Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
Knowledge is treasure of a wise man. The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help ones reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journalsNo manuscriptsNo authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case Series
Year : 2023 | Month : November | Volume : 17 | Issue : 11 | Page : UR05 - UR08 Full Version

Role of Supratrochlear and Supraorbital Nerve Block in Chronic Atypical Facial Pain Management: A Case Series


Published: November 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/65754.18757
Sanjay Kumar, Keshav Garg, Anil Agarwal, Anjali Singh, Sandeep Khuba

1. Additional Professor, Department of Anaesthesia, SGPGI, Lucknow, Uttar Pradesh, India. 2. Consultant, Department of Anaesthesia and Interventional Pain Medicine, Health Worlds Hospital, Durgapur, West Bengal, India. 3. Head, Department of Anaesthesia, Apollomedics, Lucknow, Uttar Pradesh, India. 4. Senior Resident, Department of Anaesthesia, SGPGI, Lucknow, Uttar Pradesh, India. 5. Additional Professor, Department of Anaesthesia, SGPGI, Lucknow, Uttar Pradesh, India.

Correspondence Address :
Anjali Singh,
Lucknow, Uttar Pradesh, India.
E-mail: anjalisingh14091993@gmail.com

Abstract

Chronic Atypical Facial Pain (CAFP) presents a daunting clinical challenge, characterised by persistent, unexplained facial pain that is resistant to conventional treatments. It poses a significant challenge to both patients and healthcare providers due to its poorly understood aetiologies and resistance to traditional analgesic therapies. As a result, novel approaches are sought to alleviate the suffering of affected individuals. Supratrochlear and supraorbital nerve blocks have emerged as promising interventions for CAFP. These nerve blocks target the supratrochlear and supraorbital nerves, which are branches of the ophthalmic division of the trigeminal nerve. These nerves are frequently implicated in the generation and propagation of facial pain. By interrupting the transmission of pain signals along these nerves, supratrochlear and supraorbital nerve blocks offer a targeted and minimally invasive approach to managing CAFP. Furthermore, their relatively low risk profile makes them an attractive option for individuals who have not responded well to other treatments or who wish to avoid more invasive interventions. The present case series (three males and one female) discusses the anatomical considerations, technique, and potential complications associated with supratrochlear and supraorbital nerve blocks. It also reviews the current body of evidence supporting their use in CAFP management, including outcomes such as pain reduction and improved quality of life. Supratrochlear and supraorbital nerve blocks represent a valuable addition to the armamentarium of therapies available for the management of CAFP.

Keywords

Atypical facial pain, Chronic facial pain, Trigeminal nerve

The intricacies of chronic atypical facial pain lie in its elusive aetiology, making it a source of frustration for both patients and clinicians. It leads to significant limitations in daily activities, causing psychological, social, and economic burdens. Its diagnosis primarily relies on the absence of identifiable pathology, leading to the classification of pain as “atypical” (1),(2). Consequently, conventional treatment modalities, such as medications and physical therapies, often fall short in providing adequate relief. This treatment gap necessitates a fresh perspective and novel approaches.

Supraorbital and supratrochlear nerve blocks offer a unique and minimally invasive intervention to address the persistent facial pain experienced by CAFP patients. These nerve blocks target specific branches of the trigeminal nerve, specifically the ophthalmic division, which plays a pivotal role in facial sensation. By interrupting pain signals along these neural pathways, these interventions have shown promise in providing significant pain relief for individuals struggling with CAFP, notably in the ophthalmic region (3),(4).

This exploration into the role of supraorbital and supratrochlear nerve blocks in the management of CAFP seeks to shed light on their potential as a valuable tools in the armamentarium of therapies for conditions like trigeminal neuralgia, postherpetic neuralgia, migraine, cluster headache, and neuralgia (supratrochlear or supraorbital). Furthermore, relief with diagnostic blocks can pave the way for radiofrequency ablation for long-term relief in such conditions (5),(6),(7),(8).

Case Report

The included cases involve supratrochlear and supraorbital nerve blocks for chronic refractory forehead and periorbital pain in different scenarios. All the patients had already undergone conservative management, including a gradual increase in analgesics, steroids, and antineuropathic drugs, without significant pain relief. The patients were briefed about the procedure and its implications, and written informed consent was obtained before performing the procedure.

