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Do K, Kawana E, Tian S, Bigcas JL. Treatment of Warthin's Tumors of the Parotid Gland With Radiofrequency Ablation: A Systematic Review of the Current Literature. EAR, NOSE & THROAT JOURNAL 2024:1455613241248119. [PMID: 38647239 DOI: 10.1177/01455613241248119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Objective: Warthin's tumors of the parotid gland can be safely observed. Definitive treatment usually requires parotidectomy under general anesthesia. The decision to operate on Warthin's tumors of the parotid gland can be complicated in patients who wish to avoid risks of surgery and general anesthesia. This systematic review explores the potential of radiofrequency ablation (RFA) as a minimally invasive alternative. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model was used to collect 3 relevant studies that focused on RFA treatment for Warthin's tumors. The cumulative averages for tumor size and cosmetic scores were then quantified for patients with Warthin's tumors who underwent RFA therapy. The PRISMA systematic review method was employed to the PubMed and EMBASE databases. The comprehensive search term "Warthin Tumor Treatment" yielded 1299 articles from the years 1955 to 2023, 3 of which met inclusion criteria and were then selected. Results: The 3 quantitative studies collectively assessed 37 patients with Warthin's tumors treated with RFA. Patients experienced an average tumor size reduction of 85.03% at 12 months post-RFA. There were minimal complications associated with RFA in these patients. Conclusion: This study suggests that RFA is an alternative to parotidectomy for the symptomatic treatment of Warthin's tumors. RFA procedures demonstrated substantial tumor size reduction with few complications. However, further meta-analysis and comparison with alternative treatments is warranted to establish RFA's role in treatment of Warthin's tumors. The study is limited by its reliance on only 2 databases and a lack of comprehensive examination of different RFA settings.
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Affiliation(s)
- Kenny Do
- Department of Otolaryngology-Head and Neck Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Eric Kawana
- Department of Otolaryngology-Head and Neck Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Sisi Tian
- Department of Otolaryngology-Head and Neck Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, NV, USA
| | - Jo-Lawrence Bigcas
- Department of Otolaryngology-Head and Neck Surgery, Kirk Kerkorian School of Medicine at University of Nevada, Las Vegas, Las Vegas, NV, USA
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You S, Qin X, Tong L, Feng Z. Long-Term Follow-Up of Ultrasound-Guided Glossopharyngeal Nerve Block Treatment for Glossopharyngeal Neuralgia: A Retrospective Clinical Study of 43 Cases. J Pain Res 2024; 17:913-921. [PMID: 38476875 PMCID: PMC10927459 DOI: 10.2147/jpr.s437609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Background Glossopharyngeal neuralgia (GPN) is a rare chronic neuropathic pain disorder that significantly impacts quality of life. Ultrasound-guided glossopharyngeal nerve blocks (UGPNB) have gained popularity due to their various advantages. However, there have been no studies reporting the long-term outcomes of UGPNB in a larger cohort of GPN patients. Aim This study aims to evaluate the efficacy and safety of UGPNB in patients with GPN. Methods We reviewed the electronic medical records of patients with GPN who received UGPNB at the Department of Pain Medicine of the First Medical Center, PLA General Hospital between June 1, 2011, and June 1, 2022. The effect of UGPNB was evaluated using the Barrow Neurological Institute (BNI) scale. Improvement was defined as a reduction in pain category by comparing pain categories before and after therapy. Recovery was defined as achieving BNI I after treatment. Patients who responded to treatment but then regressed to the category before therapy were considered to have experienced pain relapse. Results A total of 43 patients with GPN who received UGPNB were included in the analysis. At discharge, 35 (81.4%) patients experienced pain improvement after treatment, and among them, 13 (30.2%) patients achieved recovery. After discharge, 13 patients (37.1%) out of the 35 effective patients experienced pain relapse at different time intervals: 0.5, 0.7, 1, 1, 3, 3, 4, 12, 15, 36, 45, 63, and 96 months. The cumulative recurrence-free survival rates were 88.85% at month 1, 82.83% at month 3, 77.04% at month 12, 70.31% at month 36, and 54.66% at month 120. Among the 13 patients who experienced relapse, four patients received a second UGPNB treatment, and pain improved in two patients (50%). No severe adverse reactions were documented. Conclusion UGPNB is an effective, repeatable, safe, and minimally invasive treatment for patients with GPN. It may be preferable to consider UGPNB before undergoing invasive intracranial surgery or neurodestructive methods.
