Percutaneous Pulsed Radiofrequency Treatment in a Patient with Chronic Bilateral Painful Glossopharyngeal Neuropathy
Challenging differential diagnosis, Unusual setting of medical care, Rare disease
Cornelis Wilhelmus Jacobus van Tilburg
Department of Pain Medicine, DC Klinieken, Breda, Netherlands
Am J Case Rep 2020; 21:e920579
Available online: 2020-01-24
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.
Keywords: Facial Neuralgia, Glossopharyngeal Nerve, Glossopharyngeal Nerve Diseases, Pulsed Radiofrequency Treatment, Surgical Procedures, Minimally Invasive