AB231. SOH25_AB_141. Trigeminal neuralgia and hydro dissection: a case report

Background: Trigeminal neuralgia is a severe and debilitating type of facial pain. Targeting the relevant three divisions of the trigeminal nerve using a nerve block (e.g., neurolytic) has been previously demonstrated as a treatment option by inhibiting afferent nerve conduction from regions innervated by the trigeminal nerve. Hydro dissection, a minimally invasive technique involving injection of fluid to separate fascial layers and release entrapped nerves and tendons, has emerged as a potential treatment. Its use in trigeminal neuralgia treatment has not been reported.

Case Description: We present the case of an 83-year-old male with trigeminal neuralgia. Despite extensive therapies, including medications and neurolytic block, he continued to experience recurrent facial pain. Intervention: the patient underwent ultrasound-guided left sided infraorbital nerve (V2 trigeminal nerve) hydro dissection as a targeted approach to address perineural inflammation and nerve entrapment. Hydro dissection of the left infraorbital nerve was performed. A low concentration (5%) dextrose solution was used to free the tendons from surrounding scar tissue and muscle adhesions. The procedure was performed in a theatre setting. Outcome: following the hydro dissection procedure, the patient experienced improvement in trigeminal neuralgia pain, with sustained improvement over three months, at follow-up. No complications were reported.

Conclusions: This case supports the potential role of dextrose hydro dissection as a safe, minimally invasive treatment option for trigeminal neuralgia. Hydro dissection offers an alternative to more invasive interventions and medications and warrants further investigation in the management of trigeminal neuralgia.

Keywords: Trigeminal neuralgia; hydrodissection; technique; case report