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What Causes Difficulty Swallowing And Persistent Muscle Spasms?
Question: Dear Doctor,
I'll start describing my problem chronologically. I'm 22 now. At the age of 6 i was diagnosed with a large underbite and until the age of 15 I had removable braces (during night only). At the age of 14 I started having problems - feeling that there's a foreign body on the left side of my neck which clicks when I move my tongue. I went to an orthodontist (diagnosed with crossed bite and open bite) who gave me fixed braces which I had removed a few days ago. During this treatment my problems became worse. i started having persistent pain in the neck and throat muscles. In the last few months I developed problems with swallowing - on the right side only. Yesterday it became do bad that I was considering going to hospital as I couldn't swallow food or water. Fortunately, a double dose of Lexaurin and a muscle relaxing cream helped me get from the worst.
So the current symptoms are - pain mainly on the right side of neck and throat. There's a painful point which feels like someone's trying to pierce my muscle with a needle and it's located in the direction slightly above and to the right of the hyoid bone. Swallowing problems of fluctuating degree on the right side. The left side is OK in this regard. As for the clicking sound, it feels like something is clicking in my throat (such as the hyoid bone) but when I put my hand on my neck I can sense the clicking in the left TMJ rather than the neck. But I have a feeling of having a foreign body on the left side in the neck. For instance, when I pull in my chin I can't do it very much because I feel that something's blocking it on the left side in the hyoid bone area. When I move my tongue backwards the blockage disappears and I can pull in my chin back normally. Sometimes the clicking is very painful. The clicking happens when I move my tongue back and forth.
I had an ENT examination (the doctor put a tube inside my throat through my nose) and everything was OK from the inside.
I had a CT scan done yesterday and I'm attaching 3 pictures. I could compress all of them into one folder and send them to you if possible.
The biggest problem now is the swallowing and the persistent muscle spasms. Thank you for your help.
Best regards,
XXXXXXX
I'll start describing my problem chronologically. I'm 22 now. At the age of 6 i was diagnosed with a large underbite and until the age of 15 I had removable braces (during night only). At the age of 14 I started having problems - feeling that there's a foreign body on the left side of my neck which clicks when I move my tongue. I went to an orthodontist (diagnosed with crossed bite and open bite) who gave me fixed braces which I had removed a few days ago. During this treatment my problems became worse. i started having persistent pain in the neck and throat muscles. In the last few months I developed problems with swallowing - on the right side only. Yesterday it became do bad that I was considering going to hospital as I couldn't swallow food or water. Fortunately, a double dose of Lexaurin and a muscle relaxing cream helped me get from the worst.
So the current symptoms are - pain mainly on the right side of neck and throat. There's a painful point which feels like someone's trying to pierce my muscle with a needle and it's located in the direction slightly above and to the right of the hyoid bone. Swallowing problems of fluctuating degree on the right side. The left side is OK in this regard. As for the clicking sound, it feels like something is clicking in my throat (such as the hyoid bone) but when I put my hand on my neck I can sense the clicking in the left TMJ rather than the neck. But I have a feeling of having a foreign body on the left side in the neck. For instance, when I pull in my chin I can't do it very much because I feel that something's blocking it on the left side in the hyoid bone area. When I move my tongue backwards the blockage disappears and I can pull in my chin back normally. Sometimes the clicking is very painful. The clicking happens when I move my tongue back and forth.
I had an ENT examination (the doctor put a tube inside my throat through my nose) and everything was OK from the inside.
I had a CT scan done yesterday and I'm attaching 3 pictures. I could compress all of them into one folder and send them to you if possible.
The biggest problem now is the swallowing and the persistent muscle spasms. Thank you for your help.
Best regards,
XXXXXXX
Brief Answer:
TMJ Dysfunction and LPR
Detailed Answer:
Hi XXXXXXX
Thanks for posting the query and an elaborate history which has made my work simpler. I will try my best to help you with this problem.
After going through the description, I am of the opinion that you are having two problems.
1. TMJ dysfunction with myofascial pain dysfunction syndrome.
2. Laryngo-pharyngeal reflux (LPR), secondary to the acid reflux from the stomach into the throat.
Radiographic examination forms an integral component of the clinical assessment routine in patients with TMJ disorders.
1. A CT imaging provides exquisite detail for bony abnormalities, such as ankylosis, fractures, and arthrosis. The technique provides some information about soft tissues, but is not recommended as a primary imaging modality for diagnosis of disc displacement.
2. MRI is the standard imaging modality for the diagnosis of TMJ disorders. Imaging of soft tissues is superior to that of CT scan. Using MRI, the evaluation of the internal derangement of TMJ (the depiction and localization of the disc) can be detected.
In the images you have posted, the condyles of the mandible are not clearly seen. Hence, I would request you to post the report rather than the images alone, as it is very difficult for you to upload all the images.
You can continue with the muscle relaxants and the local analgesic gel. Avoid using the affected side; eat soft food and use the unaffected side for chewing. You may also require a short of oral steroids to reduce the inflammation around the joint. The LPR has to be treated with proton pump inhibitors such as omeprazole or pantoperazole with a prokinetic.
Finally, I would recommend you to consult a good maxillo-facial surgeon who can help you in this regard.
