Trigeminal and Glossopharyngeal Neuralgia.

Trigeminal neuralgia and glossopharyngeal neuralgia are craniofacial pain syndromes characterized by recurrent brief shock-like pains in the distributions of their respective cranial nerves. In this article, the authors aim to summarize each condition's characteristics, pathophysiology, and current pharmacotherapeutic and surgical interventions available for managing and treating these conditions.

Neuralgia del trigémino y del glosofaríngeo concomitantes, asíncronas y refractarias. Buena respuesta al abordaje quirúrgico en un tiempo / Concomitant, asynchronous and refractory trigeminal and glossopharyngeal neuralgia. Good response to surgical approach in one time

Introducción: La cirugía de descompresión microvascular (DMV) es el tratamiento de elección de una neuralgia craneal refractaria secundaria a compresión vascular. Las neuralgias simultáneas de dos pares craneales son extremadamente infrecuentes. Describimos un caso con neuralgia concomitante del trigémino (NT) y glosofaríngeo (NG) refractarias y secundarias a cruce neurovascular abordadas quirúrgicamente en un mismo tiempo. Caso clínico: Mujer de 65 años con NT derecho (inicialmente en V2-V3) desde 2004 con control regular con carboxamidas. Diecisiete años después empeoraron los paroxismos en V2-V3, aparecieron también en V1 y en el territorio del nervio glosofaríngeo derecho (oído derecho y fosa amigdalar al hablar y deglutir). La resonancia magnética cerebral mostró contacto arterial significativo entre arteria cerebelosa superior (ACS) con origen del V par craneal derecho y de la arteria cerebelosa antero-inferior (AICA) con el origen de pares craneales bajos derechos. Se realizó DMV de ambos pares craneales en un mismo tiempo quirúrgico mediante craniectomía retrosigmoidea, y se procedió a la liberación del V par craneal, en contacto íntimo con la ACS, y del IX par craneal en contacto con la AICA derecha, para lo que se puso teflón entre ellas. La paciente tuvo una resolución inmediata de los paroxismos trigeminales y una mejoría considerable en intensidad y frecuencia de los glosofaríngeos. A los 2 años de la intervención continúa la desescalada de tratamiento neuromodulador con buena respuesta.ConclusiónLa DMV en la NT y NG simultáneas es factible y puede ofrecer un buen resultado posquirúrgico. (AU)

INTRODUCTION: Microvascular decompression (MVD) surgery is the first choice treatment for refractory cranial neuralgia secondary to vascular compression. Simultaneous neuralgia of two cranial nerves is extremely rare. We describe a case of concomitant refractory trigeminal (TN) and glossopharyngeal (GN) neuralgia secondary to neurovascular crossover, treated surgically at the same time. CASE REPORT: 65-year-old woman with right TN (initially V2-V3) since 2004 with regular control with carboxamides. Seventeen years later, paroxysms worsened in V2-V3, also appearing in V1 and in the territory of the right glossopharyngeal nerve (right ear and tonsillar fossa when speaking and swallowing). Cerebral MRI showed significant arterial contact between the superior cerebellar artery (SCA) with the origin of the right V cranial nerve and the antero-inferior cerebellar artery (AICA) with the origin of the right lower CCNN. MVD of both cranial nerves was performed at the same surgical time by means of retrosigmoid craniectomy, releasing the V cranial nerve, in intimate contact with the SCA, and the IX cranial nerve in contact with the right AICA, interposing teflon between them. The patient had an immediate resolution of the trigeminal paroxysms and a dramatic improvement in intensity and frequency of glossopharyngeal paroxysms. Two years after the intervention, de-escalation of neuromodulator treatment continues with good response. CONCLUSION. MVD in simultaneous TN and GN is feasible and can offer a good post-surgical outcome. (AU)

Glossopharyngeal neuralgia with cardioinhibitory syncope: Is a permanent pacemaker required?

Glossopharyngeal neuralgia is a rare facial pain syndrome, which in more rare cases can be associated with syncope. We present the outcome of a case report that combines this rare association that received medical therapy with anti-epileptic medication and permanent dual chamber pacemaker implantation. In this case, syncope episodes were associated with both vasodepressor and cardioinhibitory reflex syncope types. The patient found relief from syncope, hypotension, and pain after initiation of anti-epileptic therapy. Although a dual chamber pacemaker was implanted, the pacemaker interrogation revealed no requirement for pacing at one-year follow-up. As far as we know, this is the first case that reports pacemaker interrogation during follow-up and, taking into account the absence of pacemaker activation at one-year follow-up, the device was not needed to prevent bradycardia and syncope episodes. This case report supports the current guidelines for pacing in neurocardiogenic syncope, by demonstrating a lack of requirement for pacing in the event of both cardioinhibitory and vasodepressor responses.

