Preprint Case Report Version 1 Preserved in Portico This version is not peer-reviewed

A Rare Case of Idiopathic Painful Nervus Intermedius Neuropathy in a 13-Year-Old Female: A Case Report and Discussion in the Context of the Literature

Version 1 : Received: 28 July 2022 / Approved: 9 August 2022 / Online: 9 August 2022 (03:20:29 CEST)

A peer-reviewed article of this Preprint also exists.

Fernandez-Vial, D.; Sangalli, L.; Perez, C. A Rare Case of Idiopathic Painful Nervus Intermedius Neuropathy in a 13-Year-Old Female: A Case Report and Discussion in the Context of the Literature. Children 2022, 9, 1234. Fernandez-Vial, D.; Sangalli, L.; Perez, C. A Rare Case of Idiopathic Painful Nervus Intermedius Neuropathy in a 13-Year-Old Female: A Case Report and Discussion in the Context of the Literature. Children 2022, 9, 1234.

Journal reference: Children 2022, 9, 1234
DOI: 10.3390/children9081234

Abstract

(1) Background: Painful nervus intermedius neuropathy (e.g., geniculate neuralgia) involves continuous or near-continuous pain affecting the distribution of the intermedius nerve(s). The diagnosis of this entity is challenging, particularly when the clinical and demographic features do not resemble the typical presentation of this condition. To the best of our knowledge, only three case reports have described the occurrence of nervus intermedius neuropathy in young patients. (2) Case Description: A 13-year-old female referred to the Orofacial Pain clinic with a complaint of pain located deep in the right ear and mastoid area. The pain was described as a constant throbbing and dull, with an intensity of 7/10 on numerical rating scale, characterized by superimposed brief paroxysms of severe sharp pain. The past treatments included ineffective pharmacological and irreversible surgical approaches. After a comprehensive evaluation, a diagnosis of idiopathic painful nervus intermedius neuropathy was given, which was successfully managed with the use of gabapentin. (3) Conclusions and Practical Implications: The diagnosis and treatment of neuropathic pain affecting the nervus intermedius can be challenging due to the complex nature of the sensory innervation of the ear. The diagnosis can be even more challenging in cases of atypical clinical and demographic presentations, which in turn may result in unsuccessful, unnecessary, and irreversible treatments. Multidisciplinary teams and constant knowledge update are fundamental to provide good quality of care to our patients and to not overlook any relevant signs or symptoms.

Keywords

neuralgia; earache; facial pain; neuropathic pain; geniculate neuralgia; nervus intermedius; otalgia; gabapentin

Subject

MEDICINE & PHARMACOLOGY, Clinical Neurology

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