Eghtesadi Marzieh, Leroux Elizabeth, Vargas-Schaffer Grisell
Department of Pain Clinic, Headache Management, Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche de l'Université de Montréal (CRCHUM).
Department of General Neurology, Headache Management, Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche de l'Université de Montréal (CRCHUM).
J Pain Res. 2017 Feb 17;10:435-438. doi: 10.2147/JPR.S126923. eCollection 2017.
The great auricular nerve is a cutaneous branch of the cervical plexus originating from the C2 and C3 spinal nerves. It innervates the skin over the external ear, the angle of the mandible and the parotid gland. It communicates with the ansa cervicalis. Great auricular neuralgia is rarely diagnosed in clinical practice and can be refractory. We present a new approach using ultrasound-guided nerve blocks.
We present a case of a 41-year-old female with paroxysmal ear pain accompanied by dysautonomia, tingling in the tongue, dysphagia, dysarthria and abdominal symptoms. No significant findings were found on cervical and brain imaging. The patient responded partially to a great auricular nerve block. A combined approach using this block with facet block of C2 and C3 induced a more pronounced and prolonged benefit.
Great auricular neuralgia is not often encountered in practice and can be accompanied by symptoms originating from the ansa cervicalis network. A combined approach of nerve blocks can be considered in refractory cases.
耳大神经是颈丛的皮支，起源于C2和C3脊神经。它支配外耳、下颌角和腮腺表面的皮肤。它与颈袢相连。耳大神经痛在临床实践中很少被诊断出来，且可能难以治愈。我们介绍一种使用超声引导下神经阻滞的新方法。
我们报告一例41岁女性，有阵发性耳痛，伴有自主神经功能障碍、舌部刺痛、吞咽困难、构音障碍和腹部症状。颈椎和脑部影像学检查未发现明显异常。患者对耳大神经阻滞有部分反应。将这种阻滞与C2和C3关节突阻滞联合应用可产生更显著和持久的效果。
耳大神经痛在实践中并不常见，且可能伴有源自颈袢神经网的症状。对于难治性病例可考虑采用联合神经阻滞方法。