Glossopharyngeal Neuralgia/Neuropathy with Hemodynamic Instability and Associated Syncope Treated with Stereotactic Radiosurgery.

BACKGROUND: Glossopharyngeal neuralgia/neuropathy is rare, and less than 3% of cases involve cardiac arrhythmias of syncope due to activated vagal reflex pathways. Most of these cases are successfully treated with medical management with or without pacemaker placement. We present the first reported case of glossopharyngeal neuralgia/neuropathy with cardiac symptoms refractory to medical management including pacemaker placement but successfully treated with Gamma Knife Radiosurgery. CASE DESCRIPTION: A 70-year-old Caucasian man with recurrent squamous cell carcinoma of the tongue base treated with multiple surgeries, lymph node excision, chemotherapy, and external beam radiation, developed episodes of severe right ear and throat pain. These episodes would be followed by syncopal episodes associated with hypotension and bradycardia. Aggressive medical management including pacemaker could not stabilize the patient's hemodynamic instability. After extensive workup, the patient was diagnosed with glossopharyngeal neuralgia/neuropathy with associated carotid sinus instability. The patient was not a strong surgical candidate, thus the patient underwent Gamma Knife Radiosurgery. The target was set as the glossopharyngeal meatus. Within days of treatment, the patient had no further clinically significant syncope or hemodynamic instability for the remaining 6 months of his life. CONCLUSIONS: To our knowledge, we present the first case of glossopharyngeal neuralgia/neuropathy with medically refractory cardiac dysfunction successfully treated with Gamma Knife Radiosurgery. We advocate that Gamma Knife be considered for similar subsets of patients.

Percutaneous Pulsed Radiofrequency Treatment in a Patient with Chronic Bilateral Painful Glossopharyngeal Neuropathy.

BACKGROUND Due to its rareness, we present a case of chronic, bilateral, painful glossopharyngeal neuropathy, which developed after nasal septum and inferior concha surgery, and was non-surgically treated with percutaneous pulsed radiofrequency at the glossopharyngeal nerve, using an extra-oral approach. CASE REPORT A 41-year-old Caucasian female patient (60 kg, 1.57 m, body mass index 24.8 kg/m²) was referred to the Pain Center by her general practitioner because of ongoing pressing pain in her throat 4 months after nasal septum and inferior concha surgery. Based upon medical history, physical examination and the results of additional questionnaires, a probable diagnosis of atypical neck pain was made, based on ongoing glossopharyngeal stimulation, involvement of the pterygopalatine ganglion or/and superior cervical ganglion, with secondary involvement of the muscles of the neck. We changed the analgesic regimen and performed a pulsed radiofrequency treatment of the glossopharyngeal nerve on both sides. The patient had made progress and reported that she actually felt better but she asked for repeat treatment because of residual complaints. We performed the procedure for a second time on both sides. The results of the questionnaires before (T0) treatment, 3 months after the first (T1) and 3 months after the second (T2) treatment are provided. After the second procedure, the patient reported that her swallowing complaints had further diminished, as well as the pain behind her ears. She stopped using pregabalin. Residual complaints were manageable. CONCLUSIONS In patients with painful glossopharyngeal neuropathy, a non-surgically treatment with percutaneous pulsed radiofrequency at the glossopharyngeal nerve, using an extra-oral approach, seems to be an effective and safe method to use.

Glossopharyngeal Neuralgia Treatment Outcomes After Nerve Section, Microvascular Decompression, or Stereotactic Radiosurgery: A Systematic Review and Meta-Analysis.

