Involvement of the Ipsilateral Tongue, an Intraoral Structure of Referred Pain due to Entrapment of the Greater Occipital Nerve.

Abstract

This study reports a rare case of referred pain in the trigeminal nerve distribution caused by entrapment of the greater occipital nerve (GON). Notably, the pain extended to the ipsilateral tongue, an unusual intraoral involvement. GON entrapment can lead to sensitization in secondary nociceptive neurons within the trigeminocervical complex (TCC), which receives signals from both trigeminal and occipital nerves, causing referred facial pain. A 55-year-old female presented with chronic left temporo-occipital pain, along with pain in her left periorbital area, ear canal, gum, and a 20-year history of atypical facial pain on her left tongue and lower lip. Following GON decompression, her temporo-occipital pain and facial symptoms improved, with a significant reduction in burning pain on her tongue and resolution of lip tingling. The TCC, comprising convergent inputs from trigeminal and occipital nerves, is the anatomical basis of referred craniofacial pain. Chronic GON entrapment can sensitize second-order neurons in the TCC and medullary dorsal horn, explaining this unusual referred pain to the intraoral structures.