Neha Singh, MD
Resident Physician
Baylor College of Medicine
Houston, Texas, United States
Emanuel Narcis Husu, MD
Assistant Professor
Baylor College of Medicine, PM&R Program
Houston, Texas, United States
A 41-year-old patient presented with chief complaint of pain in her tongue and throat for the last 12 years, with medical history significant for medullary low-grade glioma which was diagnosed 2 years after pain onset. Patient refused further brain imaging as her tumor was inoperable. Over the last 12 years, patient reported constant pain in her throat, soft palate, tongue (predominantly on left side in the anterior half of tongue and bilateral involvement of pain in posterior half of tongue) and bilateral angle of jaw; with intermittent pain radiation to anterior chest. She stated pain exacerbation with talking, laughing, swallowing and coughing. She had trialed conservative management with minimal to no relief but had never received any formal diagnosis or diagnostic nerve block. After discussion, patient was counseled to get MRI brain and scheduled for a stellate ganglion block (SGB). Use of glossopharyngeal nerve stimulator, pending SGB was also discussed.
Discussions:
International Classification of Headache Disease-3 (ICHD-3) defines GN as presence of pain within the distribution of the glossopharyngeal nerve involving posterior part of the tongue, tonsillar fossa, pharynx, and/or beneath the angle of the lower jaw. It is often misdiagnosed as trigeminal neuralgia on account of similar pain characteristics. The diagnosis of GN is primarily clinical as per ICHD-3, and imaging is warranted to rule out any potential cause of nerve compression at the skull base, with neurovascular compression most visible on MRI.
Conclusions:
This case report aims to highlight the challenges encountered by patients with GN. Patients with chronic facial pain should be cautiously re-evaluated and examined as multiple etiologies involving ENT diseases, dental pain, tumors, temporomandibular joint dysfunction, myofascial pain syndrome, neurovascular and psychiatric disorders could present with similar symptoms.