After the procedure, the patients reported significant relief in pain scores, and no procedural or postprocedural complications or discomfort were observed. They provided consent for sharing their experiences in academic journals. Details of the cases are summarised in (Table/Fig 1). Institutional Ethics Committee approval was obtained. Excluded cases included patients with sepsis and coagulopathy. The supratrochlear and supraorbital nerve block was performed under ultrasound guidance (9).

Technique: After palpating the supraorbital foramen by following the orbital rim 2 cm from the midline, a linear high-frequency (5-6 Hz) transducer was placed over the medial one-third of the supraorbital margin, after locating the supraorbital notch (Table/Fig 2). The needle was introduced over the superior edge of the eyebrow, directed medially and caudally. When the needle tip was near the supraorbital notch, after performing a test aspiration, 1 mL of preservative-free lidocaine 2% (Loxicard) was injected, creating a subcutaneous wheal (Table/Fig 3),(Table/Fig 4).

The supratrochlear nerve was blocked immediately following the supraorbital nerve block, using the landmark technique by directing the needle at the top of the angle formed by the eyebrow and the nasal spine. After performing a test aspiration, 1 mL of preservative-free lidocaine 2% (Loxicard) was injected (Table/Fig 5).

Discussion

Supratrochlear and supraorbital nerve blocks are a part of the scalp block technique. First described for use during awake craniotomy, 6scalp blocks have been extensively used in neurosurgery to alleviate pain (10). These blocks provide safe, prudent, and effective cranial analgesia that improves perioperative management of patients undergoing craniotomy, dermatological, and plastic surgery procedures on the forehead (11),(12),(13). Additionally, these blocks have expanded their indications beyond the operation theatre in pain management, although mostly for conditions involving acute pain (14),(15),(16).

The frontal nerve, a branch of the ophthalmic division of the trigeminal nerve, divides into the supratrochlear nerve, which supplies the medial upper lid, conjunctiva, forehead, scalp, and frontal sinuses, and the supraorbital nerve, which provides sensory innervation to the conjunctiva, medial upper lid, forehead, and side of the nose. The supraorbital nerve courses anteriorly above the levator palpebrae superioris and exits the orbit through the supraorbital foramen in the superior margin of the orbit. It exits the orbit laterally to the supratrochlear nerve, which exits the orbit through the supratrochlear notch in the superomedial margin of the orbit (17). The superficial distribution of both these nerves makes them an easy target for landmark and ultrasound techniques without significant adverse effects. The procedure is generally well-tolerated and can be performed in an outpatient setting. Due to its simplicity, it carries a low risk of complications. Potential risks include mild discomfort during the injection, bleeding, nerve injury, neuropraxia, localised swelling, periorbital ecchymosis, or infection at the injection site, although such complications are rare (3). Patients should be carefully screened for contraindications such as coagulopathy and sepsis, and the procedure should be performed by skilled practitioners to ensure safety.

Govindappagari S et al., performed peripheral nerve blocks, including supratrochlear and supraorbital nerve blocks, in pregnant patients with migraines successfully, providing relief for a few days (18). Ilhan Alp S and Alp R found that injecting 1% lidocaine into the supraorbital and infraorbital nerves three times over three days significantly prevented acute migraine attacks during a six-month follow-up period without notable adverse effects (5). Similarly, in the present case series, the patient experienced severe debilitating migraine attacks unresponsive to conservative management. After receiving the supraorbital and supratrochlear nerve blocks, the patient had significant pain relief that lasted for four days.

Eker HE et al., performed supraorbital and supratrochlear nerve blocks using the modified Van Lint technique in two cases of acute zoster, resulting in significant pain relief post-procedure (19). Yamanaka D et al., successfully treated neuropathic complaints of post herpetic itch refractory to medical management with a supraorbital nerve block, providing a long-term pain relief (7). Similarly, in present case, the patient experienced severe refractory burning pain associated with allodynia. After receiving the supraorbital and supratrochlear nerve block, the patient had notable pain relief for seven days.