BACKGROUND: Glossopharyngeal neuralgia (GPN) is a rare neuralgic pain syndrome amenable to neurosurgical treatments, including nerve section (NS), microvascular decompression (MVD), and stereotactic radiosurgery (SRS). However, thorough comparisons of the modalities have not been performed to date. The objective of the present study was to compare the pain and complication outcomes after these approaches to GPN. METHODS: Searches of 7 electronic databases from inception to June 2018 were conducted following the appropriate guidelines. The incidence rates (IRs) of short-term (≤3 months) and long-term (≥12 months) pain relief and complications were extracted and analyzed using a meta-analysis. Meta-regression was used to assess for heterogeneity. RESULTS: A total of 792 GPN cases managed by NS, MVD, or SRS were described by 6, 11, and 6 studies, reporting outcomes for 282 (36%), 446 (56%), and 67 (8%) cases. The short-term pain relief rate was highest after NS postoperatively (IR, 94%; 95% confidence interval [CI], 88%-98%) and lowest after SRS at 3 months postoperatively (IR, 80%; 95% CI, 68%-96%). The postoperative complication rate was greatest after MVD (IR, 26%; 95% CI, 16%-38%) and lowest after SRS (IR, 0%; 95% CI, 0%-4%). The long-term pain relief rate was greatest after NS (IR, 96%; 95% CI, 91%-99%) and lowest after SRS (IR, 82%; 95% CI, 67%-94%). Statistically significant differences between the approaches were found for each outcome. CONCLUSION: Neurosurgical treatment of GPN is frequently performed by 1 of 3 modalities with unique outcomes profiles. NS might provide the most favorable treatment response, with respect to short- and long-term pain relief and postoperative outcomes.

Trigeminal Neuralgia, Glossopharyngeal Neuralgia, and Myofascial Pain Dysfunction Syndrome: An Update.

Neuropathic pain is a common phenomenon that affects millions of people worldwide. Maxillofacial structures consist of various tissues that receive frequent stimulation during food digestion. The unique functions (masticatory process and facial expression) of the maxillofacial structure require the exquisite organization of both the peripheral and central nervous systems. Neuralgia is painful paroxysmal disorder of the head-neck region characterized by some commonly shared features such as the unilateral pain, transience and recurrence of attacks, and superficial and shock-like pain at a trigger point. These types of pain can be experienced after nerve injury or as a part of diseases that affect peripheral and central nerve function, or they can be psychological. Since the trigeminal and glossopharyngeal nerves innervate the oral structure, trigeminal and glossopharyngeal neuralgia are the most common syndromes following myofascial pain dysfunction syndrome. Nevertheless, misdiagnoses are common. The aim of this review is to discuss the currently available diagnostic procedures and treatment options for trigeminal neuralgia, glossopharyngeal neuralgia, and myofascial pain dysfunction syndrome.

Vagoglossopharyngeal Neuralgia Occurred Concomitantly with Ipsilateral Hemifacial Spasm and Versive Seizure-Like Movement: A First Case Report.

Vagoglossopharyngeal neuralgia (VGPN) is a very rare condition. VGPN with convulsive like attack is even rarer All of the cases had their head turned to the opposite side of facial pain. Hemifacial spasm occurring concurrently with VGPN has never been reported. Herein, we present the first case of VGPN that had ipsilateral hemifacial spasm and versive seizure-like movement to the same side of facial pain. We reported a 71-year-old man presenting with multiple episodes of intermittent sharp shooting pain arising on the right middle neck, followed by hemifacial spasm on right face. Then the patient became syncope while his head and gaze turned to the same side of the painful neck. Electrocardiography showed sinus arrest. Interictal Electroencephalography was normal. This patient initially responded to pregabalin for two weeks, then the symptoms became worse. Microvascular decompression and carbamazepine resulted in the complete remission of all symptoms after six months of follow-up. We could not explain the pathophysiology of unilateral versive seizure like movement.

[Orofacial pain - Trigeminal neuralgia and posttraumatic trigeminal neuropathy: Common features and differences]. / Orofazialer Schmerz - Trigeminusneuralgie und posttraumatische Trigeminusneuropathie : Gemeinsamkeiten und Unterschiede.

Neuropathic pain is the result of a lesion or disease of the somatosensory system in the peripheral or central nervous system. Classical trigeminal neuralgia and posttraumatic trigeminal neuropathy are pain disorders which oral and maxillofacial surgeons and dentists are confronted with in the differential diagnostics in routine daily practice. The etiopathogenesis of classical trigeminal neuralgia is attributable to pathological blood vessel-nerve contact in the trigeminal nerve root entry zone to the brain stem. The typical pain symptoms are characterized by sudden stabbing pain attacks. The pharmaceutical prophylaxis is based on the individually titrated administration of anticonvulsant drugs. The indications for interventional treatment are dependent on the course, response to drug treatment, resilience and wishes of the patient. The neuropathic mechanism of posttraumatic trigeminal neuropathy originates from nerve damage, which leads to peripheral and central sensitization with lowering of the pain threshold and multiple somatosensory disorders. The prophylaxis consists of avoidance of excessive acute and long-lasting pain stimuli. Against the background of the biopsychosocial pain model, the treatment of posttraumatic trigeminal neuropathy necessitates a multimodal, interdisciplinary concept.

