Case reportTwo cases of idiopathic superior laryngeal neuralgia treated by superior laryngeal nerve block with a high concentration of lidocaine
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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Neuropathic Orofacial Pain
2018, Dental Clinics of North AmericaGamma Knife Radiosurgery of the Superior Laryngeal Neuralgia: A Report of 3 Cases
2018, World NeurosurgeryCitation Excerpt :According to a literature review, there are several reported options to treat SLN. Oral administration of a high dose of carbamazepine was used to achieve pain relief by Schmidt and Strutz12 and Kodama et al.9 Successful blockage of the superior laryngeal nerve using a high concentration of lidocaine was performed to treat 2 SLN patients by Takahashi Sato.6 Superior laryngeal neurectomy also achieved nearly complete resolution of SLN in a 60-year-old man, as reported by O'Neill et al.13 In the current study, the 3 patients had taken carbamazepine orally, but the degree of pain relief was not satisfactory.
Cranial Neuralgias
2016, Oral and Maxillofacial Surgery Clinics of North AmericaCitation Excerpt :Treatment is the same as with TN. Vagal neuralgia can respond well to high-concentration lidocaine injection nerve blocks if the pain is refractory to typical conservative medications such as carbamazepine.134 Surgical interventions such as MVD can be considered when other conservative treatments fail.135
Superior laryngeal nerve syndrome and the evaluation of anterior neck pain
2012, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryTreatment of trigeminal neuralgia with bupivacaine HCL using a temporary epidural catheter and pain pump: Preliminary study
2012, Journal of Cranio-Maxillofacial SurgeryCitation Excerpt :In our cases, the duration of effective pain relief with high concentrations of analgesic was much shorter than that in previous reports in which an infraorbital nerve block was used for TN. Sato et al. reported two cases of idiopathic superior laryngeal neuralgia treated with a superior laryngeal nerve block using a high concentration of lidocaine; the pain was alleviated for 1 year without the need to continue block therapy after 10 treatments using 1 mL of 10% lidocaine over 12 days (Takahashi et al., 2007). They postulated that the effective period in previous cases was shorter because the injected local anaesthetic remained in the trigger zone for a shorter time (Takahashi et al., 2007).