Surgical interventions targeting the nucleus caudalis: a systematic review and historical perspective.

Introduction: Chronic facial pain is a prevalent group of conditions and when refractory to common treatments poses a social and economic burden. The last decade has seen a multitude of advancements in the multimodal management of pain. Ablative or neuromodulatory interventions targeting the nucleus caudalis (NC) of the trigeminocervical complex is one such treatment that has remained underutilized. Methods: Here we present a systematic review of the literature and historical perspective regarding interventions targeting the NC. We examine the various intervention techniques, clinical indications, and procedural efficacy. A novel outcome reporting scheme was devised to allow comparison between studies using differing outcome reporting methods. Results: A review of the literature revealed 49 retrospective studies published over the last 80 years, reporting on 858 patients. The most common technique was the open NC dorsal root entry zone nucleotomy/tractotomy (n=515, 60.0%); however, there has been an emergence of novel approaches such as endoscopic (n=6, 0.7%) and spinal cord stimulation (n=20, 2.3%) in the last 10 years. Regardless of intervention technique or preoperative diagnosis, 90.4% of patients demonstrated some improvement from treatment. Conclusion: This systematic review highlights recent advancements in NC intervention technique and the wide range of facial pain syndromes for which these interventions show promising efficacy. New and less invasive techniques continue to emerge, however prospective studies remain absent in the literature. Future work should address efficacy comparisons between intervention type and preoperative diagnosis.

Unilateral Eagle’s Syndrome

Eagle’s syndrome represent as a neck, cervicofacial pain, dysphagia, facial pain, globus sensation, tinnitus, otalgia and headache, it may be unilateral or bilateral. About 4% of adult population accounted elongated styloid process, which are the principal factor of Eagle’s syndrome and followed by 0.16% of patients are symptomatic. Stylohyoid ligament calcification is the second most common factor. The diagnosis must be made through a detailed history, clinical examination, and various imaging modalities. A 36 years old female patient presented with persistent pain in the throat. An elongated styloid process was diagnosed and was removed by transoral approach following the patient was relieved from her symptoms. J Bangladesh Coll Phys Surg 2022; 40: 72-74

Clinical manifestations, diagnostics and treatment of persistent idiopathic facial pain

Persistent idiopathic facial pain (PIFP) is often regarded as an undiagnosed condition with a poor prognosis. Extensive research on this topic is limited, and there are few effective treatments. Even with an established diagnosis of PIFP, due to poor awareness of the etiology and pathogenesis of the development of the disease, patients struggle with the acceptance of the ‘all-encompassing’ disorder in search of the causes that led to the disease and often undergo unnecessary tests and procedures in search of alternative diagnoses.

Delayed-Onset Neuropathic Pain after Septoplasty

Postoperative pain following a septoplasty is expected to be mild and limited to a few days after the operation. Chronic pain following the procedure is rare. No cases of delayed-onset neuropathic pain or allodynia have been described in the literature. This paper presents a case of delayed-onset neuropathic pain after septoplasty in a previously pain-free asthmatic patient that was successfully managed by administration of intranasal local anaesthesia. Physical examination and imaging excluded any other cause of neuralgia. A literature review revealed reports of chronic pain in patients following septoplasty if there were nasal contact or compression points or nasal tumours. Separately, acute postseptoplasty allodynia is documented in iatrogenic maxillary nerve damage. However, delayed-onset neuralgic pain, exacerbated by certain environmental triggers, has not been previously described. Facial pain can be debilitating; successfully managing this neuralgic pain with administration of intranasal local anaesthetic had a substantial effect on the patient’s quality of life.

Prevalence of Trigeminal Neuralgia in Patients with Chronic Facial Pain in Neurology Lrh Hospital Peshawar.

Background: Trigeminal Neuralgia (TN) consist of brief periodic but severe and chronic facial pain in acial region in single or multiple branches of the trigeminal nerve. Objective: The objective of this study was to find the prevalence of TN in patients with chronic facial pain. Methodology: This cross sectional observational study was conducted at Department of Neurology OPD Lady Reading Hospital, Peshawar. 46 patients with chronic facial pain were selected for the study. All data was taken on a structured Performa and was entered and analyzed using SPSS version 21. Using non probability consecutive sampling after taking approval from Ethical Committee of the hospital, study duration was 10 months from 25-1-2019 to 25-10-2019. Results: Out of 46 patients, there were 18 (39.1%) males and 28 (60.9%) females. The mean age of the patients was 50.67, the Standard Deviation recorded was 11.56. Minimum age was 21 and maximum age was 67. 23. Out of 31 patients diagnosed with TN had history of tooth extraction and 8 had no extraction. Out of 31 patients presented with TN, right side was involved in 24 (52.2%) patients and left side was involved in 7 (15.2%) patients. Mandibular never was more common in the patients with TN which was 37% followed by maxillary nerve 21.7%, and ophthalmic nerve at 8.7%. Majority of the patients 28 (75.7%) belonged to the age group of 40 to 67. Females having TGN were 78% and males were 50%. Right side (52.2%) was more involved than left side. Mandibular division (37%) was more involved than maxillary and ophthalmic division. Conclusion: We conclude that females are more at risk of developing TN than males. Increasing age has a higher chance of developing TN. Right side is more involved than left. Mandibular division is more involved than maxillary and ophthalmic.

Trigeminal paresthesia secondary to responsive neurostimulation (RNS) lead migration

Background: The responsive neurostimulation system (RNS) is used in patients with drug-resistant epilepsy who are not candidates for surgical resection of a seizure focus. As a relatively new therapy option, the adverse effects of long-term implantation are still being clarified. We present a series of two patients who presented with similar symptoms which were attributable to migration of the intracranially implanted subdural leads. Case Description: Two patients who had subdural RNS lead implantation presented with symptoms of paroxysmal unilateral facial pain which were thought to be related to the stimulation of the trigeminal nerve secondary to RNS lead migration. Adjustment of the stimulation parameters improved the symptoms in both patients. Conclusion: Chronically implanted subdural RNS leads can migrate over time stimulating nerves in the intracranial space. Strategies to avoid and overcome the complication are discussed.