From the Guidelines
Glossopharyngeal nerve block with corticosteroid is the recommended procedure for longer-lasting pain relief, as it has demonstrated advantages over normal saline injection or no injection in reducing postoperative pain. The procedure involves using a mixture of local anesthetic with a corticosteroid, such as 2-4 mL of 0.25% bupivacaine or 1% lidocaine with 40 mg methylprednisolone or 10 mg dexamethasone, and injecting the mixture near the glossopharyngeal nerve, typically at the styloid process or in the tonsillar fossa 1. Some key points to consider when performing the block include:
- Using sterile technique to minimize the risk of infection
- Being aware of potential complications such as intravascular injection or spread to nearby cranial nerves, as reported in two studies involving 57 patients, which described severe complications including intravascular injection, tachycardia, hypotension, and bradycardia 1
- Monitoring patients for at least 30 minutes post-procedure for any adverse reactions
- Considering the addition of steroid particularly beneficial for patients with chronic glossopharyngeal neuralgia or those who have not responded well to nerve blocks with local anesthetic alone
- Being cautious in patients with contraindications to steroids, such as uncontrolled diabetes or active infection, and considering alternative procedures or consulting with a specialist if necessary.
From the Research
Efficacy of Glossopharyngeal Nerve Block
The efficacy of glossopharyngeal nerve block with or without corticosteroid (steroid) has been studied in various research papers.
- A study published in 2011 2 found that a glossopharyngeal nerve block using the anterior tonsillar pillar method, combined with daily levobupivacaine and oral amitriptyline, as well as a single injection of methylprednisolone acetate, was effective in controlling pain in a patient with glossopharyngeal neuralgia.
- Another study published in 2013 3 compared the analgesic efficacy and safety of medical therapy alone versus combined medical therapy and extraoral glossopharyngeal nerve block in patients with glossopharyngeal neuralgia. The results showed that both treatments were effective in reducing pain intensity and improving quality of life, with no significant hemodynamic adverse outcomes.
Comparison of Treatment Modalities
- A study published in 2020 4 examined the long-term quality of life and pain-free survival after microvascular decompression (MVD) and sectioning of the vagoglossopharyngeal complex in patients with glossopharyngeal neuralgia. The results showed that sectioning of the CN IX/X complex with or without MVD was a safe and effective surgical therapy for glossopharyngeal neuralgia, with initial pain freedom in 94% of patients and excellent long-term pain relief.
- A systematic review published in 2023 5 analyzed the effectiveness of MVD with or without rhizotomy, as well as stereotactic radiosurgery (SRS), in treating glossopharyngeal neuralgia. The results showed that MVD alone was successful in achieving pain relief in about 85% of patients, while MVD with rhizotomy and SRS also showed promising results.
Ultrasound-Guided Glossopharyngeal Nerve Block
- A retrospective study published in 2019 6 examined the effectiveness and safety of ultrasound-guided glossopharyngeal nerve block via the styloid process for primary glossopharyngeal neuralgia. The results showed that the treatment was effective in providing pain relief in 83.3% of patients at discharge, with a significant decrease in visual analog scale (VAS) scores.
- The use of corticosteroids in glossopharyngeal nerve block was studied in 2, which found that the addition of methylprednisolone acetate to the block was effective in controlling pain in a patient with glossopharyngeal neuralgia. However, the efficacy of corticosteroids in combination with glossopharyngeal nerve block was not consistently evaluated across all studies.