Great Auricular Neuralgia: Case Series

Botulinum toxin type a for great auricular neuralgia

great auricular neuralgia is a rare disorder with only 18 cases described in the literature. Since it's a rare disorder, there are no evidence-based therapeutic recommendations but only case reports to guide physicians. We report a case of great auricular neuralgia treated with botulinum toxin type A subcutaneous injection with significant remission of pain. Botulinum toxin type A could be an effective and safe treatment in this setting; however, more studies are needed to confirm our results.

Experience with three-dimensional exoscope-assisted surgery of giant mastoid process osteoma

BACKGROUND

The excision of a giant mastoid process osteoma can be challenging. In such situations, the three-dimensional exoscope intra-operative optic may be a promising tool.

CASE REPORT

This paper provides a technical description of a giant mastoid osteoma excised under three-dimensional exoscope magnification. A fragmented excision by intralesional curettage was adopted to prevent peri-tumoural damage. This technique had been previously described for the excision of large osteomas of the sinus.

CONCLUSION

The three-dimensional exoscope magnification tool had excellent applicability during surgery of a rare mastoid osteoma. In complex anatomical areas, the cavitation and fragmented excision of the tumour may prevent complications and is therefore recommended.

Ultrasound-Guided Selective Pulsed Radiofrequency Treatment of Great Auricular Nerve for Post-Herpetic Neuralgia of the Head and Neck: A Case Report

Objective

The current study aimed to further verify the feasibility of ultrasound-guided selective pulsed radiofrequency (PRF) therapy of greater auricular nerve (GAN) in the treatment of head and neck post-herpetic neuralgia (PHN) by observing the efficacy and safety.

Methods

Under the guidance of high-frequency ultrasound (Frequency: 10 MHz), the GAN was identified by a radiofrequency electrode trocar with a transverse in-plane approach, which was inserted into the GAN, then the inner needle of the trocar was retracted. After adjusting the technical variables (electrode tip temperature: 42°C, output voltage: 60 V, pulse frequency: 2 Hz, pulse width: 22 ms, single duration: 240 s, two times), the radiofrequency electrode placed on the auricle and below the ear for sensory and motor tests began to work.

Results

The pain in the left head and neck of the patient lasted for more than 1 month, we decided to try selective PRF of GAN guided by ultrasound for the first time. Immediately after the treatment, 11-point pain intensity numerical rating scale (PI-NRS) score ranged from 5 to 1. During his hospitalization, mecobalamine and gabapentin were taken instead of opioids. Seven days after the procedure, PI-NRS score was 2, the degree of numbness the patient he felt by himself in the original lesion area relieved from 100% to 40%, the depression module of the Patient Health Questionnaire-9 (PHQ-9) score was from 7 to 5, the Generalized Anxiety Disorder-7 (GAD-7) score from 8 to 4, the range of pain areas was reduced to external auditory tract, and there were no adverse events occurring.

Conclusion

The ultrasound-guided selective PRF treatment of GAN was safe and effective in the improvement of PHN in the head and neck, which is worthy of clinical promotion.

Nerve block as neuropathic pain treatment for the great auricular nerve neuropathy: A case report

OBJECTIVE/BACKGROUND

The great auricular nerve (GAN) is a major sensory branch of the cervical plexus. Painful great auricular neuropathy causes pain circumscribed to the inferior preauricular region, the jaw angle, the ventral pinna, and the mastoid region.

METHODS

We present a 46-year-old woman experiencing facial pain in the bilateral preauricular and infra-auricular region, constant, of abrasive quality without any other associated symptomatology that is triggered or aggravated with cephalic movements, cervical turn, mandibular movement, and palpation on the affected area.

RESULTS

Symptomatic treatment with analgesics, anti-inflammatories, and neuropathic preventive medications was ineffective. However, nerve block anesthetic treatment resulted in complete pain remission.

CONCLUSION

Great auricular neuropathy is an uncommon cause of facial pain; our case report is the first bilateral occurrence reported to date. It should be suspected in patients with circumscribed shooting or lancinating paroxysmal pain in the territory of the GAN. It is characterized by the aggravation of pain with cervical movements and complete relief after anesthetic blockade.

First Bite Syndrome: What Neurologists Need to Know

PURPOSE OF REVIEW

Though first bite syndrome is well known in surgical settings, it is not commonly included in the differential for sharp paroxysmal facial pain in the neurology literature. This paper will highlight the clinical features and relevant anatomy of first bite syndrome, with the goal of helping clinicians differentiate this from other similar facial pain disorders.

RECENT FINDINGS

First bite syndrome is severe sharp or cramping pain in the parotid region occurring with the first bite of each meal and improving with subsequent bites. Pathophysiology has been attributed to imbalanced sympathetic/parasympathetic innervation of the parotid gland. This is seen most typically in the post-surgical setting following surgery in the parotid or parapharyngeal region, but neoplastic etiologies have also been reported. It is common for patients to present with concurrent great auricular neuropathy and/or Horner's syndrome. Evidence regarding treatment is limited to case reports/series, however, botulinum toxin injections and neuropathic medicines have been helpful in select cases. It is critical for clinicians to be able to differentiate first bite syndrome from other paroxysmal facial pain. To help with this, we have proposed diagnostic criteria for clinical assessment. Patients often improve gradually over time, but symptomatic treatment with botulinum toxin or neuropathic medicine may be required.

A comprehensive review of the great auricular nerve graft

The great auricular nerve (GAN) is a superficial branch of the cervical plexus that innervates parts of the mandible, auricle, and earlobe. Over the past 30 years, the GAN has become the nerve graft donor of choice for many surgeons for reconstructing injured facial nerves. In this review, we discuss the anatomy and function of the GAN, while focusing on surgical landmarks and the characteristics that make it a suitable nerve graft donor. In addition, we present and summarize published case reports on use of the GAN for grafting. We hope that this review will provide surgeons with an up-to-date and concise reference.

Craniofacial neuralgias

While non-headache, non-oral craniofacial neuralgia is relatively rare in incidence and prevalence, it can result in debilitating pain. Understanding the relevant anatomy of peripheral branches of nerves, natural history, clinical presentation, and management strategies will help the clinician better diagnose and treat craniofacial neuralgias. This article will review the nerves responsible for neuropathic pain in periorbital, periauricular, and occipital regions, distinct from idiopathic trigeminal neuralgia. The infratrochlear, supratrochlear, supraorbital, lacrimal, and infraorbital nerves mediate periorbital neuralgia. Periauricular neuralgia may involve the auriculotemporal nerve, the great auricular nerve, and the nervus intermedius. The greater occipital nerve, lesser occipital nerve, and third occipital nerve transmit occipital neuralgias. A wide range of treatment options exist, from modalities to surgery, and the evidence behind each is reviewed.