Question
Thanks so much for your in depth answer, Dr. Leatherman!  Just two other questions if I may..
1- I didn't mention the cyst I have in my sinus cavity (I think in the maxillary area), maybe that might be adding problems as well?
and 2- Since it sounds trigeminal nerve related, is it possible it could be neuralgia even though I don't have pain (aside from the TMD pain)?

I may make an appointment with a neurologist to rule out any other wierd things.  I had a CT of the brain about 5 years ago when we were looking into the neck injury (I had vertigo from that) and all was normal there at that time, but I don't know how long the CT scan is good for..  Anyway, thanks in advance for your help!!
-Krista
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Followup To

Question -
Hi Dr. Leatherman:

I am a 35 yo female.  For the past few months I have been experiencing some tingling-like sensations in my face (both sides but mostly left) and if I rub my left eye, it twitches.  The tingling happens at random with no apparent cause.  I do have a bulging disk in my neck (and one in my low back) caused by car accidents.  In addition to this, I have suffered from TMD since I was 19.  Could either of these two conditions cause facial tingling?  I have no other symptoms and I have had a check up with my GP just prior to the tingling (general blood work and all) and the normal things are ok.  Thanks in advance for your advice.

Answer -
Dear Krista,

Yes the tingling can come from TMD and from a disk bulge, but tingling can also manifest from a host of other problems.  Tingling from the disk bulge itself is a very common symptom, but it rarely occurs in the face...the anatomical arrangement of the nerves that supply information to the face come from the cranial nerves, so it is more likely that this is the cause of the problem.

At this point you are only complaining about sensation changes/tingling/twitching so that would encompass the trigeminal nerve. Consequently the trigeminal nerve also supplies sensation to the mouth/lips. Now the trigeminal nerve has three divisions: opthalmic, maxillary, and mandibular.  They have seperate courses on the face...opthalmic more towards the forehead, eyes, and upper cheeks, maxillary above and below the lips, and mandibular along the jaw lines.  Of course these areas have overlap as well.

Now we get more complicated.  The opthalmic,maxillary and mandibular divisions are further divided into terminal branches. To further complicate the issue there is the origin of the trigeminal nerve which courses through the trigeminal ganglion where it splits into the three divisions, travels through various openings in the skull, and their terminal courses.  For an illustration of these nerves and their courses, there is a great picture in a text, Clinically Oriented Anatomy, 4th edition, by Moore & Dalley, page 858.  Additionally, there are four seperate cranial nerves that supply information to and from the eyes, but these concern mostly moto information in the eye, as well as visual processing which you do not seem to be having problems with.

In relation to the TM joint and your TMD, again tingling can occur as a result of this problem, but pain and popping with jaw motion is more common and indicative of dysfunction in that area.

In addition, imbalances to electrolytes such a potassium, calcium, sodium, bicarbonate, and chloride can cause diffuse symptoms throughout the body which include tingling/changes in sensation and altered nerve function.(Electrolytes are substances that become ions in solution and acquire the capacity to conduct electricity.) The balance of the electrolytes in our bodies is essential for normal function of our cells and our organs. This could be an easy to fix cause of your symptoms.  The best sources of electrolytes are colorful fruits and vegetables.

Since you have had a recent normal "check-up" with your GP, I would just monitor your symptoms for the next few weeks, increase your intake of electrolytes, and water to facillitate proper transport to the tissues and re-evaluate your symptoms.  If there are increases in frequency, intesity, or duration of your symptoms, then I would schedule another exmaination to further investigate possible sources.  As I stated before tingling can be the result of many different conditions such as multiple sclerosis, tumors, viruses etc...these types of problems are infrequent and need more indepth examinations and testing to be diagnosed.

Krista, Feel free to follow-up with any further comments or questions you may need addressed.  Best wishes.

Respectfully,
Dr. J. Shawn Leatherman


Answer
Dear Krista,

Yes, yes, yes!!!  Most definitely the cyst could be infringing or causing irritation to the maxillary portion of the trigeminal nerve.  WOW...I guess you forgot to tell me that little tidbit of information...ha, ha.  In all seriousness though, you should have that followed up with by an EENT specialist.  

In regard to the trigeminal neuralgia, the answer is no.  You must have associated pain to qualify for that diagnosis, and the pain that accompanies it, is pretty severe.  Consider yourself lucky not to be affected that way.  

Respectfully,
Dr. J. Shawn Leatherman