Great Auricular Neuralgia: Case Series.
great auricular nerve
nerve block
neuralgia
neuropathic pain
peripheral nerve stimulation
red ear syndrome
Journal
Headache
ISSN: 1526-4610
Titre abrégé: Headache
Pays: United States
ID NLM: 2985091R
Informations de publication
Date de publication:
01 2020
01 2020
Historique:
accepted:
10
10
2019
pubmed:
22
11
2019
medline:
6
5
2021
entrez:
22
11
2019
Statut:
ppublish
Résumé
The great auricular nerve (GAN) arises from C2-C3 and provides innervation over the skin in the pre-auricular region, jaw angle, posteroinferior pinna, and mastoid. Although damage to the GAN has been reported following trauma or procedures nearby this nerve course, neuralgia of this nerve is uncommon with knowledge based on a handful of case reports in literature. The objective of this study is to describe the presentation, treatment, and outcome of 13 cases of GAN neuralgia. Case series. Retrospecive review of charts from 1994 to 2018 with diagnoses: "auricular neuralgia," "auricular neuritis," or "auricular neuropathy." We included subjects with neuralgic pain within the distribution of the GAN, and excluded patients with atypical facial pain, GAN neuropathy, or unclear etiology. Of 79 charts, 13 patients met criteria (age at onset 11-59; 11 women, 2 men). Pain was most often described as paroxysmal stabbing provoked by: turning the head (n = 7), touching the neck (n = 5), neck position during sleep (n = 2), jaw movement (n = 2), and other (n = 2). Seven patients received GAN blocks: all noted dramatic improvement in pain, including 3 who continued to receive serial blocks at our institution successfully for the next 2 to 5 years. Two patients successfully transitioned from GAN blocks to GAN stimulators. One patient with GAN lymphoma had resolution of pain following GAN resection. GAN neuralgia should be considered in the differential for periauricular pain. GAN blocks or stimulators may be helpful for pain management.
Sections du résumé
BACKGROUND/OBJECTIVE
The great auricular nerve (GAN) arises from C2-C3 and provides innervation over the skin in the pre-auricular region, jaw angle, posteroinferior pinna, and mastoid. Although damage to the GAN has been reported following trauma or procedures nearby this nerve course, neuralgia of this nerve is uncommon with knowledge based on a handful of case reports in literature. The objective of this study is to describe the presentation, treatment, and outcome of 13 cases of GAN neuralgia.
METHODS
Case series. Retrospecive review of charts from 1994 to 2018 with diagnoses: "auricular neuralgia," "auricular neuritis," or "auricular neuropathy." We included subjects with neuralgic pain within the distribution of the GAN, and excluded patients with atypical facial pain, GAN neuropathy, or unclear etiology.
RESULTS
Of 79 charts, 13 patients met criteria (age at onset 11-59; 11 women, 2 men). Pain was most often described as paroxysmal stabbing provoked by: turning the head (n = 7), touching the neck (n = 5), neck position during sleep (n = 2), jaw movement (n = 2), and other (n = 2). Seven patients received GAN blocks: all noted dramatic improvement in pain, including 3 who continued to receive serial blocks at our institution successfully for the next 2 to 5 years. Two patients successfully transitioned from GAN blocks to GAN stimulators. One patient with GAN lymphoma had resolution of pain following GAN resection.
CONCLUSION
GAN neuralgia should be considered in the differential for periauricular pain. GAN blocks or stimulators may be helpful for pain management.
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
247-258Informations de copyright
© 2019 American Headache Society.
Références
Christ S, Kaviani R, Rindfleisch F, et al. Brief report: Identification of the great auricular nerve by ultrasound imaging and transcutaneous nerve stimulation. Anesth Analg. 2012;114:1128-1130.
Ryan WR, Fee WE. Long-term great auricular nerve morbidity after sacrifice during parotidectomy. Laryngoscope. 2009;119:1140-1146.
Nusair YM, Dickenson AJ. Great auricular causalgia: An unusual complication of excision of the submandibular gland. Br J Oral Maxillofac Surg. 2003;41:334-335.
de Chalain T, Nahai F. Amputation neuromas of the great auricular nerve after rhytidectomy. Ann Plast Surg. 1995;35:297-299.
Rohrich RJ, Taylor NS, Ahmad J, et al. Great auricular nerve injury, the “subauricular band” phenomenon, and the periauricular adipose compartments. Plast Reconstr Surg. 2011;127:835-843.
Arias M, Arias-Rivas S, Perez M, et al. Numb ears in resurrection: Great auricular nerve injury in hanging attempt. Neurology. 2005;64:2153-2154.
LaPrade CM, Foad A. Greater auricular nerve palsy after arthroscopic anterior-inferior and posterior-inferior labral tear repair using beach-chair positioning and a standard universal headrest. Am J Orthop (Belle Mead NJ). 2015;44:188-191.
AbuRahma AF, Choueiri MA. Cranial and cervical nerve injuries after repeat carotid endarterectomy. J Vasc Surg. 2000;32:649-654.
Blumenthal HJ. Great auricular neuralgia. Headache. 1992;32:413-415.
Patel N, Har-El G, Rosenfeld R. Quality of life after great auricular nerve sacrifice during parotidectomy. Arch Otolaryngol Head Neck Surg. 2001;127:884-888.
Galli J, Pandolfini M, Rigante M, et al. Sensory dysfunction and quality of life after great auricular nerve sacrifice during parotidectomy: Our experience. J Laryngol Otol. 2015;129:1121-1127.
