Ultrasound Guided Infraorbital Nerve Radiofrequency Thermocoagulation in Patients with Trigeminal Neuralgia

Abstract

Trigeminal neuralgia (TN) is a sudden intensive orofacial pain disorder characterized by a unilateral recurrent paroxysmal lancinating pain occurring in the area of trigeminal nerve distribution. Diagnosis is made with characteristic clinical presentations and requires brain magnetic resonance imaging to rule out intracranial tumor or multiple sclerosis which potentially causes secondary TN. Among the various interventional managements, the conventional radiofrequency thermocoagulation (RFT) of Gasserian ganglion results in the highest rate of complete pain relief. We report two cases who presented severe facial pain due to intractable TN of V2 division. For pain relief, Gasserian ganglion RFT was planned. However, both patients could not tolerate the neck extension and chin-up position. Therefore, ultrasound guided infraorbital nerve RFT which does not require such position was performed successfully. When the patients came to the pain clinic 2 weeks later, the numerical rating scale for TN was 2/10 with mild hypoesthesia of V2 division. Infraorbital nerve RFT is an alternative option in patients who is unable to tolerate the ganglion RFT.