Introduction: Glossopharyngeal neuralgia (GPN) is a rare condition in which typically there is unilateral pain in the distribution of the glossopharyngeal nerve such as in the throat, ear, and neck. Bilateral GPN is extremely rare. To date, there has been no surgical report describing the safe surgical management of bilateral GPN, which can potentially be high risk. We describe a 24-year old female patient with bilateral GPN who underwent staged surgery for bilateral GPN without major complications.
Methods: A right-handed female with a history of a complex facial pain syndrome since her teens presented with right-sided GPN. The patient had already exhausted medical therapy and had undergone surgery for left-sided GPN two years prior, which consisted of sectioning the left glossopharyngeal nerve root and upper rootlets of the vagus nerve. Her current right-sided GPN consisted of pain behind the mandibular angle and just below the ear, and was described as being sharp and stabbing in nature. Pre-operative oropharyngeal (swallowing, vocal cord) and cardiac (arrhythmia) function tests showed no evidence of an increased risk for developing life-threatening oropharyngeal or cardiac complications from surgery. Imaging showed no evidence of vascular compression of the nerves or bony abnormalities. Therefore, a right-sided retrosigmoid craniectomy was performed to treat her pain, which consisted of sectioning the left glossopharyngeal nerve and upper rootlets of the vagus nerve.
Results: The patient did not develop any cardiac or oropharyngeal complications during surgery. The patient experienced complete relief from pain just within the first few days after surgery. At one-year follow-up, the patient maintained continued relief from pain with no associated dysphagia or cardiac arrhythmias.
Conclusions: Staged surgery for bilateral GPN may be a viable option in carefully selected patients who have undergone thorough pre-operative assessment of oropharyngeal and cardiac functions.
Patient Care: Our case report will inform surgeons of an effective and safe method to surgically treat refractory bilateral glossopharyngeal neuralgia (GPN).
Learning Objectives: By the conclusion of this session, participants should be able to: 1) identify the potential complications of surgery for glossopharyngeal neuralgia (GPN), and 2) understand the importance of performing cardiac and oropharyngeal functional tests pre- and post-operatively in surgical candidates.