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01-03-2019 | Review Article

Pediatric glossopharyngeal neuralgia: a comprehensive review

Authors: Rafik Shereen, Brady Gardner, Juan Altafulla, Emily Simonds, Joe Iwanaga, Zachary Litvack, Marios Loukas, R. Shane Tubbs

Published in: Child's Nervous System | Issue 3/2019

ABSTRACT

Introduction

Debilitating facial pain can seriously affect an individual’s daily living. Given that the pathophysiology behind neuropathic and myofascial pain is not fully understood, when chronic facial pain goes undiagnosed, it has been proposed that one of the two is the likely cause. Since their discovery, glossopharyngeal neuralgia (GN) and Eagle’s syndrome have been considered mostly conditions afflicting the adult population. However, when pediatric patients present with symptoms resembling GN or Eagle’s syndrome, physicians are less apt to include these as a differential diagnosis simply due to the low prevalence and incidence in the pediatric population.

Materials and methods

A literature review was performed with the aim to better understand the history of reported cases and to provide a comprehensive report of the anatomical variations that lead to these two conditions as well as the way these variations dictated medical and surgical management. Articles were obtained through Google Scholar and PubMed. Search criteria included key phrases such as pediatric glossopharyngeal neuralgia and pediatric Eagle syndrome. These key phrases were searched independently. PubMed was searched primarily then cross-referenced articles were found via Google Scholar. Results from non-English articles were excluded.

Results

A total of 58 articles were reviewed. Most of the articles focused on adult glossopharyngeal neuralgia, and the majority was comprised of case reports. When searched via PubMed, a total of 16 articles and 2 articles returned for glossopharyngeal neuralgia and Eagle’s syndrome, respectively. After criteria selection and cross-referencing, a total of seven articles were found with respect to pediatric glossopharyngeal neuralgia.

Conclusions

While they are rare conditions, there are multiple etiologies that lead to the debilitating symptoms of GN and Eagle’s syndrome. The clinical anatomy proved notable as multiple causes of GN and Eagle’s syndrome are due to variation in the anatomy of the neurovascular structures surrounding the glossopharyngeal nerve, an elongated styloid process, a calcified stylohyoid ligament as well as a calcified stylomandibular ligament. Due to the success of different treatment modalities, the treatment of choice is dependent on clinical judgment.

(IHS) HCCotIHS (2013) The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33:629–808. https://doi.org/10.1177/0333102413485658 CrossRef

Baddour H, McAnear J, Tilson H (1978) Eagle’s syndrome. Report of a case. Oral Surg Oral Med Oral Pathol 46:486–494PubMedCrossRef

Bitner DP, Uzbelger Feldman D, Axx K, Albandar JM (2015) Description and evaluation of an intraoral cervical plexus anesthetic technique. Clin Anat 28:608–613. https://doi.org/10.1002/ca.22543 PubMedCrossRef

Buch HA (2017) Lingual nerve: in search of a landmark for its position. Clin Anat 30:1009–1012. https://doi.org/10.1002/ca.22921 PubMedCrossRef

Cesmebasi A, Spinner RJ (2015) An anatomic-based approach to the iatrogenic spinal accessory nerve injury in the posterior cervical triangle: how to avoid and treat it. Clin Anat 28:761–766. https://doi.org/10.1002/ca.22555 PubMedCrossRef

Childs AM, Meaney JF, Ferrie CD, Holland PC (2000) Neurovascular compression of the trigeminal and glossopharyngeal nerve: three case reports. Arch Dis Child 82:311–315PubMedPubMedCentralCrossRef

Davies JC, Ravichandiran M, Agur AM, Fattah A (2016) Evaluation of clinically relevant landmarks of the marginal mandibular branch of the facial nerve: a three-dimensional study with application to avoiding facial nerve palsy. Clin Anat 29:151–156. https://doi.org/10.1002/ca.22570 PubMedCrossRef

De Ridder D, Møller A, Verlooy J, Cornelissen M, De Ridder L (2002) Is the root entry/exit zone important in microvascular compression syndromes? Neurosurgery 51:427–433 discussion 433-424PubMedCrossRef

Dubey A, Mujoo S, Sakarde SB, Dubey AK (2012) Paroxysmal neuralgia in pediatric population--a diagnostic dilemma for physicians and dental practioners. Kathmandu Univ Med J (KUMJ) 10:74–77CrossRef

10.

Flory T, Chung J, Ozner J (2015) Resolution of facial neuralgia following reduction of atlas subluxation complex: a case study. J Upper Cervical Chiro:6–13

11.

Golden AS, Haut SR, Moshé SL (2006) Nonepileptic uses of antiepileptic drugs in children and adolescents. Pediatr Neurol 34:421–432. https://doi.org/10.1016/j.pediatrneurol.2005.08.017 PubMedCrossRef

12.

