CHAPTER 19 GLOSSOPHARYNGEAL AND OTHER FACIAL NEURALGIAS
1. What is the clinical presentation of glossopharyngeal neuralgia?
The pain of glossopharyngeal neuralgia is similar in many ways to that seen in trigeminal neuralgia, but it has a different distribution. It presents with paroxysms of lancinating pain that involve the glossopharyngeal and vagus nerves. Pain is felt around the jaw, throat, ears, larynx, and/or base of the tongue. The pain is typically unilateral and lasts for about 1 minute. Multiple attacks can occur throughout a day and may even awaken the patient out of a sound sleep. The usual triggers are talking and chewing. Odynophagia is a specific trigger in glossopharyngeal neuralgia that is rarely, if ever, seen in trigeminal neuralgia. When glossopharyngeal neuralgia is not caused by an underlying tumor, spontaneous remissions often occur.
3. How common is glossopharyngeal neuralgia?
Glossopharyngeal neuralgia is an uncommon disorder with a prevalence of only about 1/100 that of trigeminal neuralgia. Symptoms of the primary disorder usually begin when the patient is in his or her 60s.
4. A patient experiences neck pain upon swallowing and a sudden loss of consciousness. What is a likely explanation?
Swallow syncope is a syndrome of unclear mechanism that occurs in patients with glossopharyngeal neuralgia. It is thought that a barrage of impulses from the glossopharyngeal nerve, through the tractus solitarius, to the dorsal motor nucleus of the vagus nerve produces bradycardia or brief asystole. It is most commonly seen in patients with tumors of the neck and, in previously operated-on patients, usually represents tumor recurrence.
5. What is the difference between idiopathic glossopharyngeal neuralgia and secondary glossopharyngeal neuralgia?
The difference between idiopathic and secondary glossopharyngeal neuralgia is a clearly identified underlying cause. Clinically, idiopathic glossopharyngeal neuralgia rarely, if ever, shows objective sensory impairment on physical examination. If there is sensory loss, a causative lesion (oropharyngeal tumor, peritonsillar infection, or vascular compression) must be sought. Tumors at the base of the skull, particularly around the jugular foramen, may also cause pain radiating to the throat, so careful imaging of the oropharynx and the base of the skull must be undertaken.
Full access? Get Clinical Tree
