- Nervus intermedius neuralgia (NIN) is rare craniofacial neuralgia involving the sensory and parasympathetic fibers of the facial nerve

- Unique Pain Presentation : within in the ear canal and auricle.

- Few reports are published within scientific literature.

Story : 63y male with 10+ year history of right facial allodynia and frequent stabbing sharp right auricular pain secondary to NIN.

PMH : Arthritis, Multiple Sclerosis, Pulmonary Embolus

Current Symptoms : Sharp stabbing pain originating along the upper aspect of his right auricle and radiating into the right jaw, down the lateral aspect of his neck into the supraclavicular and infraclavicular region of the right arm and the right shoulder.

Relevant Medications. : Diclofenac, Gabapentin, Baclofen, Klonopin, Eliquis, Hydrocodone

Interventions (Prior) : 4x ENT Periauricular nerve blocks with Kenalog (“injection inside and around the ear)

Physical Therapy : No Physical therapy

Tests : Brian MRI & MRA of the Head: No abnormalities

Ultrasound Guided Stellate Ganglion Block

- 7 ml of 0.25% bupiv­­acaine with 5 mcg of epinephrine per mL 

- Visual thecarotid(CA), internal jugular(IJ) & the stellate ganglion(SG) identified above the longus coli muscle(LC)  and inferolateral to the carotid.

Results

- 70% Pain Reduction in 2 Month Follow-up

Conclusions

- SGB’s  treat sympathetically mediated pain.

-Effective, Long-Lasting, Safe

- Option for patients who fail medical management.