Ultrasound-guided trigeminal nerve block for refractory TMJ pain: a case report

Case Diagnosis: 30-year-old female with refractory TMJ and facial pain treated with trigeminal nerve
block.

Case Description or Program Description: 30-year-old female with 12+ years of left temporomandibular joint (TMJ) and facial pain
which started at the TMJ and radiates to her jaw. Patient failed TMJ corticosteroid
injection, TMJ repair, TMJ replacement, TMJ revision, Botox, multiple pain medications,
and mouthguards without adequate symptom relief. Pain level was disruptive to
patient’s work, causing her to work night shifts to avoid talking. Patient presented to
pain clinic for chemodenervation of the masseter and temporalis muscles which did not
provide relief. Given the lack of improvement following multiple other treatment
modalities, the decision was made to trial an ultrasound guided trigeminal nerve block
and steroid injection.

Setting: Veteran’s Affair’s Outpatient Pain Clinic

Assessment/Results: At 1 week follow up patient reported 50% pain relief versus prior injection. Patient is
planned for additional follow up with the Pain clinic for further evaluation of results.

Discussion (relevance): TMJ pain can be debilitating to patients. The TMJ receives sensory innervation from the
auriculotemporal nerve and masseteric nerve, both branches of the mandibular
trigeminal nerve (V3). In this patient, ultrasound guided trigeminal nerve block provided
more relief than any prior treatment she had received up to this point, including
surgeries, injections, and medications.

Conclusions: This case highlights the potential role of ultrasound-guided trigeminal nerve block as an
effective intervention for refractory TMJ pain. Further studies are warranted to establish
optimal protocols and assess long-term efficacy.