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glossopharyngeal_neuralgia

Glossopharyngeal neuralgia

Glossopharyngeal nerve neuralgia are recurring attacks of severe pain in the back of the throat, the area near the tonsils, the back of the tongue, part of the ear, and/or the area under the back of the jaw. The pain is due to malfunction of the 9th cranial nerve (glossopharyngeal nerve)

Epidemiology

Glossopharyngeal neuralgia (GPN) (a.k.a. vagoglossopharyngeal neuralgia) is a rare condition, with an estimated incidence of 0.8 cases per 100,000 persons per year 1).

Predilection among females, principally within the fifth decade of life 2).

Corresponds to 0.2-1.3% of all facial pain syndromes 3).

GPN occurs more frequently on the left side and involvement is bilateral (not simultaneously) in only 2% of the cases 4).

Classification

The GPN can be classified by the clinical features, including the classic GPN (episodic pain) and the symptomatic GPN (continuous pain), and the second is classified by the etiology, including an idiopathic origin or a secondary nature (e.g., tumor, neurovascular compression) 5).

Etiology

The cause is often unknown but sometimes is an abnormally positioned artery that puts pressure on (compresses) the glossopharyngeal nerve, where the nerve exits the brain stem.

Clinical features

The neuropathic pain is characterized by paroxysmal pain episodes localized in the posterior tongue, tonsil, throat, and/or the external ear canal. Vagal involvement can produce bradycardia, syncope or asystole. Common triggers include eating, swallowing and speaking 6).

The long, pointed bone at the base of the skull (styloid process) is abnormally long and compress the nerve.

Attacks are brief and occur intermittently, but they cause excruciating pain. Attacks may be triggered by a particular action, such as chewing, swallowing, talking, yawning, coughing, or sneezing. The pain usually begins at the back of the tongue or back of the throat. Sometimes pain spreads to the ear or the area at the back of the jaw. The pain may last several seconds to a few minutes and usually affects only one side of the throat and tongue.

Diagnosis

The diagnosis of GPN is primarily clinical, and complimentary imaging can be performed, including computed tomography (CT) or magnetic resonance imaging (MRI) scans, which can reveal adjacent tumors, neurovascular conflicts, arteriovenous malformations (AVMs), demyelinating lesions, or an elongated styloid process involving the IX and X cranial nerves (CN) 7).

Treatment

1)
Katusic S, Williams DB, Beard CM, Bergstralh EJ, Kurland LT. Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945-1984. Neuroepidemiology. 1991;10(5-6):276-81. PubMed PMID: 1798430.
2)
Rushton JG, Stevens JC, Miller RH. Glossopharyngeal (vagoglossopharyngeal) neuralgia: a study of 217 cases. Arch Neurol. 1981 Apr;38(4):201-5. PubMed PMID: 7213143.
3)
Singh PM, Kaur M, Trikha A. An uncommonly common: Glossopharyngeal neuralgia. Ann Indian Acad Neurol. 2013 Jan;16(1):1-8. doi: 10.4103/0972-2327.107662. PubMed PMID: 23661955; PubMed Central PMCID: PMC3644765.
4)
Rey-Dios R, Cohen-Gadol AA. Current neurosurgical management of glossopharyngeal neuralgia and technical nuances for microvascular decompression surgery. Neurosurg Focus. 2013 Mar;34(3):E8. doi: 10.3171/2012.12.FOCUS12391. Review. PubMed PMID: 23451790.
5)
Silberstein SD, Olesen J, Bousser MG, Diener HC, Dodick D, First M, Goadsby PJ, Göbel H, Lainez MJ, Lance JW, Lipton RB, Nappi G, Sakai F, Schoenen J, Steiner TJ; International Headache Society. The International Classification of Headache Disorders, 2nd Edition (ICHD-II)–revision of criteria for 8.2 Medication-overuse headache. Cephalalgia. 2005 Jun;25(6):460-5. Erratum in: Cephalalgia. 2006 Mar;26(3):360. PubMed PMID: 15910572.
6)
Martínez-Álvarez R, Martínez-Moreno N, Kusak ME, Rey-Portolés G. Glossopharyngeal neuralgia and radiosurgery. J Neurosurg. 2014 Dec;121 Suppl:222-5. doi: 10.3171/2014.8.GKS141273. PubMed PMID: 25434956.
7)
Ordónez-Rubiano EG, García-Chingaté CC, Rodríguez-Vargas S, Cifuentes-Lobelo HA, Perilla-Cepeda TA. Microvascular Decompression for a Patient with a Glossopharyngeal Neuralgia: A Technical Note. Cureus. 2017 Jul 20;9(7):e1494. doi: 10.7759/cureus.1494. PubMed PMID: 28948114; PubMed Central PMCID: PMC5606712.
glossopharyngeal_neuralgia.txt · Last modified: 2018/01/11 17:27 by administrador