Short-term infraorbital nerve electrical stimulation for herpes zoster herpetic trigeminal maxillary division neuralgia: A case report

Rationale: Herpetic neuralgia of the maxillary division of the trigeminal nerve is a rare clinical condition characterized by unilaterally distributed burning pain with clustered blister-like lesions. Peripheral nerve stimulation, an effective neuromodulation technique, has demonstrated significant efficacy in treating herpetic neuralgia. However, the application of peripheral nerve stimulation to herpes zoster (HZ) of the maxillary division of the trigeminal nerve is still limited. This study reports a case of HZ trigeminal neuralgia maxillary division neuralgia treated with a short-term infraorbital nerve stimulation guided by digital subtraction angiography (DSA) with satisfactory results. Patient concerns: The patient, a 77-year-old male, was admitted to the hospital with “left-sided facial pain with herpes for 1 month.” On examination, the left side of the face showed an incompletely dislodged crust and hyperpigmented scar, and the lesion was confined to the infraorbital innervation area. It did not cross the midline of the face, with a positive trigger pain test. Pain assessment: Numerical Rating Scale (NRS) 7 to 8, nocturnal eruptive pain episodes 3 to 4 times/night, Pittsburgh Sleep Quality Index 19 to 20. Diagnosis: Herpes zoster neuralgia of the maxillary division of the trigeminal nerve. Interventions: DSA-guided short-term infraorbital nerve electrical stimulation placement. Outcomes: After a short-term infraorbital nerve stimulation, the patient experienced significant relief of pain symptoms and complete healing of the skin lesions. The NRS score decreased from 7 to 8 before treatment to 2 to 3, and the nocturnal eruption pain disappeared, significantly improving sleep quality. Postoperative follow-up at 1 and 3 months showed that the NRS score decreased to 1 to 2, the Pittsburgh Sleep Quality Index showed a progressive decrease, and sleep quality improved. Lessons: Our findings suggest that DSA-guided short-term infraorbital nerve electrical stimulation offers a new option for treating pain in patients with HZ herpetic trigeminal maxillary division neuralgia when commonly used clinical treatments are ineffective.