& Superior Laryngeal Neuralgia
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Vegal and Superior Laryngeal Neuralgia : The two somatic sensory branches of the vagus nerve, the auricular branch and the superior laryngeal nerve, can also be the site of a pain syndrome that resembles that of tic douloureux. This syndrome is rare.
It is thought that compression of the upper fibers of the vagal nerve as they leave the brain stem and traverse the subarachnoid space to the jugular foramen is the cause of vagal neuralgia.
Symptoms and Signs
Vagus nerve neuralgia is characterized by paroxysms of shock-like pain in the side of the throid cartilage, pyriform sinus, angle of the jaw, and, rarely, in the ear. Occasionally the pain radiates into the upper thorax or up into the jaw. The trigger zone is usually in the larynx; attacks are precipitated by talking, swallowing, yawning, or coughing. When other portions of the vagus nerve are involved, the patient might have hiccups, inspiratory stridor, excessive salivation, or coughing. The pain is in every way typical of tic douloureux except for its location. The combination of glossopharyngeal and vagal as well as trigeminal pain has been reported.
The diagnosis is established by the history and by identifying the site of the trigger zone. Associated vagal nerve findings, as described above, also pinpoint this nerve as the site of the pain. Laryngeal topical anesthesia or blockade of the superior laryngeal nerve stops the pain and is useful diagnostic and prognostic procedure.
The pharmacologic treatment of vagal neuralgia is identical to that of tic douloureux. When medications do not control the pain, suboccipital craniectomy with decompression of the upper fibers of the vagal nerve is warranted. If no lesion is seen, the upper vagal and glossopharyngeal nerves should be sectioned. This procedure is usually successful, but, when it is not, section of the medial portion of the descending trigeminal tract can be beneficial.
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