A case report of complex auricular neuralgia treated with the great auricular nerve and facet blocks

Abstract

Background

The great auricular nerve is a cutaneous branch of the cervical plexus originating from the C2 and C3 spinal nerves. It innervates the skin over the external ear, the angle of the mandible and the parotid gland. It communicates with the ansa cervicalis. Great auricular neuralgia is rarely diagnosed in clinical practice and can be refractory. We present a new approach using ultrasound-guided nerve blocks.

Case

We present a case of a 41-year-old female with paroxysmal ear pain accompanied by dysautonomia, tingling in the tongue, dysphagia, dysarthria and abdominal symptoms. No significant findings were found on cervical and brain imaging. The patient responded partially to a great auricular nerve block. A combined approach using this block with facet block of C2 and C3 induced a more pronounced and prolonged benefit.

Conclusion

Great auricular neuralgia is not often encountered in practice and can be accompanied by symptoms originating from the ansa cervicalis network. A combined approach of nerve blocks can be considered in refractory cases.

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Keywords:

• ansa cervicalis
• neuropathic pain
• facet block
• red ear syndrome
• great auricular nerve

Acknowledgments

The authors wish to thank Dr Werner Becker, Dr Carrie Robertson and Dr Ivan Garza for their review of this report.

Written informed consent was obtained from the patient for publication of this case report and the accompanying images.

Disclosure

The authors report no conflicts of interest in this work.