Case Report: Peripheral Nerve Stimulation of the Sphenopalatine Ganglion and Auriculotemporal Nerve for Chronic Facial Pain

Hesham Elsharkawy, MD, MBA, FASA; Lucas Baldo, MD; Faria Nisar, MD 

MetroHealth Medical Center affiliated with 

Case Western Reserve University School of Medicine, Cleveland, Ohio

Introduction & Background

Chronic  facial  pain  is  often  driven  by  various underlying mechanisms and can severely impact patients' quality of life. Peripheral nerve stimulation (PNS) emerges as a promising therapeutic option for managing chronic facial pain,  offering potential relief where conventional treatments may fall short.

Case Presentation

A 74-year-old male with a history of pain initially in the upper lip and later progressing to the lower lip and mandibular area. It was characterized by sharp, burning, intermittent, electric-like sensations, with varying features leading to a potential diagnosis ranging from trigeminal neuralgia to painful trigeminal neuropathy and variations.  Multiple conservative treatment attempts were unsuccessful.

Intervention

PNS  implantation  targeting  the  Sphenopalatine ganglion (SPG) and auriculotemporal nerve (ATN). The  patient  received  two  successful  diagnostic blocks, followed by a trial stimulation period of one week, in preparation for permanent implantation.

Results

The patient reported a significant reduction in facial pain frequency and intensity following the trial period. The VAS score decreased from 9/10 to 3/10. A decision to postpone definitive implantation was made, and at the 3-month follow-up, the patient continued to experience substantial pain relief with a VAS  score  of  2/10  and  a  reduction  in  pain episodes  from  daily  occurrences  to  bi-weekly. Surveys were done to reassess the condition after two  years,  with  persistent  results  supporting evidence for long-term pain relief.

Discussion

PNS with combined SPG and ATN stimulation can offer a viable and effective treatment option for patients with chronic facial pain. The substantial decrease in pain intensity and frequency and its persistence for months after trial removal highlight the  value  of  shorter  term  implants  not  only  in preparation for future longer lasting implants, but also as a possible standalone therapy. Further studies with  larger  cohorts  are  warranted  to  establish long-term efficacy and safety.

References

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2. Greenberg JS, Breiner MJ. Anatomy, Head and Neck: Auriculotemporal Nerve. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544240/

1. Ho KWD, Przkora R, Kumar S. Sphenopalatine ganglion: block, radiofrequency ablation and neurostimulation - a systematic review. J Headache Pain. 2017 Dec 28;18(1):118