Jaw/neck pain after surgery

These are common problems after neurosurgical procedures. The below sections are some pointers on why you may have this pain and ways to manage and improve it with time. It is important even if you feel stiff and sore after any procedure to keep active, maintain good posture, comfortable sleeping and sitting positions and try and relax the tender areas.

Jaw pain

Jaw pain after cranial surgery is not uncommon, when chewing or opening your mouth wider. It is particularly common after a form of approach called a 'pterional craniotomy' as this approach requires working through a large muscle at the side of the temple (called temporalis) which is a major muscle group in helping you chew.

If you have had this type of approach strategies that may help with any pain or stiffness are as follows:

- Icing: 24-48hrs after surgery you can start to use ice packs over the area, taking care that they do not touch your wound directly, so applying it to the temple in front of your wound. Consider applying the ice pack for 5-10 minutes up to four times a day and this can be continued for as long as you feel this is helping.

- Give your jaw muscles a rest for the first 1-2 weeks after surgery: reduced talking, try and consciously reduce stress which leads to muscle tension, try not to clench your teeth, avoid difficult to chew foods/gum, practice good posture and positioning.

- Eat more soft foods: for the first 1-2 weeks after this type of approach we recommend eating softer foods as this will put less strain on the muscle as it starts to heal, and will cause you less discomfort. Then start building in tougher foods again. Examples of tougher foods includes whole nuts, hard vegetables like carrots, toffee, large sandwiches/burgers which require wide mouth opening to eat.

- Posture: good posture of your head and neck helps avoid strain on your muscles. Keep your head, neck and back in alignment (relax your shoulders and bring your head over your shoulders) and concentrate on relaxing the muscles in your face as regularly as you can though the day.

- Massage: gently massage the muscles of your head, face and neck to ease pain and tension. Avoiding your wound for the first 4 weeks while it heals and with clean hands gently rub the tender area in a small circular motion 10 times each way with the pads of your hands. Once your wound has healed the massage can include your wound (please see section on 'caring for your surgical wounds' for advice).

- Acupressure: Acupressure is an ancient healing art that’s based on the traditional Chinese medicine practice of acupuncture. With acupressure, you put pressure on specific places on your body. These places are called acupoints. Pressing these points can help release muscle tension and pain. Specifically to help with headache and/or jaw pain use pressure point LI-4, also called Hegu, is located between the base of your thumb and index finger.

Find pressure point LI-4 by placing your thumb in the space between the base of your thumb and index finger.
Press down on this point for 5 minutes. Move your thumb in a circle while applying pressure.
Repeat the process on your other hand.

You can do acupressure as often as need for your symptoms to go away.

See: https://www.youtube.com/watch?v=JO2JWbHeXdY

Exercises:

• Slowly open your mouth as wide as you can.

• Slowly move your jaw forward, showing your lower teeth.

• Place the tip of your tongue on the roof of your mouth.

• Now open and close your mouth while keeping your tongue on the roof of your mouth.

• Separate your teeth slightly. Slowly try to move your jaw to the right. Then repeat on the left side.

If after 6 weeks from your operation you are continuing to struggle with jaw pain and eating harder foods let your surgical team know - it maybe helpful for you to see the maxilla-facial surgery/dental team for some further help.

Neck pain

Neck pain is again quite common after neurosurgery operations, a combination of where your surgery has been and the position you are in for the surgery. The below is some advice on helping to manage that after your operation. The best thing you can do for your neck is to try to relax it and move it as freely and normally as possible, even when it is stiff and sore!

Exercises

Try to start these as soon as you can after your operation, and repeat 4 times a day, unless you have had surgery to you neck in which case your surgical team may wish for you to wait a few days before starting any exercises - please ask!

• Slowly curl your chin to your chest, hold for 5 seconds then slowly raise your head to neutral position.

• Tuck your chin in and hold for 5 seconds before relaxing back.

• Tuck your chin in and slowly turn your head to look over your right shoulder, hold for 5 seconds. Then slowly turn your head to look over your left shoulder and again hold for 5 seconds on that side.

• Slowly tilt your head to the side bringing your ear towards your shoulder, hold for 5 seconds.

Roll your shoulders forwards and backwards.
Lift your arms forwards and above your head, thumbs leading the way.

A video routine of exercises: https://www.youtube.com/watch?v=sQvVdcJtaJs

Icing

Icing the back of your neck/where it feels stiff and sore for 5-10 minutes a day up to 4 times a day can help. You can start the after your operation, taking care to avoid your wound, and continue this for as long as possible. Some people find icing after they have done their exercises can be a helpful routine.

Massage

Regularly massage your neck/tender areas up to four times a day, with clean hands and avoiding any incision until they have healed (approximately 4 weeks from your surgery) and then incorporating your wound into the massaged area after that.