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GLOSSOPHARYNGEAL NEURALGIA
Conditions: Other Cranial Disorders

Disclaimer.

Glossopharyngeal Neuralgia is described as a deep stabbing pain in one side of the throat. The pain is near the tonsil area and can extend into the ear.

Links:

Glossopharyngeal Neuralgia - Singapore Journal 1999

Medline on Glossopharyngeal Neuralgia

Merk Manual-- glossopharyngeal neuralgia

Glossopharyngeal neuralgia, CCND Winnipeg

Glossopharyngeal neuralgia University of Pittsburgh

Glossopharyngeal Neuralgia , B.Todd Troost

The following article goes into greater detail although it does not discuss microvascular decompression surgery as a possible treatment..

The following article is excerpted from:
THE MANAGEMENT OF PAIN,
VOL 1, Second Edition, 1990, Lea & Febiger, Philadelphia]
CRANIAL NEURALGIAS
John D. Loeser

This article is posted here in compliance with the FAIR USE DOCTRINE and is for educational purposes only, not for commercial use.

"Glossopharyngeal neuralgia is characterized by shock like pains in the territory of the glossopharyngeal nerve. It is in every way similar to tic douloureux except for the distribution of the pain and the customary site of the triggering stimulus.

Etiology

"The vast majority of patients with glossopharyngeal neuralgia are thought to have an artery compressing the nerve as it exits from the medulla and travels through the subarachnoid space to the jugular foramen. This syndrome can be seen in patients with multiple sclerosis, but it is rare.

Symptoms and Signs

"Glossopharyngeal neuralgia is characterized by excruciating shock-like-pain in the region of the tonsilar fossa, pharynx, or base of the tongue. It can radiate to the ear or the angle of the jaw or into the upper lateral neck. The trigger zone is often in the same area, and patients frequently report that swallowing, yawning, clearing the throat, or talking is the precipitating stimulus. The pain often appears to be spontaneous. Chewing or touching the face does not precipitate an attack. Glossopharyngeal neuralgia is much less common than tic douloureux---the incidence ratio is about 1:100.

Diagnosis

"The nature of the pain, its description by the patient, and the chronology of the attacks are identical to those of tic douloureux of the trigeminal nerve. Indeed, glossopharyngeal tic is sometimes mistaken for mandibular division trigeminal tic douloureux. Involvement of the glossopharyngeal nerve can be demonstrated by localizing the triggering stimulus to the pharyngeal structures that it innervates. Blocking the trigger area with local anesthetic can confirm the site of the trigger and nerve involvement. This is unsuccessful in some patients because the vagus nerve can contain the involved sensory fibers. The role of the glossopharyngeal nerve in the regulation of heart rate and blood pressure is thought to be why some patients with glossopharyngeal neuralgia have profound cardiac arrhythmia's and even asystole with the attack of pain. The presence of such phenomena guarantees that the pain syndrome involves this nerve. The diagnosis can be confirmed by the cessation of pain when this nerve is blocked at the jugular foramen or when topical anesthesia of the pharynx stops the pain.

Treatment

"The pharmacologic management is the same as that for tic douloureux of the trigeminal nerve. When medical management fails, suboccipital craniectomy with exploration of the glossopharyngeal nerve is indicated. If a compressing blood vessel is found it can be mobilized, and the pain usually stops without any loss of nerve function. When no structural pathology can be identified, the glossopharyngeal nerve should be Sectioned. In such a case it is wise to Section the upper fibers of the vagus nerve as well, because they can also be involved in the pain syndrome. When rhizotomy is unsuccessful, which happens rarely, the medial aspect of the descending tract of the trigeminal nerve can be Sectioned to produce loss of pain and temperature sensation in the pharynx.

"A percutaneous technique of glossopharyngeal neurolysis has been described, but it has not been widely used because of cardiovascular and laryngeal complications. "

 

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