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Efficacy of Botulinum Toxin Injection via Coronoid Approach in Refractory Trigeminal Neuralgia: A Case Report and

Mahmoud Reza Alebouyeh¹, Saeid Reza Entezary¹, Sajede Salehi¹

¹Iran University of Medical Sciences, Tehran, Iran.

Pain Medicine Case Reports

|April 21, 2025

Abstract

Background:

Trigeminal neuralgia (TN) is a well-characterized form of cranial neuralgia that affects one or more divisions of the trigeminal nerve. The first-line treatment for TN is pharmacotherapy, though over 40% of patients may become refractory to medication or experience intolerable side effects. A Gasserian ganglion block is a minimally invasive procedure aimed at alleviating TN symptoms and reducing the reliance on pharmacotherapy.

Case Report:

We present a case of TN that was refractory to 2 times Gasserian ganglion block. While botulinum toxin has been effectively used in various nerve blocks, we opted to manage the patient's TN by targeting the peripheral mandibular nerve (V3) via a coronoid approach by using botulinum toxin injection.

Conclusions:

Our patient experienced 5 months' considerable pain relief, which demonstrates that the V3 injection of botulinum toxin may offer a viable alternative for managing refractory TN.

Keywords:

Botulinum toxin Gasserian ganglion block case report coronoid approach trigeminal neuralgia

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