In a retrospective case series by Perioff MD and Chung JS, they found rapid and sustained pain relief in patients with refractory trigeminal neuralgia using peripheral trigeminal nerve blocks (20). Similarly, in this case, the patient had trigeminal neuralgia with lancinating pain in the forehead and experienced complete pain relief that lasted for 36 hours after receiving the supraorbital and supratrochlear nerve block.

Severe ocular pain, headaches, or hazy vision can occasionally occur during haemodialysis, leading to considerable morbidity for dialysis patients. This can happen due to various reasons, such as changes in intraocular pressure, blood pressure fluctuations, fluid shifts, or vascular access procedures. In this case, the patient experienced severe pain in the forehead region and around the eye that did not respond to conservative measures. There is a paucity of literature on interventional management of haemodialysis eye pain in refractory cases. Here, authors have described a novel and potential approach for managing eye pain with minimally invasive supraorbital nerve block, which provided substantial pain relief during the attack (21),(22).

The role of supraorbital and supratrochlear nerve blocks in the management of chronic Cluster-like Facial Pain (CAFP) represents an innovative and promising approach to addressing the persistent and often debilitating facial pain experienced by affected individuals. These blocks have shown significant benefits, including a considerable decrease in pain, an improvement in quality of life, and a reduced need for opioid drugs. Many patients report significant and immediate pain reduction, which can be especially helpful for those who have struggled with CAFP for a long time. The duration of pain alleviation may vary depending on the patient (18),(20).

The prolonged pain-relieving effects of nerve blocks persist even after the membrane-stabilising anaesthetic effect of local anaesthesia subsides. Supraorbital nerve blockade is known to effectively block the harmful stimulus and inhibit the antidromic flow of substance P (a neuropeptide) and Calcitonin Gene-related Peptide (CGRP), both of which are present during pain to limit continuous trigeminal excitability. These chemicals act as axon reflex mediators, which are the underlying cause of perivascular neurogenic inflammation. By restoring the threshold response to nociceptor stimulation, local factors that would otherwise enhance vasodilation, extravasations, and the allogenic stimulation of these peptides are blocked (23),(24).

Conclusion

The treatment paradigm for atypical facial pain remains unclear when a patients fail conservative medical therapy, and they often consider more potent or invasive therapies, such as opioids and surgeries. Peripheral nerve blocks, which are easy and safe, can provide extended pain relief before resorting to opioids or more invasive procedures at the ganglion level, and they can also pave the way for radiofrequency ablation of the same nerves. In present case series, patients achieved rapid and significant pain relief with supraorbital and supratrochlear nerve blocks. While further research is needed to refine protocols, identify patient selection criteria, and optimise long-term outcomes, these nerve blocks offer a promising avenue for providing relief to individuals burdened by the complexities of atypical facial pain. Their role in comprehensive pain management strategies should be considered and explored to enhance the well-being of patients facing this challenging condition. Therefore, this modality should be considered as a potential diagnostic and therapeutic option for atypical facial pain.

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Yamanaka D, Kawano T, Shigematsu-Locatelli M, Nishigaki A, Kitamura S, Aoyama B, et al. Peripheral nerve block with a high concentration of tetracaine dissolved in bupivacaine for intractable post-herpetic itch: A case report. JA Clin Rep. 2016;2(1):43. Doi: 10.1186/s40981-016-0069-y. [crossref][PubMed]
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Kerscher C, Zimmermann M, Graf BM, Hansen E. Scalp blocks. A useful technique for neurosurgery, dermatology, plastic surgery and pain therapy. Anaesthesist. 2009;58(9):949-58; quiz 959-60. German. Doi: 10.1007/s00101-009-1604-2. [crossref][PubMed]
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Frost EA, Booij LH. Anesthesia in the patient for awake craniotomy. Curr Opin Anaesthesiol. 2007;20(4):331-35. Doi: 10.1097/ACO.0b013e328136c56f. [crossref][PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2023/65754.18757

Date of Submission: Jun 05, 2023
Date of Peer Review: Aug 29, 2023
Date of Acceptance: Sep 25, 2023
Date of Publishing: Nov 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 06, 2023
• Manual Googling: Sep 21, 2023
• iThenticate Software: Sep 23, 2023 (10%)

Etymology: Author Origin

EMENDATIONS: 6

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