Qu N, Zhang TT, Wen SS, et al. The application of selective neck dissection while preserving the cutaneous branches of cervical plexus in the surgical treatment of differentiated thyroid cancer-experiences from thousands of cases. Ann Transl Med. 2019;7:151.
George M, Karkos PD, Dwivedi RC, et al. Preservation of greater auricular nerve during parotidectomy: Sensation, quality of life, and morbidity issues. A systematic review. Head Neck. 2014;36:603-608.
Ozturk CN, Ozturk C, Huettner F, et al. A failsafe method to avoid injury to the great auricular nerve. Aesthet Surg J. 2014;34:16-21.
Fukushima M, Sakuraba H, Shiraiwa N, et al. Electroacupuncture therapy for auricular paresthesia. Med Acupunct. 2017;29:331-334.
Jeon Y, Kim S. Treatment of great auricular neuralgia with real-time ultrasound-guided great auricular nerve block: A case report and review of the literature. Medicine (Baltimore). 2017;96:e6325.
Maimone-Baronello M, Piccoli F, La Bella V. Great auricular neuralgia: A case report. Headache. 2003;43:1005-1006.
Hall GW. Auricular neuralgia. Arch Neurol Psychiatry. 1933;29:615-617.
O'Neill F, Nurmikko T, Sommer C. Other facial neuralgias. Cephalalgia. 2017;37:658-669.
Wilhour D, Nahas SJ. The neuralgias. Curr Neurol Neurosci Rep. 2018;18:69.
Park SW, Choi JY, Jung KJ. Management of great auricular neuralgia confirmed by electrophysiologic examination: A case report. J Oral Facial Pain Headache. 2018;32:e53-e56.
Headache Classification Committee of the International Headache Society (IHS). The International Classification of Headache Disorders, 3rd edn. Cephalalgia. 2018;38:1-211.
McKinney P, Gottlieb J. The relationship of the great auricular nerve to the superficial musculoaponeurotic system. Ann Plast Surg. 1985;14:310-314.
Lefkowitz T, Hazani R, Chowdhry S, et al. Anatomical landmarks to avoid injury to the great auricular nerve during rhytidectomy. Aesthet Surg J. 2013;33:19-23.
Kimura I, Seki H, Sasao S, et al. The great auricular nerve conduction study: A technique, normative data and clinical usefulness. Electromyogr Clin Neurophysiol. 1987;27:39-43.
Ginat DT, Bolotin D, Langerman AJ. Perineural spread of cutaneous squamous cell carcinoma along the great auricular nerve. Ear Nose Throat J. 2015;94:150-152.
Repanos C, Mitchell D, Gandhi M, et al. Great auricular nerve perineural spread of squamous cell carcinoma. ANZ J Surg. 2012;82:179-180.
Ginsberg LE, Eicher SA. Great auricular nerve: Anatomy and imaging in a case of perineural tumor spread. AJNR Am J Neuroradiol. 2000;21:568-571.
DeLange JM, Garza I, Robertson CE. Clinical reasoning: A 50-year-old woman with deep stabbing ear pain. Neurology. 2014;83:e152-e157.
Peuker ET, Filler TJ. The nerve supply of the human auricle. Clin Anat. 2002;15:35-37.
Moss CE, Johnston CJ, Whear NM. Amputation neuroma of the great auricular nerve after operations on the parotid gland. Br J Oral Maxillofac Surg. 2000;38:537-538.
Lieba-Samal D, Pivec C, Platzgummer H, et al. High-resolution ultrasound for diagnostic assessment of the great auricular nerve-normal and first pathologic findings. Ultraschall Med. 2015;36:342-347.
Raieli V, Compagno A, D'Amelio M. Red ear syndrome. Curr Pain Headache Rep. 2016;20:19.
de Amorim IL, Kauppila LA, Martins IP. Red ear: Syndrome or symptom? Headache. 2018;58:885-891.
Purdy RA. Red ear syndrome or red ear symptom/sign? Headache. 2018;58:792-794.
Ryan S, Wakerley BR, Davies P. Red ear syndrome: A review of all published cases (1996-2010). Cephalalgia. 2013;33:190-201.
Lambru G, Miller S, Matharu MS. The red ear syndrome. J Headache Pain. 2013;14:83.
Selekler M, Kutlu A, Ucar S, et al. Immediate response to greater auricular nerve blockade in red ear syndrome. Cephalalgia. 2009;29:478-479.
Thallaj A, Marhofer P, Moriggl B, et al. Great auricular nerve blockade using high resolution ultrasound: A volunteer study. Anaesthesia. 2010;65:836-840.
Burtles R. Analgesia for “bat ear” surgery. Ann R Coll Surg Engl. 1989;71:332.
Ritchie MK, Wilson CA, Grose BW, et al. Ultrasound-guided greater auricular nerve block as sole anesthetic for ear surgery. Clin Pract. 2016;6:856.
Yang HM, Kim HJ, Hu KS. Anatomic and histological study of great auricular nerve and its clinical implication. J Plast Reconstr Aesthet Surg. 2015;68:230-236.
Elahi F, Reddy C, Bellinger A, et al. Neuromodulation of the great auricular nerve: A case report. Neuromodulation. 2014;17:784-787.
Elahi F, Reddy C. Neuromodulation of the great auricular nerve for persistent post-traumatic headache. Pain Physician. 2014;17:E531-E536.
Min HJ, Lee HS, Lee YS, et al. Is it necessary to preserve the posterior branch of the great auricular nerve in parotidectomy? Otolaryngol Head Neck Surg. 2007;137:636-641.