Auricular temporal neuralgia

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Classification according to ICD-10
G50 Diseases of the trigeminal nerve (cranial nerve vein)
G50.1 Atypical facial pain
ICD-10 online (WHO version 2019)

The auriculotemporal neuralgia belongs to the group of facial neuralgia (facial pain). Part of their symptoms, the so-called "parotid sweating" (or "taste sweating"), was mentioned as early as 1853 by Jules Baillarger . However, it was only described as a clinical picture by Łucja Frey-Gottesman in 1923.

Symptoms

With auriculotemporal neuralgia, burning pain occurs in the supply area of ​​the auriculotemporal nerve, i.e. in front of the ear. At the same time, there is a circumscribed reddening of the skin and a tendency to perspire ( hyperhidrosis ). The symptoms are triggered by chewing movements or taste stimuli. Approximately one minute after exposure to the triggering stimulus ( trigger ) occur flushing or tingling paraesthesia, which are increasingly painful. The affected skin areas turn red. There is an increase in skin temperature. A few minutes later, drops of sweat appear, sometimes accompanied by increased saliva secretion. Hyperesthesia or hypesthesia of the affected half of the face are typical . It is also typical that the areas of spread of sweating, reddening of the skin and sensory disturbances do not completely coincide. Hyperhidrosis can even occur in completely different places, for example under the chin.

Anatomical basics

The pathomechanism of auriculotemporalis syndrome presumably runs via the reflex arc of parotid secretion. The afferent impulses travel via the glossopharyngeal nerve and reach the solitary nucleus via the cranial nerves V ( trigeminal nerve ), VII ( facial nerve ) and X ( vagus nerve ) . There they are switched to the nucleus salivatorius , which controls the reflex response. About glossopharyngeal, vagus tympanic , nerve superficial petrosal , via the otic ganglion and the nerve auriculotemporalis reaching efferent nerve impulses then the anatomical areas where the symptoms occur.

etiology

Auriculotemporal neuralgia is caused by diseases of the parotid gland. Etiologically , it is mostly a consequence of inflammation of the salivary gland or injury to the parotid compartment. The syndrome is also observed after ear infections ( otitis ) or it occurs for no apparent reason. Then one speaks of a so-called idiopathic or primary form, which is differentiated from the symptomatic forms mentioned above.

Pathogenesis

It is assumed that damaged nerve fibers sprout incorrectly after a causative underlying disease. The characteristic combination of symptoms could arise from the fact that parasympathetic nerve fibers, which supply the salivary gland, grow into sympathetic , sudorisecretory and sensitive skin nerves. Since the syndrome occurs sporadically but also a few days after parotid disease, i.e. at a point in time at which an incorrect sprouting of nerve fibers cannot have occurred, other authors have suspected other pathomechanisms. Haxton assumes a physiological reflex as the basis of the syndrome, the normal inhibition of which has merely failed.

course

The syndrome develops weeks to years after the corresponding parotid damage. After that, it remains untreated for life. In rare cases, the symptoms appear after a few days.

Differential diagnosis

The auricular temporal neuralgia must be differentiated from the trigeminal neuralgia in the differential diagnosis because the localization of pain can be similar. In temporal neuralgia, however, the pain kicks in suddenly, while in auriculotemporal neuralgia it swells more slowly. In addition, the typical taste sweating is absent in trigeminal neuralgia. Taste sweating also occurs in syringomyelia or encephalitides , less often in vegetative instability and occasionally in healthy people.

therapy

Botulinum injections are the first choice therapy today . Lasting improvements can also be achieved by blocking the auriculotemporal nerve with procaine , alcohol or phenol injections. If that doesn't help, the glossopharyngeal nerve can be switched off. Drug treatments with anticonvulsants are still recommended today. Mention should be made of gabapentin , carbamazepine and phenytoin , less often valproic acid . However, these drugs are not usually effective.

literature

  • Dieter Soyka: Headache, Practical Neurology Volume 1 (Ed .: Bernhard Neundörfer, Dieter Soyka and Klaus Schimrigk), Edition Medicine of Verlag Chemie GmbH, Weinheim 1984, ISBN 3-527-15179-6 .
  • Marco Mumenthaler : Neurology. Georg Thieme Verlag, 2002, ISBN 3-13-380010-8 .
  • Werner Scheid: Textbook of Neurology. Georg Thieme Verlag, 1983, ISBN 3-13-394105-4 .
  • Klaus Poeck and Werner Hacke: Neurology. Springer Verlag, Berlin 2006, ISBN 3-540-29997-1 .
  • Peter Duus: Neurological-topical diagnostics. Georg Thieme Verlag, 2003, ISBN 3-13-535808-9 .

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