A case report of complex auricular neuralgia treated with the great auricular nerve and facet blocks
Authors Eghtesadi M, Leroux E, Vargas-Schaffer G
Received 7 November 2016
Accepted for publication 10 January 2017
Published 17 February 2017 Volume 2017:10 Pages 435—438
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Lucy Goodman
Peer reviewer comments 3
Editor who approved publication: Professor Michael Schatman
Marzieh Eghtesadi,1 Elizabeth Leroux,2 Grisell Vargas-Schaffer3
1Department of Pain Clinic, Headache Management, Centre Hospitalier de l’Université de Montréal (CHUM), Centre de Recherche de l’Université de Montréal (CRCHUM), 2Department of General Neurology, Headache Management, Centre Hospitalier de l’Université de Montréal (CHUM), Centre de Recherche de l’Université de Montréal (CRCHUM), 3Department of Anesthesiology, Pain Clinic, Centre Hospitalier de l’Université de Montréal (CHUM), Centre de Recherche de l’Université de Montréal (CRCHUM), Montreal, QC, Canada
Background: The great auricular nerve is a cutaneous branch of the cervical plexus originating from the C2 and C3 spinal nerves. It innervates the skin over the external ear, the angle of the mandible and the parotid gland. It communicates with the ansa cervicalis. Great auricular neuralgia is rarely diagnosed in clinical practice and can be refractory. We present a new approach using ultrasound-guided nerve blocks.
Case: We present a case of a 41-year-old female with paroxysmal ear pain accompanied by dysautonomia, tingling in the tongue, dysphagia, dysarthria and abdominal symptoms. No significant findings were found on cervical and brain imaging. The patient responded partially to a great auricular nerve block. A combined approach using this block with facet block of C2 and C3 induced a more pronounced and prolonged benefit.
Conclusion: Great auricular neuralgia is not often encountered in practice and can be accompanied by symptoms originating from the ansa cervicalis network. A combined approach of nerve blocks can be considered in refractory cases.
Keywords: ansa cervicalis, neuropathic pain, facet block, red ear syndrome, great auricular nerve
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