Hostname: page-component-6766d58669-kl59c Total loading time: 0 Render date: 2026-05-19T17:20:04.190Z Has data issue: false hasContentIssue false
  • English
  • Français

Geniculate neuralgia: a systematic review

Published online by Cambridge University Press:  13 May 2014

I P Tang ,
S R Freeman ,
G Kontorinis ,
M Y Tang ,
S A Rutherford ,
A T King  and
S K W Lloyd
I P Tang*
Affiliation:
Department of ORL-HNS, Salford Royal Hospital, Manchester, UK Department of ORL-HNS, University Malaysia Sarawak, Malaysia
S R Freeman
Affiliation:
Department of ORL-HNS, Salford Royal Hospital, Manchester, UK
G Kontorinis
Affiliation:
Department of ORL-HNS, Salford Royal Hospital, Manchester, UK
M Y Tang
Affiliation:
Department of Anaesthesia and Pain Management, University Malaysia Sarawak, Malaysia
S A Rutherford
Affiliation:
Department of Neurosurgery, Salford Royal Hospital, Manchester, UK
A T King
Affiliation:
Department of Neurosurgery, Salford Royal Hospital, Manchester, UK
S K W Lloyd
Affiliation:
Department of ORL-HNS, Salford Royal Hospital, Manchester, UK
*
Address for correspondence: Dr I P Tang, Department of ORL-HNS, Salford Royal Hospital, Manchester M5 5AP, UK E-mail: ingptang@yahoo.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To systematically summarise the peer-reviewed literature relating to the aetiology, clinical presentation, investigation and treatment of geniculate neuralgia.

Data sources:

Articles published in English between 1932 and 2012, identified using Medline, Embase and Cochrane databases.

Methods:

The search terms ‘geniculate neuralgia’, ‘nervus intermedius neuralgia’, ‘facial pain’, ‘otalgia’ and ‘neuralgia’ were used to identify relevant papers.

Results:

Fewer than 150 reported cases were published in English between 1932 and 2012. The aetiology of the condition remains unknown, and clinical presentation varies. Non-neuralgic causes of otalgia should always be excluded by a thorough clinical examination, audiological assessment and radiological investigations before making a diagnosis of geniculate neuralgia. Conservative medical treatment is always the first-line therapy. Surgical treatment should be offered if medical treatment fails. The two commonest surgical options are transection of the nervus intermedius, and microvascular decompression of the nerve at the nerve root entry zone of the brainstem. However, extracranial intratemporal division of the cutaneous branches of the facial nerve may offer a safer and similarly effective treatment.

Conclusion:

The response to medical treatment for this condition varies between individuals. The long-term outcomes of surgery remain unknown because of limited data.

Keywords

Geniculate NeuralgiaNervus Intermedius NeuralgiaNeuralgiaFacial NeuralgiaNeuropathic PainOtalgia