Gracco A, De Stefani A, Bruno G, Balasso P, Alessandri-Bonetti G, Stellini E (2017) Elongated styloid process evaluation on digital panoramic radiograph in a North Italian population. J Clin Exp Dent 9:e400–e404. https://doi.org/10.4317/jced.53450 PubMedPubMedCentralCrossRef

13.

Grazzi L, Usai S, Rigamonti A (2005) Facial pain in children and adolescents. Neurol Sci 26(Suppl 2):s101–s103. https://doi.org/10.1007/s10072-005-0419-4 PubMedCrossRef

14.

Harris W (1921) Persistent pain in lesions of the peripheral and central nervous system. Br Med J 2:896–900PubMedPubMedCentralCrossRef

15.

Heir GM, Masterson M (2016) Bilateral glossopharyngeal neuropathy following chemo and radiation therapy for a primitive neuroectodermal tumour. J Oral Rehabil 43:154–158. https://doi.org/10.1111/joor.12347 PubMedCrossRef

16.

Hodnett BL, Schmitt NC, Clayburgh DR, Burkowsky A, Balzer J, Thirumala PD, Duvvuri U (2015) Superior laryngeal nerve monitoring using laryngeal surface electrodes and intraoperative neurophysiological monitoring during thyroidectomy. Clin Anat 28:460–466. https://doi.org/10.1002/ca.22487 PubMedCrossRef

17.

Holloway M, Wason S, Willging J, Myer CR, Wood B (1991) Radiological case of the month. A pediatric case of Eagle’s syndrome. Am J Dis Child 3:339–340. doi:https://doi.org/10.1001/archpedi.1991.02160030109031, 145

18.

Iwanaga J (2017) The clinical view for dissection of the lingual nerve with application to minimizing iatrogenic injury. Clin Anat 30:467–469. https://doi.org/10.1002/ca.22877 PubMedCrossRef

19.

Iwanaga J, Saga T, Tabira Y, Nakamura M, Kitashima S, Watanabe K, Kusukawa J, Yamaki K (2015) The clinical anatomy of accessory mental nerves and foramina. Clin Anat 28:848–856. https://doi.org/10.1002/ca.22597 PubMedCrossRef

20.

Iwanaga J, Watanabe K, Henry B, Tomaszewski KA, Walocha JA, Oskouian RJ, Tubbs RS (2017) Anatomical study of the internal nasal branch of the infraorbital nerve: application to minimizing nerve damage with surgery in and around the nose. Clin Anat 30:817–820. https://doi.org/10.1002/ca.22927 PubMedCrossRef

21.

Iwanaga J, Watanabe K, Kusukawa J, Fisahn C, Alonso F, Oskouian RJ, Tubbs RS (2017) A novel treatment for keratitis sicca (dry eye): anatomical feasibility study. Clin Anat 30:839–843. https://doi.org/10.1002/ca.22946 PubMedCrossRef

22.

Iwanaga J, Watanabe K, Oskouian RJ, Tubbs RS (2017) Previously undescribed palpebral branch from the infraorbital canal: application to surgery of the eyelid and treatment of orbital floor fractures. Clin Anat 30:835–838. https://doi.org/10.1002/ca.22940 PubMedCrossRef

23.

Iwanaga J, Watanabe K, Saga T, Tabira Y, Kitashima S, Kusukawa J, Yamaki K (2016) Accessory mental foramina and nerves: application to periodontal, periapical, and implant surgery. Clin Anat 29:493–501. https://doi.org/10.1002/ca.22635 PubMedCrossRef

24.

Joo W, Rhoton AL (2015) Microsurgical anatomy of the trochlear nerve. Clin Anat 28:857–864. https://doi.org/10.1002/ca.22602 PubMedCrossRef

25.

Kandt RS, Daniel FL (1986) Glossopharyngeal neuralgia in a child. A diagnostic and therapeutic dilemma. Arch Neurol 43:301–302PubMedCrossRef

26.

Katusic S, Williams DB, Beard CM, Bergstralh EJ, Kurland LT (1991) Epidemiology and clinical features of idiopathic trigeminal neuralgia and glossopharyngeal neuralgia: similarities and differences, Rochester, Minnesota, 1945-1984. Neuroepidemiology 10:276–281. https://doi.org/10.1159/000110284 PubMedCrossRef

27.

Kehrer A, Engelmann S, Bauer R, Taeger C, Grechenig S, Kehrer M, Prantl L, Tamm ER, Bleys RLAW, Mandlik V (2018) The nerve supply of zygomaticus major: variability and distinguishing zygomatic from buccal facial nerve branches. Clin Anat 31:560–565. https://doi.org/10.1002/ca.23044 PubMedCrossRef

28.

