Glossopharyngeal Neuralgia

This is an uncommon disorder, occurring with an annual crude incidence of 0.7 per 100,000 population. y The pain of glossopharyngeal neuralgia is located at the base of the tongue, tonsils, ear, or angle of the jaw and is triggered by talking, swallowing, and coughing. Glossopharyngeal neuralgia produces symptoms similar in character to those of trigeminal neuralgia: brief, recurrent, stabbing pains lasting seconds to a couple of minutes. Of these two cranial nerve disorders glossopharyngeal neuralgia is less common; the ratio of trigeminal to glossopharyngeal neuralgia is 5.9:1. y The attacks of glossopharyngeal neuralgia are comparatively more mild, and in contrast to trigeminal neuralgia bilateral symptoms frequently occur. y The course tends to be relapsing and remitting.

Epidemiological data from a population in Minnesota found men and women equally affected with rates of incidence highest in the sixth through eighth decades. y Syncope is an unusual accompaniment of glossopharyngeal neuralgia. y Spontaneous discharges of the glossopharyngeal nerve to the medulla may cause bradycardia or even asystole by reflexive vagal nerve cardiac inhibitory output. y The syncopal episode is produced by this bradycardia together with hypotension caused by reduced sympathetic output. Clonic jerking mimicking seizure may accompany the syncopal spells, although electroencephalographic recording during spells has demonstrated slowing and suppression of activity rather than seizure activity. y

Glossopharyngeal neuralgia is divided into idiopathic and symptomatic forms, with the latter due to identifiable pathology such as oropharyngeal or neck carcinoma or a posterior fossa arteriovenous malformation.y y y Although results of the neurological examination are normal in idiopathic glossopharyngeal neuralgia, patients with symptoms of this disorder should have careful examination of the oral cavity and neck and brain imaging with attention to the posterior fossa to exclude underlying pathology. Treatment for the symptoms of glossopharyngeal neuralgia includes the medications used for trigeminal neuralgia, including carbamazepine, baclofen, phenytoin, or combinations of these.

Surgical treatment is an option for patients with symptoms refractory to medical therapy. Sectioning of the rootlets of the glossopharyngeal nerve effectively terminates symptoms but obviously sacrifices the nerve. Alternatively, microvascular decompression has also been successful in treating this disorder and spares the function of the glossopharyngeal nerve. This technique is based upon the idea that the neuralgia is due, at least partly, to an adjacent blood vessel producing mechanical irritation to the glossopharyngeal nerve. In one series of 40 patients, the most common offending blood vessel was the posterior inferior cerebellar artery, followed by an artery and vein combination. y In this surgery the glossopharyngeal nerve is identified along with the offending vessels and they are separated. A piece of Teflon felt may be placed between the nerve and an artery. Successful treatment of the neuralgia, by medical or surgical means, should also eliminate any associated syncopal episodes.

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