Diagnosis and treatment of glossopharyngeal neuralgia

Morioka Motohiro

doi:10.14821/stomatopharyngology.26.39

Glossopharyngeal neuralgia (GPN) is a rare disease characterized by severe, short and stabbing pain at the unilateral pharynx and base of the tongue. Some patients have described having severe pain beneath their ear and when the pain is located at this site it causes difficulty in distinguishing GPN from trigeminal neuralgia. The cause of GPN is widely accepted is as vascular compression at the root entry zone (REZ) of the glossopharyngeal and vagal nerves. GPN has been diagnosed by the pain area innervated by the glossopharyngeal and vagal nerves. If local anesthesia of the region of the pharynx (classically called the “cocaine test”) relieved the pain, it strongly suggests a diagnosis of GPN. The MRI images of CISS (or FIESTA) clearly show the compressing artery supporting the diagnosis. Although the treatment of choice is an anti-epileptic drug such as Carbamazepine, surgical treatment is performed for the cases in which the pain is uncontrollable by medication. Microvascular decompression by suboocipital craniotomy can relieve the pain in the long-term for about 80% of patients. Another surgical treatment is an intracranial section (rhizotomy) of both the glossopharyngeal nerve and the sensory part of the vagal nerves which can achieve pain relief in 85% of patients with uncontrollable pain, although there is the complication of hoarseness and irritating cough can occur in 10% of patients.

Diagnosis and treatment of glossopharyngeal neuralgia

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