Infraorbital Neuralgia Secundary to a Retention Mucous Cyst in Maxillary Sinus: A Case Report
Thiago Messias Zago*
Departament of Otorhinolaryngology, Hospital Sao Francisco Mogi, Brazil
Submission: February 23, 2018; Published: March 12, 2018
*Corresponding author: Thiago Messias Zago, Departament of Otorhinolaryngology, Head and Neck surgery, Hospital Sao Francisco Mogi, Guacu, Brazil, Email: email@example.com
How to cite this article: Thiago Messias Zago. Infraorbital Neuralgia Secundary to a Retention Mucous Cyst in Maxillary Sinus: A Case Report. Glob J Oto 2018; 13(4): 555867. DOI: 10.19080/GJO.2018.13.555867.
The infraorbital nerve is a branch of the maxillary nerve which emerges in the infraorbital foramen in the roof of the maxilary sinus . The infraorbital neuralgia is a king of trigeminal neuralgia, a patology more common in elder people and is unnilateral in 95% of the cases . The charachetiscs of trigeminal neuralgia include sudden, severe, periodic, stabbing, lancinating, lightining-like and shock-like pain attacks in the territory of the 2th or 3th portion of the trigeminal nerve . The purpose of this article is describe a case of infraorbital neuralgia casued by an uncommum sequelae of acute rhinossinusitis: a retention mucous cyst.
Male, 62 years old with a paroxistic and intense pain in the region of the zigomatic arch desencadeated by chew that lasted minuts and was followed by a moderate pain in the same region for some hours. All the attacks were associated with the sensantions of ipsilateral nasal obstruction. This patient had no comorbidities and no chronic nasal symptons. RMI was normal, nasoendoscopy was normal and the head and sinuses CT showed a retention mucous cyst in the area of the infraorbital foramen. These exams showed no other anormalities. Because of the risk of lesion of the infraorbital nerve in a surgery to remove the retention mucous cyst it was decided to initiate amytriptiline ina dose of 25mg dially. The patient after some days referred total recovery of the pain, with high impact in his quality of life.
The trigeminal neuralgia can be divided in primary or idiopathic, when no cause is identified and in secondary when a cause is identified in the central nervous system: tumor, infartion, multiple sclerosis or trauma . According to the symptomatic aspect, the trigeminal neuralgia can be divided in "typical", when the pain is paxorismal and "atypical", when the paroxismal pains is associated with constant pain, as the patient descrbied in the case . The pathophysiology of idiopathic of TN occurs due to the specific abnormalities of the trigeminal nerve in the trigeminal root or ganglion.The pathophysiological characteristics of classic or idiopathic TN are identified with the pressure of the trigeminal nerve root by a vein at or nearby the root passage zone. An artery crossing the nerve can provoke further displacement, which can lead to damage and injury of the trigeminal nerve .
The diagnostic is essentially clinical, but some image investigation is necessary. It is recommended that a Computed Tomography and a Magnetic Ressonace be performed to exclude seconday causes . Several treatments have been described for TN: the first line are anticonvulsivants as carbamazepine but other drugs has positive effects like gabapentin, baclofen, lamotrigin and amytriptiline. More recently, non pharmacological treatments have been described as ultrasound- guided infraorbital nerve block with combination of steroid and local anesthetic  and Pulsed Radiofrequency Treatment Guided by Computed Tomography for Refractory Neuralgia of Infraorbital Nerve .