Information

Type
Review Article
Information
The Journal of Laryngology & Otology , Volume 128 , Issue 5 , May 2014 , pp. 394 - 399
Copyright
Copyright © JLO (1984) Limited 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalagia 2004;24:9–160Google Scholar
2Pulec, JL. Geniculate neuralgia: diagnosis and surgical management. Laryngoscope 1976;86:955–64Google Scholar
3Pulec, JL. Geniculate neuralgia: long-term results of surgical treatment. Ear Nose Throat J 2002;81:30–3Google Scholar
4Rupa, V, Saunders, RL, Weider, DJ. Geniculate neuralgia: the surgical management of primary otalgia. J Neurosurg 1991;75:505–11Google Scholar
5Lovely, TJ, Jannetta, PJ. Surgical management of geniculate neuralgia. Am J Otol 1997;18:512–17Google Scholar
6Sachs, E Jr.The role of the nervus intermedius in facial neuralgia. Report of four cases with observations on the pathways for taste, lacrimation, and pain in the face. J Neurosurg 1968;28:54–60Google Scholar
7Tubbs, RS, Mosier, KM, Cohen-Gadol, AA. Geniculate neuralgia: clinical, radiologic, and intraoperative correlates. World Neurosurg 2013;80:e353–7Google Scholar
8Saers, SJ, Han, KS, De Ru, JA. Microvascular decompression may be an effective treatment for nervus intermedius neuralgia. J Laryngol Otol 2011;125:520–2Google Scholar
9Sakas, DE, Panourias, IG, Stranjalis, G, Stefanatou, MP, Maratheftis, N, Bontozoglou, N. Paroxysmal otalgia due to compression of the intermediate nerve: a distinct syndrome of neurovascular conflict confirmed by neuroimaging. Case report. J Neurosurg 2007;107:1228–30Google Scholar
10Bellotti, C, Medina, M, Oliveri, G, Ettorre, F, Barrale, S, Sturiale, C et al. Neuralgia of the intermediate nerve combined with trigeminal neuralgia: case report. Acta Neurochir (Wien) 1988;91:142–3CrossRefGoogle ScholarPubMed
11Younes, WM, Capelle, HH, Krauss, JK. Microvascular decompression of the anterior inferior cerebellar artery for intermediate nerve neuralgia. Stereotact Funct Neurosurg 2010;88:193–5Google Scholar
12Ozer, FD, Duransoy, YK, Camlar, M. Atypic geniculate neuralgia: atypic anatomic correlation of cranial nerve roots and AICA. Acta Neurochir (Wien) 2009;151:1003–4CrossRefGoogle ScholarPubMed
13Furuya, Y, Ryu, H, Uemura, K, Sugiyama, K, Isoda, H, Hasegawa, S et al. MRI of intracranial neurovascular compression. J Comput Assist Tomogr 1992;16:503–5CrossRefGoogle ScholarPubMed
14Cooper, DW, Cavicke, DC. Primary juvenile otalgia. Report of a case with surgical cure. J Neurosurg 1963;20:895–8CrossRefGoogle ScholarPubMed
15Furlow, LT. Tic douloureux of the nervus intermedius (so-called idiopathic geniculate neuralgia). JAMA 1942;119:255–9CrossRefGoogle Scholar
16Hunt, JR. Geniculate neuralgia (neuralgia of the nervus facialis). A further contribution to the sensory system of the facial nerve and its neuralgic conditions. Arch Neurol Psychiat 1937;37:253–85CrossRefGoogle Scholar
17Quaknine, GE, Robert, F, Molina-Negro, P, Hardy, J. Geniculate neuralgia and audio-vestibular disturbance due to compression of the intermediate and eighth nerves by the postero-inferior cerebellar artery. Surg Neurol 1980;13:147–50Google Scholar
18Wilson, AA. Geniculate neuralgia. Report of a case relieved by intracranial section of the nerve of Wrisberg. J Neurosurg 1950;7:473–81Google Scholar
19Yeh, HS, Tew, JM Jr.Tic convulsif, the combination of geniculate neuralgia and hemifacial spasm relieved by vascular decompression. Neurology 1984;34:682–4Google Scholar
20McQuay, HJ, Carroll, D, Jadad, AR, Wiffen, P, Moore, A. Anticonvulsant drugs for management of pain: a systemic review. BMJ 1995;311:1047–52CrossRefGoogle Scholar
21Wiffen, PJ, Derry, S, Moore, RA, McQuay, HJ. Carbamazepine for acute and chronic pain in adults. Cochrane Database Syst Rev 2011;(1):CD005451Google Scholar
22Centre for Clinical Practice at NICE. Neuropathic Pain. The Pharmacological Management of Neuropathic Pain in Adults in Non-specialist Settings. NICE Clinical Guideline 96. Centre for Clinical Practice at NICE (UK). London: National Institute for Health and Clinical Excellence (UK), 2010Google Scholar
23Moore, RA, Wiffen, PJ, Derry, S, McQuay, HJ. Gabapentin for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2011;(16):CD007938Google Scholar
24Allen, S. Pharmacotherapy of neuropathic pain. Contin Educ Anaesth Crit Care Pain 2005;5:134–7Google Scholar
25Wiffen, PJ, Derry, S, Moore, RA. Lamotrigine for acute and chronic pain. Cochrane Database Syst Rev 2011;(16):CD006044Google Scholar
26Dworkin, RH, Backonja, M, Rowbotham, MC, Allen, RR, Argoff, CR, Bennett, GJ et al. Advances in neuropathic pain: diagnosis, mechanisms and treatment recommendations. Arch Neurol 2003;60:1524–34Google Scholar
27Moore, RA, Derry, S, Aldington, D, Cole, P, Wiffen, PJ. Amitriptyline for neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev 2012;(12):CD008242CrossRefGoogle ScholarPubMed
28Alferi, A, Strauss, C, Prell, J, Peschke, E. History of the nervus intermedius of Wrisberg. Ann Anat 2010;192:139–44Google Scholar
29Rhoton, AL Jr, Kobayashi, S, Hollinshead, WH. Nervus intermedius. J Neurosurg 1968;29:609–18CrossRefGoogle ScholarPubMed
30Oh, CS, Chung, IH, Lee, KS, Tanaka, S. Morphological study on the rootlets comprising the root of the intermediate nerve. Anat Sci Int 2003;78:111–13Google Scholar
31Eshraghi, AA, Buchman, CA, Telischi, FF. Sensory auricular branch of the facial nerve. Otol Neurotol 2002;23:393–6Google Scholar
32Siccoli, MM, Bassetti, CL, Sandor, PS. Facial pain: clinical differential diagnosis. Lancet Neurol 2006;5:257–67Google Scholar
33Ulubil, SA, Eshraghi, AA, Telischi, FF. Sectioning the sensory auricular branch of the facial nerve to treat recalcitrant otalgia. Otol Neurotol 2009;30:522–4CrossRefGoogle ScholarPubMed
34Yap, L, Pothula, VB, Lesser, T. Microvascular decompression of the cochleovestibular nerve. Eur Arch Otorhinolaryngol 2008;265:861–9Google Scholar
35Adler, CH, Bernardi, B, Bosley, TM, Savino, PJ, Sergott, RC, Zimmerman, RA. Hemifacial spasm: evaluation by magnetic resonance imaging and magnetic resonance tomographic angiography. Ann Neurol 1992;32:502–6CrossRefGoogle ScholarPubMed
36Bernardi, B, Adler, C, Savino, PJ, Zimmerman, RA. Magnetic resonance tomographic angiography in the investigation of hemifacial spasm. Neuroradiology 1993;35:606–11Google Scholar
37Vlassakov, KV, Narang, S, Kissin, I. Local anesthetic blockade of peripheral nerves for treatment of neuralgias: systematic analysis. Anesth Analg 2011;112:148–93CrossRefGoogle ScholarPubMed