Case report
Two cases of idiopathic superior laryngeal neuralgia treated by superior laryngeal nerve block with a high concentration of lidocaine

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Abstract

Carbamazepine therapy is among the most effective drug regimens to treat patients who have superior laryngeal neuralgia similar to trigeminal neuralgia. However, some patients are resistant to carbamazepine. We report two patients with superior laryngeal neuralgia who were successfully treated with superior laryngeal block using high concentrations of lidocaine, after treatment with carbamazepine failed.

Introduction

For treatment of neuralgia, nerve block can alleviate the pain immediately after injection. Although nerve block using neurolytic agents, that is, alcohol or phenol, can sustain or prolong the effect, some cases have experienced prolonged discomfort, such as alcohol neuralgia and hypoesthesia. To alleviate the adverse effects, high concentrations of local anesthetics were reportedly used in several cases [1], [2], [3], [4].

Idiopathic superior laryngeal neuralgia (SLN) is a very rare form of neuralgia that is generally treated with carbamazepine [6], [7]. However, some cases were resistant to this drug therapy. We experienced two cases of SLN that were treated successfully with superior laryngeal nerve block (SLB) using high concentrations of lidocaine when treatment with other drugs, including carbamazepine, failed.

Section snippets

Case 1

A 78-year-old woman was admitted to our hospital with paroxysms of colic pain radiating from the right upper portion of the thyroid cartilage to the ear. These episodes lasted for periods of several seconds to minutes. The results of general and neurologic examinations, including computed tomography (CT), magnetic resonance imaging (MRI), and direct laryngoscopy, were entirely normal. Carbamazepine and clonazepam did not adequately alleviate her pain, and in fact they induced dizziness. She

Discussion

Superior laryngeal neuralgia is characterized by unilateral paroxysms of shooting pain radiating from the hyoid bone to the angle of the jaw and sometimes to the ear. The differential diagnosis includes symptomatic neuralgia due to an inflammatory or neoplastic process in the larynx. Superior laryngeal nerve block at the point where the nerve pierces the hyothyroid membrane is most curative and helpful for the differential diagnosis because other nerves are not nearby.

Peripheral nerve block

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