Kent D, Rath T, Snyderman C (2015) Conventional and 3-dimensional computerized tomography in Eagle’s syndrome, glossopharyngeal neuralgia, and asymptomatic controls. Otolaryngol Head Neck Surg 153:41–47. https://doi.org/10.1177/0194599815583047 PubMedCrossRef

29.

Kondev L, Minster A (2003) Headache and facial pain in children and adolescents. Otolaryngol Clin N Am 36:1153–1170CrossRef

30.

Lindeman P (1985) The elongated styloid process as a cause of throat discomfort. Four case reports. J Laryngol Otol 99:505–508PubMedCrossRef

31.

Ling XY, Smoll NR (2016) A systematic review of variations of the recurrent laryngeal nerve. Clin Anat 29:104–110. https://doi.org/10.1002/ca.22613 PubMedCrossRef

32.

Lobón MJ, Bautista F, Riet F, Dhermain F, Canale S, Dufour C, Blauwblomme T, Zerah M, Beccaria K, Saint-Rose C, Puget S, Carrie C, Lartigau E, Bondiau PY, Valteau-Couanet D, Grill J, Bolle S (2016) Re-irradiation of recurrent pediatric ependymoma: modalities and outcomes: a twenty-year survey. Springerplus 5:879. https://doi.org/10.1186/s40064-016-2562-1 PubMedPubMedCentralCrossRef

33.

López-Elizalde R, Campero A, Sánchez-Delgadillo T, Lemus-Rodríguez Y, López-González MI, Godínez-Rubí M (2018) Anatomy of the olfactory nerve: a comprehensive review with cadaveric dissection. Clin Anat 31:109–117. https://doi.org/10.1002/ca.23003 PubMedCrossRef

34.

McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK (1999) Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90:1–8. https://doi.org/10.3171/jns.1999.90.1.0001 PubMedCrossRef

35.

Moffat DA, Ramsden RT, Shaw HJ (1977) The styloid process syndrome: aetiological factors and surgical management. J Laryngol Otol 91:279–294PubMedCrossRef

36.

Monsour PA, Young WG (1986) Variability of the styloid process and stylohyoid ligament in panoramic radiographs. Oral Surg Oral Med Oral Pathol 61:522–526PubMedCrossRef

37.

Müderris T, Bercin S, Sevil E, Beton S, Kırıs M (2014) Surgical management of elongated styloid process: intraoral or transcervical? Eur Arch Otorhinolaryngol 271:1709–1713. https://doi.org/10.1007/s00405-013-2664-0 PubMedCrossRef

38.

Mueller D, Obermann M, Yoon MS, Poitz F, Hansen N, Slomke MA, Dommes P, Gizewski E, Diener HC, Katsarava Z (2011) Prevalence of trigeminal neuralgia and persistent idiopathic facial pain: a population-based study. Cephalalgia 31:1542–1548. https://doi.org/10.1177/0333102411424619 PubMedCrossRef

39.

Nam YS, Kim IB, Shin SY (2017) Detailed anatomy of the abducens nerve in the lateral rectus muscle. Clin Anat 30:873–877. https://doi.org/10.1002/ca.22918 PubMedCrossRef

40.

Park HK, Rha HK, Lee KJ, Chough CK, Joo W (2017) Microsurgical anatomy of the oculomotor nerve. Clin Anat 30:21–31. https://doi.org/10.1002/ca.22811 PubMedCrossRef

41.

Polednak AP (2017) Relationship of the recurrent laryngeal nerve to the inferior thyroid artery: a comparison of findings from two systematic reviews. Clin Anat 30:318–321. https://doi.org/10.1002/ca.22851 PubMedCrossRef

42.

Quereshy F, Gold E, Arnold J, Powers MP (2001) Eagle’s syndrome in an 11-year-old patient. J Oral Maxillofac Surg 59:94–97. https://doi.org/10.1053/joms.2001.19302 PubMedCrossRef

43.

Resnick DK, Jannetta PJ, Bissonnette D, Jho HD, Lanzino G (1995) Microvascular decompression for glossopharyngeal neuralgia. Neurosurgery 36:64–68 discussion 68–69PubMedCrossRef

44.

Restrepo CE, Tubbs RS, Spinner RJ (2015) Expanding what is known of the anatomy of the spinal accessory nerve. Clin Anat 28:467–471. https://doi.org/10.1002/ca.22492 PubMedCrossRef

45.

Rushton JG, Stevens JC, Miller RH (1981) Glossopharyngeal (vagoglossopharyngeal) neuralgia: a study of 217 cases. Arch Neurol 38:201–205PubMedCrossRef

46.

