- Background and aims: To explore new treatment for atypical orofacial pain when other treatments have failed.
- Methods: 44yo female referred for treatment for glossopharyngeal neuralgia. Before referal the following treatment had already failed: Gabapentinoids, duloxetine, tapenadol, buprenorphine, estelate ganglon blocks, iv lidocaine&ketamine, carbamazepine, biofeedback, cognitive-behavioral therapy and hypnosis.
A glossopharyngeal ganglion block was perfomed under CT scan with positive results for a few days. But patient denied new interventional techniques due to her bad experience. Topical intranasal lidocaine for treating the glossopharyngeal ganglion was accepted by the patient as palliative out-of-order treatment.
First of all, a cold 2% viscous lidocaine was introduced through the right nose hole with a 20G cannula. Up to 3-4cc could be administered before she reported swallowing. Then a thicker excipient was changedby the pharmacy department to 2% lidocaine in adhesive oral excipient (AOE) leading to adensity similar to pharyngeal mucus.
- Results: are shown on table 1.
- Conclusions: Transnasal transmucosal topical 2% lidocaine in AOE may be an alternative for the treatment of atypical facial neuralgia. Different concentrations must be explored for greater effectiveness and safety.