A Rare Case of Glossopharyngeal Neuralgia due to Neurovascular Conflict

Abstract

In the context of painful cranial neuropathies, a very rare cause is represented by the irritation of the glossopharyngeal nerve due to various aetiologic factors. Here, we present a case of neuralgia of the ninth right cranial nerve due to a compression of its nerve root upon the kinking of the homolateral vertebral artery, resulting in a disabling clinical overview for the patient. Our objective was to focus the reader’s attention on the clinical manifestation, which alone could lead to an immediate diagnosis. The imaging and laboratory studies proved to be fundamental in diagnosing the causes, yet the knowledge of the symptoms and the signs of this rare clinical entity can prevent misdiagnosis, mismanagement and consequent economic expenditure as occurred in the case described here.

Gabapentinoid prescription in Oral Medicine and Oral Surgery practice. Part II − a systematic scoping review of the literature

“…Three case reports (of poor methodological quality) have suggested the use of gabapentin [24] or pregabalin [25,26] at various doses for the successful management of glossopharyngeal neuralgias (complete pain relief). The lack of proper randomized trials can be explained by the rarity of this painful condition.…”

Glossopharyngeal Neuralgia: MVD vs GKS

“…The mechanical compression induces a functional hyperactivity of paroxysmal excitement of the glossopharyngeal nerve and its branches. Secondly, the inflammatory diseases, infectious diseases and demyelinating diseases such as sarcoidosis, HIV and sclerosis plaques [3]. Other causes of secondary GPN include metastasis to petrous temporal bone from breast carcinoma, post-tonsillectomy, carcinoma of the parapharyngeal space carcinoma of the pharynx and nasopharyngeal carcinoma [12].…”

“…NC IX emits several branches as the tympanic nerve, that projects itself to the tympanic cavity, where divides into the intramucosal tympanic plexus and the lesser petrosal nerve that Citation: Enrico Affonso Barletta runs parallel to the greater petrosal nerve and passes through the foramen lacerum to come to the optic ganglion. Besides that, there are parasympathetic secretory fibers directed at the parotid gland when passing through this ganglion [1][2][3]. The lingual branches contain gustatory fibers for the posterior third of the tongue, that conduct taste sensations to the nuclei of solitary tract, and tonsillar branches supply sensory fibers to the palatine tonsil.…”

“…Other branches are the muscular branches, to stylopharyngeus muscle, and the pharyngeal branches, to the superior pharyngeal constrictor, palatoglossus and palatopharyngeus muscle. Together with the sympathetic trunk and the vagus nerve [X] innervates the following muscles: inferior pharyngeal constrictor, tensor veli palatini and uvula [2,3]. Sensory fibers to the pharyngeal mucosa and to the pharyngeal glands are CN IX branches too.…”

“…The most frequent causes are the ones that have an extrinsic compression compound, like neurovascular conflict due to excessive tortuosity or an ectasia of the vertebrobasilar trunk, being a congenital cause, which can be seen in Figure 1. The GPN can also be caused by atherosclerotic phenomena, mainly in elderly people [3].…”