Sharma N, Ram R, Kamal R (2016) Unusually elongated styloid process: a report of two cases with literature review. Ann Maxillofac Surg 6:297–299. https://doi.org/10.4103/2231-0746.200343 PubMedPubMedCentralCrossRef

47.

Slavin KV (2002) Eagle syndrome: entrapment of the glossopharyngeal nerve? Case report and review of the literature. J Neurosurg 97:216–218. https://doi.org/10.3171/jns.2002.97.1.0216 PubMedCrossRef

48.

Spina A, Boari N, Gagliardi F, Bailo M, Morselli C, Iannaccone S, Mortini P (2017) The emerging role of gamma knife radiosurgery in the management of glossopharyngeal neuralgia. Neurosurg Rev. https://doi.org/10.1007/s10143-017-0886-0

49.

Tseng SC, Cheng AM, Fu Y (2017) Retrospective study to identify trigeminal-cervical ocular referred pain as a new causative entity of ocular pain. J Pain Res 10:1747–1754. https://doi.org/10.2147/JPR.S140895 PubMedPubMedCentralCrossRef

50.

Tubbs RS, Loukas M, Dixon J, Cohen-Gadol AA (2010) Compression of the cervical internal carotid artery by the stylopharyngeus muscle: an anatomical study with potential clinical significance. Laboratory investigation. J Neurosurg 113:881–884. https://doi.org/10.3171/2010.1.JNS091407 PubMedCrossRef

51.

Tubbs RS, Mortazavi MM, Loukas M, Shoja MM, Cohen-Gadol AA (2011) Intraoperative and anatomical descriptions of intracranial connections between the glossopharyngeal and vagus nerves: clinical implications. J Neurosurg 115:179–181. https://doi.org/10.3171/2011.2.JNS101757 PubMedCrossRef

52.

Vanelderen P, Lataster A, Levy R, Mekhail N, van Kleef M, Van Zundert J (2010) 8. Occipital neuralgia. Pain Pract 10:137–144. https://doi.org/10.1111/j.1533-2500.2009.00355.x PubMedCrossRef

53.

Walco GA, Dworkin RH, Krane EJ, LeBel AA, Treede RD (2010) Neuropathic pain in children: special considerations. Mayo Clin Proc 85:S33–S41. https://doi.org/10.4065/mcp.2009.0647 PubMedPubMedCentralCrossRef

54.

Wong K, Opimo AB, Olch AJ, All S, Waxer JF, Clark D, Cheng J, Chlebik A, Erdreich-Epstein A, Krieger MD, Tamrazi B, Dhall G, Finlay JL, Chang EL (2016) Re-irradiation of recurrent pineal germ cell tumors with radiosurgery: report of two cases and review of literature. Cureus 8:e585. https://doi.org/10.7759/cureus.585 PubMedPubMedCentralCrossRef

55.

Yglesias A, Narbona J, Vanaclocha V, Artieda J (1996) Chiari type I malformation, glossopharyngeal neuralgia and central sleep apnoea in a child. Dev Med Child Neurol 38:1126–1130PubMedCrossRef

56.

Yomo S, Arkha Y, Donnet A, Régis J (2009) Gamma knife surgery for glossopharyngeal neuralgia. J Neurosurg 110:559–563. https://doi.org/10.3171/2008.8.17641 PubMedCrossRef

57.

Yoshihara N, Okuda M, Takano K, Wada T, Osaka H (2012) Idiopathic cranial polyneuropathy with unilateral IX and X and contralateral XI nerve palsy in a 4-year-old boy. Pediatr Neurol 47:198–200. https://doi.org/10.1016/j.pediatrneurol.2012.04.021 PubMedCrossRef

58.

Zeiler FA, Janik MK, McDonald PJ, Kaufmann AM, Fewer D, Butler J, Schroeder G, West M (2016) Gamma knife radiosurgery for pediatric arteriovenous malformations: a Canadian experience. Can J Neurol Sci 43:82–86. https://doi.org/10.1017/cjn.2015.267 PubMedCrossRef

Title: Pediatric glossopharyngeal neuralgia: a comprehensive review
Authors: Rafik Shereen
Brady Gardner
Juan Altafulla
Emily Simonds
Joe Iwanaga
Zachary Litvack
Marios Loukas
R. Shane Tubbs
Publication date: 01-03-2019
Publisher: Springer Berlin Heidelberg
Published in: Child's Nervous System / Issue 3/2019
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-018-3995-3

At a glance: The STEP trials

Springer Medicine

Pediatric glossopharyngeal neuralgia: a comprehensive review

ABSTRACT

Introduction

Materials and methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

ABSTRACT

Introduction

Materials and methods

Results

Conclusions

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