a dental professional that there are a lot of nerves in your mouth especially in the gums which makes it difficult to get the Novocain in the right spot. In my case dentists will sometimes have problems getting me numb in the right place. So I have to have addition injections. In fact I was at my previous dentist office because the tooth the he had just done a root canal on, was really hurting badly. I still had my temporary cap on. When the assistant tried to pull it off the pain sent me thru the roof. So she gave me a shot to deaden the area but I told her I was not numb, so she gave me a second shot which also didn't make me numb in the right spot. By  this time I was plenty numb in my chin and lower lip but not where the bad tooth was located. At that point she was convinced that I was numb and was being a baby about it. In fact she said that all I was feeling was the pressure from her pulling the cap off. So she pulled the cap off, even as I kept telling her how much it hurt. By the time she was done I was in tears from the pain and anger. I can't remember what the resolution was on that tooth, but after the dentist fixed my problem I left his practice. 

Oh no, amkoffee - I wouldn't presume to have anything like your own wonderful dental background!

Your question is a bit like asking why, if 20 people eat the same contaminated food at a communal meal, do only five or six get sick.

There are so many variables.

For a start, some people have a higher pain threshold than others. I once had a root canal done on a four-canal molar, two of which couldn't be anaesthetised at all due to the rheumatic calcifications in my teeth. (Which incidentally might explain your painful experience.) Removing these two nerves wasn't the pleasantest of procedures and had to be done over two different appointments, with a temporary dressing inserted each time, but I coped.

(On the other hand I'm a total baby when it comes to upper endoscopy!) Horses for courses, as they say.

Some people have more peripheral nerve endings than others in a given area, and surgeons may vary slightly in the exact position from which they take the biopsy, which can have also have an impact. Some surgeons get luckier than others too, and manage not to damage as many nerve endings on some patients. Same deal with intramuscular injections, for example. Sometimes an injection of the same drug, given into a similar site by the same nurse can be excruciating, whereas others are hardly felt. Just depends how many peripheral nerve endings you happen to hit on the way in. It's all chance. (Provided you avoid the major motor or sensory nerves, of course, just as the surgeon has to avoid the mental nerve when doing a lip biopsy.)

And don't forget healing of nerve damage takes place more quickly in some individuals than others, just like healing of skin wounds.

As far as I'm concerned, the bottom line remains that people shouldn't be bullied into lip biopsy, nor should they be scared off from having it done. We all need to make our own informed choices. This is the value of sites like this one, where people can share their different experiences.