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Affiliation(s)
- Shaohua You
- Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Xiaoyan Qin
- Department of Clinical Laboratory, Shijingshan Teaching Hospital of Capital Medical University, Beijing Shijingshan Hospital, Beijing, 100049, People’s Republic of China
| | - Li Tong
- Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
| | - Zeguo Feng
- Department of Pain Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, 100853, People’s Republic of China
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Wu Z, Zhao Y, Wu F, Fan Y, Yang Y. Percutaneous radiofrequency thermocoagulation and microvascular decompression for treating glossopharyngeal neuralgia: a retrospective clinical study. BMC Neurol 2023; 23:384. [PMID: 37872489 PMCID: PMC10591372 DOI: 10.1186/s12883-023-03415-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/30/2023] [Indexed: 10/25/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the differences in the effectiveness of percutaneous radiofrequency thermocoagulation (PRT) and microvascular decompression (MVD) in treating glossopharyngeal neuralgia (GPN). METHODS Medical records of patients were reviewed to investigate their baseline characteristics and immediate postoperative prognosis. Long-term outcomes of these patients were obtained through telephone interviews. Visual analog scale (VAS) and Pittsburgh sleep quality index (PSQI) scores at 1 day and 1, 4, 12, 24, and 48 weeks after surgery were compared between the MVD and PRT groups, in addition to complete pain relief rate, effective rate, adverse reactions, length of hospital stay, and economic indicators. RESULTS The VAS and PSQI scores of the two groups at 1 day and 1, 4, 12, 24, and 48 weeks after surgery were significantly lower (P < 0.05) than those before surgery. At 48 weeks, the complete remission rate was significantly higher (P < 0.05) in the MVD group than in PRT group. No significant difference in adverse reactions was observed between the two groups. The length of hospital stay, operative time, and cost were significantly higher (P < 0.05) in the MVD group than in the PRT group. CONCLUSIONS Both PRT and MVD can significantly reduce patients' degree of pain and improve their sleep quality. In the medium term, MVD is better than PRT in terms of the complete curative effect. In young patients with GPN, MVD is more often recommended than PRT; however, MVD is costlier than PRT.
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Affiliation(s)
- Zeyu Wu
- Department of Pain,The Affiliated Nanchong Central Hospital of North Sichuan Medical College, 97, South Renmin Road, Shunqing District, Nanchong, Sichuan, China
| | - Yongming Zhao
- Department of Pain,The Affiliated Nanchong Central Hospital of North Sichuan Medical College, 97, South Renmin Road, Shunqing District, Nanchong, Sichuan, China
| | - Fan Wu
- Department of Pharmacy, Sichuan Nanchong Mental Health center, The Second People's Hospital of Nanchong, Nanchong, Sichuan, China
| | - Yiyue Fan
- Department of Pain,The Affiliated Nanchong Central Hospital of North Sichuan Medical College, 97, South Renmin Road, Shunqing District, Nanchong, Sichuan, China.
| | - Ying Yang
- Department of Pain,The Affiliated Nanchong Central Hospital of North Sichuan Medical College, 97, South Renmin Road, Shunqing District, Nanchong, Sichuan, China.
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Jia Y, Cheng H, Shrestha N, Ren H, Zhao C, Feng K, Luo F. Effectiveness and safety of high-voltage pulsed radiofrequency to treat patients with primary trigeminal neuralgia: a multicenter, randomized, double-blind, controlled study. J Headache Pain 2023; 24:91. [PMID: 37464283 DOI: 10.1186/s10194-023-01629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/10/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Trigeminal neuralgia (TN) is a debilitating pain disorder that still lacks an ideal treatment option. Pulsed radiofrequency (PRF), especially with high output voltage, is a novel and minimally invasive technique. PRF is regarded a promising treatment option for TN patients who respond poorly to medical treatment; however, the available evidence still lacks high quality randomized controlled trials (RCTs). Our study aimed to evaluate the long-term (1 year and 2 years) effects and safety of high-voltage PRF in primary TN patients and provide stronger evidence for TN treatment options. METHODS We performed a multicenter, double-blind, RCT in adults (aged 18-75 years) with primary TN who responded poorly to drug therapy or were unable to tolerate the side effects of drug. Eligible participants were randomly assigned (1:1) to receive either high voltage PRF or nerve block with steroid and local anesthetic drugs. The primary endpoint was the 1-year response rate. This trial has been registered in the clinicaltrials.gov website (registration number: NCT03131466). RESULTS One hundred and sixty-two patients were screened for enrollment between April 28th,2017 and September1st, 2019, among whom, 28 were excluded. One hundred and thirty-four participants were randomly assigned to either receive high voltage PRF (n = 67) or nerve block (n = 67). The proportion of patients with a positive response at 1-year after the procedure in the PRF group was significantly higher than that in the nerve block group in the intention-to-treat population (73.1% vs. 32.8%, p < 0.001). There was no difference between groups in the incidence of adverse events. CONCLUSIONS Our findings support that high voltage PRF could be a preferred interventional choice prior to receiving more invasive surgical treatment or neuro-destructive treatment for TN patients who have poor responses to medical treatment. TRIAL REGISTRATION Our study has been registered at ClinicalTrials.gov (trial registration number: NCT03131466).
