Korean J Pain.  2014 Jan;27(1):81-85. 10.3344/kjp.2014.27.1.81.

Ultrasound-Assisted Mental Nerve Block and Pulsed Radiofrequency Treatment for Intractable Postherpetic Neuralgia: Three Case Studies

• Park HG
• Park PG
• Kim WJ
• Park YH
• Kang H
• Baek CW
• Jung YH
• Woo YC
• Koo GH
• Shin HY

• KMID: 2278208
• DOI: http://doi.org/10.3344/kjp.2014.27.1.81

Abstract

Postherpetic neuralgia (PHN) is one of the most difficult pain syndromes to treat. Invasive treatments may be considered when patients fail to obtain adequate pain relief from noninvasive treatment approaches. Here, we present three cases of PHN in the mandibular branch treated with ultrasound-assisted mental nerve block and pulsed radiofrequency treatment. None of the patients had adequate pain relief from the medical therapy, so we performed the mental nerve block on the affected side under ultrasound assistance. Two patients showed satisfactory pain relief continuously over 12 months without any further interventions, whereas one patient only had short-term pain relief. For the patient had short-term pain relief we performed pulsed radiofrequency treatment (PRFT) on the left mental nerve under ultrasound assistance. After PRFT, the patient had adequate pain relief for 6 months and there was no need for further management.

Keyword

mental nerve; postherpetic neuralgia; pulsed radiofrequency treatment; ultrasound

MeSH Terms

Humans
Nerve Block*
Neuralgia, Postherpetic*
Pulsed Radiofrequency Treatment*
Ultrasonography

Figure

• 

  Fig. 1 A photograph of the needle placement in the mental foramen under ultrasound guidance (10-12 MHz linear transducer). (A) In the actual patient. (B) Anterior view in a human skull model, which is empirically depicted. The transducer (white box) was moved like ① for identifying the mental foramen and mental foramen was positioned at the end of transducer ②. (C) An ultrasound image of the radiofrequency needle in the mental foramen (10-12 MHz linear transducer, long-axis in-plane technique). The cleft within the hyperechoic line indicates the mental foramen. The radiofrequency needle has passed through the mental foramen and is indicated with arrow heads.

• 

  Fig. 2 Fluoroscopic images during pulsed radiofrequency treatment of the left mental nerve of the mandibular branch. (A) Anteroposterior view. (B) Lateral view. Fluoroscopic images show that the needle was in the mental foramen. No vascular uptake of radio-contrast agent was observed.

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