Hope I have answered your query; I will be available for the follow-up queries.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
TMJ Dysfunction and LPR
Detailed Answer:
Hi XXXXXXX
Thanks for posting the query and an elaborate history which has made my work simpler. I will try my best to help you with this problem.
After going through the description, I am of the opinion that you are having two problems.
1. TMJ dysfunction with myofascial pain dysfunction syndrome.
2. Laryngo-pharyngeal reflux (LPR), secondary to the acid reflux from the stomach into the throat.
Radiographic examination forms an integral component of the clinical assessment routine in patients with TMJ disorders.
1. A CT imaging provides exquisite detail for bony abnormalities, such as ankylosis, fractures, and arthrosis. The technique provides some information about soft tissues, but is not recommended as a primary imaging modality for diagnosis of disc displacement.
2. MRI is the standard imaging modality for the diagnosis of TMJ disorders. Imaging of soft tissues is superior to that of CT scan. Using MRI, the evaluation of the internal derangement of TMJ (the depiction and localization of the disc) can be detected.
In the images you have posted, the condyles of the mandible are not clearly seen. Hence, I would request you to post the report rather than the images alone, as it is very difficult for you to upload all the images.
You can continue with the muscle relaxants and the local analgesic gel. Avoid using the affected side; eat soft food and use the unaffected side for chewing. You may also require a short of oral steroids to reduce the inflammation around the joint. The LPR has to be treated with proton pump inhibitors such as omeprazole or pantoperazole with a prokinetic.
Finally, I would recommend you to consult a good maxillo-facial surgeon who can help you in this regard.
Hope I have answered your query; I will be available for the follow-up queries.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Thank you so much for your answer!
In fact, I don't have the report since the doctors keep these things for themselves in my country....Sadly... But I've come up with an innovative solution - I've captured all the pictures into 3 video files. You can pause the video file at any point and you'll see the scan you need.
Would it be too much to ask from you if you could check the scans please?
I have a few more questions:
1) How come the clicking sound and the feeling of a foreign body in the neck is on the left side, whereas all the pain and spasms are on the right side of the neck? Which TMJ is dysfunctional then?
2) What causes the feeling of the foreign body in the neck on the left side?
3) My jaw specialist has suggested I may have Eagle syndrome. Could you confirm/disconfirm that based on the pictures?
4) Based on your evaluation of the pictures I've sent to you, would you recommend to proceed with an MRI of both TMJs?
Best wishes,
XXXXXXX
In fact, I don't have the report since the doctors keep these things for themselves in my country....Sadly... But I've come up with an innovative solution - I've captured all the pictures into 3 video files. You can pause the video file at any point and you'll see the scan you need.
Would it be too much to ask from you if you could check the scans please?
I have a few more questions:
1) How come the clicking sound and the feeling of a foreign body in the neck is on the left side, whereas all the pain and spasms are on the right side of the neck? Which TMJ is dysfunctional then?
2) What causes the feeling of the foreign body in the neck on the left side?
3) My jaw specialist has suggested I may have Eagle syndrome. Could you confirm/disconfirm that based on the pictures?
4) Based on your evaluation of the pictures I've sent to you, would you recommend to proceed with an MRI of both TMJs?
Best wishes,
XXXXXXX
Brief Answer:
TMJ Dysfunction on the right, LPR on the left...
Detailed Answer:
Hi
Thanks for writing back
1. The TMJ dysfunction is on the right side, while the sensation of foreign body in the throat on the left side is because of LPR, the clicking sound is due to opening and closing of the Eustachian tube (the tube connecting nose and the ear)
2. When the acid from the stomach regurgitates into the throat, it will burn the mucosa of the throat causing inflammation of the mucosa. The inflamed mucosa thus gives the sensation of foreign body in the throat. Most of the times, the sensation is unilateral.
3. Eagle syndrome can be confirmed by the reconstruction of the CT scan images or with Ortho-pantomography. In these sections, it is difficult to identify the elongated styloid process.
4. I have examined the images thoroughly and I feel there is some osseous inflammation with the reduction in the joint space on the right side. MRI will be helpful in clearing all the doubts.
Hope I have cleared your doubts. I wish you good luck and good health.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
TMJ Dysfunction on the right, LPR on the left...
Detailed Answer:
Hi
Thanks for writing back
1. The TMJ dysfunction is on the right side, while the sensation of foreign body in the throat on the left side is because of LPR, the clicking sound is due to opening and closing of the Eustachian tube (the tube connecting nose and the ear)
2. When the acid from the stomach regurgitates into the throat, it will burn the mucosa of the throat causing inflammation of the mucosa. The inflamed mucosa thus gives the sensation of foreign body in the throat. Most of the times, the sensation is unilateral.
3. Eagle syndrome can be confirmed by the reconstruction of the CT scan images or with Ortho-pantomography. In these sections, it is difficult to identify the elongated styloid process.
4. I have examined the images thoroughly and I feel there is some osseous inflammation with the reduction in the joint space on the right side. MRI will be helpful in clearing all the doubts.
Hope I have cleared your doubts. I wish you good luck and good health.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Answered by
Dr. Dr. Naveen Kumar Nanjasetty
Otolaryngologist / ENT Specialist
Practicing since :2001
Answered : 2543 Questions
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