Remission of neurovascular conflicts in the cerebellopontine angle in interventional neuroradiology.

BACKGROUND AND PURPOSE: To investigate the efficacy of endovascular treatment (EVT) for neurovascular conflicts (NVCs) in the cerebellopontine angle (CPA) caused by intracranial aneurysms (IAs) and intracranial arteriovenous malformations (AVMs), including trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. MATERIALS AND METHODS: From January 2010 to January 2014, 14 consecutive patients presenting with three NVCs caused by IAs or intracranial AVMs were admitted to our department. The clinical outcomes of these NVCs after EVT were retrospectively analyzed. RESULTS: For four patients with IAs, angiographic follow-up confirmed total occlusion of the lesion in all, and the clinical outcomes of NVC were as follows: gradual relief in two (50%), transient partial relief but recurrence in one (25%), and no palliative effect in one (25%). For the 10 patients with intracranial AVMs, one (10%) experienced transient relief of NVC after angiogram examination (no EVT was performed). Of the other nine patients who received EVT, angiographic follow-up was obtained in seven (70%), demonstrating total obliteration of the lesion in three (30%), subtotal obliteration in two (20%), and partial obliteration in two (20%). Clinical outcomes included immediate relief of NVCs after single EVT in two cases (20%), gradual relief after single EVT in five (50%, one of them experienced transient aggravation), and complete relief after two sessions of EVT in two (20%). Complications of transient cranial nerve paresis related to EVT occurred in two cases (20%) with intracranial AVMs. In all, complete lasting relief of the NVCs was obtained finally in 11 cases (78.6%). CONCLUSIONS: EVT is a feasible and less invasive approach for relief of NVCs in the CPA caused by IA or intracranial AVM and could be considered as a therapeutic option in these situations.

Trigeminal and glossopharyngeal neuralgia.

Trigeminal neuralgia and glossopharyngeal neuralgia are two causes of paroxysmal craniofacial pain. Either can be debilitating in affected individuals. This article reviews the epidemiology, pathogenesis, diagnosis, and treatment options for these disorders.

Cranial neuralgias.

This article describes the clinical findings of cranial neuralgias, such as trigeminal neuralgia, glossopharyngeal neuralgia, nervus intermedius neuralgia, and others, and postherpetic neuralgia. Pathophysiology of these neuralgias, diagnostic methods, and treatment are also discussed. This information will enable the dentist to diagnose patients who have these rare conditions.

Glossopharyngeal neuralgia.

In this review, the clinical characteristics, differentiating features from other forms of neuralgia, etiology and treatment options of glossopharyngeal neuralgia will be discussed.

[Guillain-Barré syndrome with dysphagia after frontal sinusitis]. / Guillain-Barré-Syndrom mit Dysphagie nach Sinusitis frontalis.

One week after an acute sinusitis, a male patient developed a hypernasal voice, dysphagia, diplopic images, ataxia and paresthesias. He had paresis of the glossopharyngeal and abducens nerves, weakness of the arms and legs, and reflex deficiency. The neurography showed a motor axonal demyelinating neuropathy, so that the diagnosis of Guillain-Barré syndrome was made. After five courses of plasmapheresis, the symptoms improved rapidly.

Non-surgical therapy for bilateral glossopharyngeal neuralgia caused by Eagle's syndrome, diagnosed by three-dimensional computed tomography: a case report.

Eagle's syndrome is an uncommon sequela of elongation of the styloid process. Symptoms include recurrent throat pain and anterolateral neck pain, with referred pain to the ear. We report a 65-year-old man who presented with bilateral glossopharyngeal neuralgia. We performed three-dimensional computed tomography which revealed that the right styloid process was 35.1 mm and the left process was 29.6 mm, leading to diagnosis of an elongated styloid process, i.e. Eagle's syndrome. Because the patient refused surgical treatment, conservative therapy was selected. Oral gabapentin, stellate ganglion block, and 8 % lidocaine spray on the tonsillar branches of the glossopharyngeal nerve resulted in complete resolution of the paroxysms of pain in approximately 3 weeks.

Paroxysmal neuralgia in pediatric population--a diagnostic dilemma for physicians and dental practioners.

Paroxysmal neuralgia is relatively uncommon in children. Neuropathic orofacial pain is a challenge for the clinician, as no obvious dental pathology exists either clinically or radiographically. Dentist and physician should be able to recognize the characteristics of neuropathic pain so as to correctly diagnose these conditions hence avoid unnecessary dental intervention. This article reviews the conditions with paroxysmal neuralgia in children and available treatment strategies.