Continuos Inferior Alveolar Nerve Block Using an Indwelling Catheter and Inferior Maxillary Artery
Embolization for the Management of Atypical Trigeminal Neuralgia 377
control epistaxis and life threatening bleeding following
facial trauma [20,21]. However, its use for trigeminal
neuralgia is uncommon. One study reported the use of
maxillary embolization in 76 patients with trigeminal
neuralgia with achievement of absolute improvement
[22]. Since in our case the patient’s pain had a throbbing
component we thought she might benefit from internal
maxillary artery embolization. We first used a balloon
trial to test if artery occlusion will provide pain resolu-
tion, when the patient passed the trial we embolized the
artery, the patient reported complete resolution of the
throbbing pa in. The pro cedure is safe as th e area su pp lied
by the artery has collateral blood supply. We recommend
this procedure for patients with throbbing pain not con-
trolled by medical management with emphasis on a bal-
loon trail before permanent occlusion.
4. Conclusion
Treatment of TN should be tailored to the individual
situation. Several interventional pain and surgical proce-
dures are available to treat pain resistant to medical
management. Continuous mandibular or alveolar nerve
blocks with local anesthetics using an indwelling cath eter
can provide complete pain resolution and patient satis-
faction but with a risk of infection on long term use. In-
ternal maxillary embolization is a permanent treatment
modality to be considered in patients with a throbbing
pain.
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