Management of Chronic Nasal Pain Developing After Rhinoseptoplasty or Nasal Trauma

Background: Management of patients who experience refractory chronic nasal pain (CNP) of no apparent cause can be unclear. Objectives: To measure pain outcomes in managing patients with CNP after rhinoseptoplasty or nasal trauma. Methods: We retrospectively reviewed patients with CNP after rhinoseptoplasty or trauma, treated with a gabapentinoid drug, local nerve block with lidocaine plus dexamethasone, or both. Results: The study included 28 patients, 12 men and 16 women, of mean age 39.1 years (range 22-66), experiencing CNP after rhinoseptoplasty (n = 22) and nasal bone fracture (n = 6). Pain was distributed at the nasal dorsum (53%), periorbital area (15%), septum (13%), nasal tip (13%), and cheek (6%). The most common types of pain pattern, onset time, and duration were pressing and stabbing pain (41%), immediately developed (43%), and lasting 3-6 months (39%), respectively. After treatment, pain was relieved completely in 12 (43%) patients and mild to moderate in 7 (25%), but 9 (32%) showed no response. Conclusions: Postoperative or traumatic CNP can be a complex manifestation with several atypical characteristics. The combination of a gabapentinoid drug and local nerve block with lidocaine plus dexamethasone improved CNP in 68% of patients.