title: A case report of complex auricular neuralgia treated with the great auricular nerve and facet blocks.
abstract: BACKGROUND
  The great auricular nerve is a cutaneous branch of the cervical plexus originating from the C2 and C3 spinal nerves. It innervates the skin over the external ear, the angle of the mandible and the parotid gland. It communicates with the ansa cervicalis. Great auricular neuralgia is rarely diagnosed in clinical practice and can be refractory. We present a new approach using ultrasound-guided nerve blocks.
  
  
  METHODS
  We present a case of a 41-year-old female with paroxysmal ear pain accompanied by dysautonomia, tingling in the tongue, dysphagia, dysarthria and abdominal symptoms. No significant findings were found on cervical and brain imaging. The patient responded partially to a great auricular nerve block. A combined approach using this block with facet block of C2 and C3 induced a more pronounced and prolonged benefit.
  
  
  CONCLUSIONS
  Great auricular neuralgia is not often encountered in practice and can be accompanied by symptoms originating from the ansa cervicalis network. A combined approach of nerve blocks can be considered in refractory cases.
authors.affiliation: Department of Pain Clinic, Headache Management, Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche de l'Université de Montréal (CRCHUM).
authors.forename: Marzieh
authors.initials: M
authors.lastname: Eghtesadi
authors.affiliation: Department of General Neurology, Headache Management, Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche de l'Université de Montréal (CRCHUM).
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Leroux
authors.affiliation: Department of Anesthesiology, Pain Clinic, Centre Hospitalier de l'Université de Montréal (CHUM), Centre de Recherche de l'Université de Montréal (CRCHUM), Montreal, QC, Canada.
authors.forename: Grisell
authors.initials: G
authors.lastname: Vargas-Schaffer
keywords: ansa cervicalis; facet block; great auricular nerve; neuropathic pain; red ear syndrome