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Affiliation(s)
- Yitong Jia
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Hao Cheng
- Department of Anesthesiology, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Niti Shrestha
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Ren
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunmei Zhao
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kunpeng Feng
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fang Luo
- Department of Pain Management, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Jia Y, Wang Z, Ma Y, Wang T, Feng K, Feng G, Wang T. Efficacy and safety of high-voltage versus standard-voltage pulsed radiofrequency ablation for patients with neuropathic pain: protocol for a systematic review and meta-analysis. BMJ Open 2022; 12:e063385. [PMID: 35803629 PMCID: PMC9272125 DOI: 10.1136/bmjopen-2022-063385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Pulsed radiofrequency (PRF) ablation is commonly used for the treatment of neuropathic pain (NP). However, it is unclear whether increasing the output voltage of PRF can safely improve its efficacy. This study aims to compare the efficacy and safety of high-voltage PRF ablation and standard-voltage PRF ablation for the treatment of patients with NP. METHODS AND ANALYSIS We will search PubMed/MEDLINE, EMBASE, Web of Science, the Cochrane Library, conference proceedings for relevant abstracts, clinical trials registers (ClinicalTrials.gov) and the WHO's International Clinical Trial Registry Platform (from the date of inception until 15 March 2022). Only randomised controlled trials will be included. Two reviewers (YJ and GF) will independently perform study screening and selection, data extraction, risk-of-bias assessment and quality-of-evidence assessment. The primary outcome of this meta-analysis will be the efficiency rate in patients with NP. The secondary outcomes will include numeric rating scale score, visual analogue scale score, time to take effect, rescue drug dosage, quality of life using the health questionnaire (SF-36) and the incidence of adverse events. Meta-analyses will be conducted using standard meta-analysis software (RevMan V.5.3, The Nordic Cochrane Center, The Cochrane Collaboration, Copenhagen, Denmark). ETHICS AND DISSEMINATION The requirement for ethical approval was waived as our systematic review will be based on the published literature. The results of this study will be submitted to a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022297804.
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Affiliation(s)
- Yitong Jia
- Department of Anesthesiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Zheng Wang
- Department of General Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yanhui Ma
- Department of Anesthesiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Tengteng Wang
- Department of Thoracic Surgery, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Kunpeng Feng
- Department of Anesthesiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Guang Feng
- Department of Anesthesiology, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Tianlong Wang
- Xuanwu Hospital, Capital Medical University, Beijing, China
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Han A, Montgomery C, Zamora A, Winder E, Kaye A, Carroll C, Aquino A, Kakazu J, Kaye A. Glossopharyngeal Neuralgia: Epidemiology, Risk factors, Pathophysiology, Differential diagnosis, and Treatment Options. Health Psychol Res 2022; 10:36042. [PMID: 35774913 DOI: 10.52965/001c.36042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/04/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose of Review This is a comprehensive review of the most recent literature on glossopharyngeal neuralgia (GPN), a relatively rare form of neuropathic facial pain. It covers the epidemiology, risk factors, pathophysiology, and differential diagnosis given that glossopharyngeal neuralgia can often be confused with other facial pain syndromes. Finally, we extensively review recent findings regarding medical or conservative measures, minimally invasive, and surgical options for potentially treating and managing glossopharyngeal neuralgia. Recent Findings An in-depth analysis of the recent literature indicates that glossopharyngeal neuralgia is not only rare but its etiology and pathophysiology are complex and are often secondary to other disease processes. Regardless, current management options are shown to be effective in controlling pain. Conservatively, first-line management of GPN is carbamazepine, but gabapentin and eslicarbazepine acetate are suitable alternatives. In terms of current minimally invasive pain management techniques, pulsed radiofrequency ablation, nerve blocks, or percutaneous radiofrequency thermocoagulation are effective. Finally, surgical management involves microvascular decompression and rhizotomy. Summary While there are currently many viable options for addressing glossopharyngeal neuralgia pain ranging from conservative to surgical management, the complex nature of GPN etiology, pathophysiology, and involved anatomical structures prompts further research for more effective ways to treat the disease.
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Affiliation(s)
- Andrew Han
- School of Medicine, Georgetown University School of Medicine
| | | | | | | | - Adam Kaye
- Pharmacy and Health Sciences, Thomas J. Long School of Pharmacy and Health Sciences
| | | | | | - Juyeon Kakazu
- School of Medicine, Georgetown University School of Medicine
| | - Alan Kaye
- Louisiana State University Shreveport
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