Head / Face
Auriculotemporal Neuralgia
이개측두신경통
Neuropathic pain in auriculotemporal nerve distribution (preauricular/temporal)
- How common
- Uncommon
- Typical age
- Ages 30–60
What is it?
Auriculotemporal nerve (V3 branch) irritated by TMJ surgery, trauma, tumor, or vascular compression causes preauricular/temporal neuropathic pain; gustatory sweating (Frey syndrome) may coexist.
Commonly affected: Auriculotemporal nerve (branch of V3)
How it develops
- Nerve Injury/CompressionTMJ surgery, trauma, tumor
- Aberrant RegenerationParasympathetic-sympathetic misrouting
- Sensitization and DischargeEctopic firing in auriculotemporal nerve
- Gustatory SweatingMay manifest as Frey syndrome
Symptoms
- Preauricular stabbing painElectric-shock quality, seconds to minutes
- Triggered by chewing/yawningProvoked by mandibular motion
- Temporal referralRadiates up to temple
- Local paresthesia/hyperesthesiaAltered skin sensation
- Gustatory sweating/flushingFrey syndrome pattern
How it is examined
- Tinel signTapping anterior to TMJ reproduces shooting pain
- Diagnostic nerve blockAuriculotemporal block transiently relieves pain
- TMJ evaluationJoint sounds, opening pattern (co-existing pathology)
- V3 sensory examSensory testing of preauricular/temporal region
Imaging
Panoramic/CBCT evaluates TMJ bone; nerve itself not visible.
- Rules out TMJ osseous change
- Excludes fracture
- Excludes odontogenic lesion
High-resolution MRI assesses nerve course, parotid, and TMJ masses; usually normal.
- Often normal
- Excludes parotid/TMJ mass
- Rarely vascular compression
Non-surgical care
- Control triggersSoft diet, avoid big jaw motions
- Neuropathic agentsCarbamazepine, gabapentin, pregabalin
- Auriculotemporal nerve blockLocal anesthetic ± steroid injection
- Botulinum toxin injectionEffective for Frey sweating and pain
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Refractory pain with confirmed structural entrapment
Procedures that may be discussed
- Nerve decompression
- Neurectomy
Outlook
Many patients improve with pharmacotherapy and nerve blocks.