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Abstract
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Background and Aims Glossopharyngeal neuralgia (GN) prevalence in pediatrics is unknown(1). Common causes are schwannoma(2) and Chiari malformation(3). Pharmacotherapy is the cornerstone with a poor efficacy around%(4). Invasive treatment has been described(5) ,but there is not date about the use of pulsed radiofrequency (PRF) on pediatric patients with GN, although in adults there are some(6). We present a successful case of a child with primary GN treated with PRF.
Methods A 9-year-old female with a history of one year of GN unresponsive to medical treatment was referred to our pain clinic. She had a glossopharyngeal nerve block with complete pain relief for 2 weeks. Because the short-pain-relief a PRF was scheduled. After informed consent, using GA with aseptic conditions using ultrasound with a linear-high- frequency-transducer, the styloid process and the carotid artery were identified. An in-plane approach toward the posterior aspect of the styloid using hydrodissection with saline with a further Contrast injection verifying with fluoroscopy the final target. Because she was under GA no sensitive stimulus was delivered. PRF was performed with 2 cycles of 42C/4minutes/85volts. Then 3ml of bupivacaine-0.5% without epinephrine plus 2 milligrams of dexamethasone were administered (figures 1,2)
Results There were not complications recorded during or after the procedure. The patient experienced a pain relief of 60% during the first week, and a continues benefit of 85% during a 6-month-follow-up.
Ultrasound shows Styloid process and mandible
Ultrasound shows styloid process and Carotid artery
Conclusions PRF may represent an interesting therapeutic alternative and minimally invasive option in pediatric population. Further studies are needed to stablish the role of PRF in craniofacial pain in pediatrics.
Attachment Glossopharyngeal neuralgia case.pdf