Peripheral surgical techniques for the management of trigeminal neuralgia--alcohol and glycerol injections

Trigeminal neuralgia remains a difficult condition to manage. Surgery aimed at peripheral nerve branches continues to be used extensively by oral and maxillofacial surgeons. The efficacy of 68 peripheral alcohol injections (retrospective study) and 22 peripheral glycerol injections (prospective study) were assessed in comparison with peripheral cryotherapy. The results indicate that the median time for total pain control after the first alcohol block was 13 months. When individual branches were assessed it was 13 months for the infra-orbital nerve and 19 months for the inferior alveolar nerve. These results compare with the published results on cryotherapy. The results for glycerol were disappointing with a mean time of pain relief of 7 months. The results suggest that peripheral alcohol nerve blocks do still have a role to play in the management of trigeminal neuralgia, particularly in the elderly, medically compromised and those unwilling to undergo more extensive surgery. They also provide a means of temporary relief.